CMS on Sunday announced it had approved Georgia's request to lower individual market insurance premiums by establishing a reinsurance program and enabling people to buy coverage directly through web brokers or insurance companies instead of HealthCare.gov.
It is the first state to do away with the marketplace without establishing another hub to purchase coverage. The state requested a 1332 state innovation waiver to eliminate the HealthCare.gov portal provided by the Affordable Care Act for individuals to purchase coverage.
"Today's approval of the state's waiver will usher in a groundswell of healthcare innovation that will deliver lower costs, better care, and more choice to Georgians in the individual market," CMS Administrator Seema Verma said.
Beginning in 2023, premiums in the state could drop by 13% on average, CMS said in a news release. That would occur through a reinsurance program that would start in 2022 and would reimburse insurers a percentage of claims paid between $20,000 and an estimated $500,000 cap.
Under the Georgia Access Model, the state will stop using the HealthCare.gov marketplace and instead "private sector entities would provide all of the front-end consumer shopping experience and enrollment operations with the state providing back-end operations to handle eligibility determinations and enrollment reconciliation," according to a letter from Verma to Georgia Gov. Brian Kemp granting the waiver.
But the progressive Center on Budget Policy Priorities warned in a report released Sept. 1 that the plan would likely cause many Georgians to become uninsured.
"The ACA requires that Section 1332 waivers cover as many people, with coverage as affordable and comprehensive, as would be covered absent the waiver, without increasing the federal deficit. Georgia's waiver fails those tests," stated the report. "There is a high chance that the waiver would cause (tens of) thousands of Georgians to lose coverage and no reason to expect it would meaningfully increase coverage. It also would likely leave many Georgians with less affordable or less comprehensive coverage than they would otherwise have."
Between 2016 and 2019, total individual market enrollment on the Affordable Care Act marketplace exchange in Georgia fell 22%, according to the CMS, with over 129,000 consumers fleeing the market.
Georgia continues to have one of the highest uninsured rates in the country at 13.7%, according to the news release. That leaves about 1.38 million people uninsured across the state.
Earlier this month, Georgia received the green light to expand Medicaid with the condition that enrollees work, job train, volunteer or pursue education for at least 80 hours a month.
The ACA enrollment period, which started Sunday and ends on Dec. 15 is taking place during a pandemic that has left record numbers of people unemployed. Insurers selling plans on the ACA marketplace have lowered rates in some states and raised rates modestly in others.