Gov. Brian Kemp has released his long-awaited plan that he says will lower costs and increase options for people who buy health coverage on the individual insurance marketplace.
Kemp will ask the Trump administration for permission to set up a reinsurance program that uses hundreds of millions of state and federal dollars to help insurance companies cover high-cost claims.
He also wants to break Georgia’s ties with the Obamacare enrollment website, Healthcare.gov, and give third-party platforms and brokers a larger role in connecting people to coverage. That would allow people to enroll in plans that don’t meet Affordable Care Act standards.
“Through these new innovative measures, Georgians will have access to new insurance options, like association health plans,” Kemp said during a press conference Thursday. “We will allow folks to tailor health care plans to meet the family’s needs and goals that they have.”
Kemp will make his requests using a State Innovation Waiver. They were established by the Affordable Care Act and allow states to tweak their insurance marketplaces while staying within the basic protections set out by the health care law.
A handful of other states, liberal and conservative, have used the waivers to establish reinsurance programs that reimburse insurance companies for portions of high-cost claims. The idea is that if insurance companies know they’ll get that help, they’ll lower the prices they charge consumers each month for their plans.
Kemp’s plan, called Georgia Access, would pay out up to 80% of claims as high as $500,000 in parts of the state, according to his office.
They estimate the program will cost the state $104 million in the first year and bring in about $260 million in federal money. They say that could lower premiums by as much as 25% in some places, though there’s no guarantee insurance companies will do that.
“As we’ve seen in states like Colorado, Wisconsin, and Maryland, state reinsurance programs lower premiums by stabilizing a volatile marketplace, creating more choice and more competition in the marketplace,” Kemp said.
Georgia’s insurance marketplace has seen some turbulent times, but it’s settled down as of late. Two new companies will offer coverage in the state next year, and premiums have dropped. Still, many people don’t qualify for federal subsidies to offset the costs of their health care premiums and face high monthly costs.
In the second part of the waiver, Georgia will ask for permission to stop using Healthcare.gov, the website where people go to sign up for individual health plans.
Instead, consumers would sign up for coverage through brokers — there are several nongovernment websites where people can currently shop for plans — or directly with insurance companies.
Abandoning the website worries consumer advocates, such as Laura Colbert with Georgians For a Healthy Future.
“Healthcare.gov is actually a really important platform. It provides an unbiased central location for people to compare plans across carriers, and there’s no bias or preference about one carrier or another,” she said.
Colbert worries third-party brokers will steer consumers into plans that might not be as comprehensive as what’s available on the exchange. Down the road, Kemp’s plan would subsidize non-ACA compliant coverage.
Kemp’s office hopes to submit the proposal to federal regulators for their review by the end of the year. They expect a response by the mid-2020.
If everything gets approved, the governor’s office says, they hope to have the reinsurance program running for coverage for 2021 and to break ties with Healthcare.gov as people shop for coverage for 2022.
This is the first of two waivers Kemp plans to submit this year to tweak Georgia’s health care system. The other would alter how the state runs its Medicaid program, which could end up covering more people. Details about that plan are expected in the coming days.
