Georgia may lose CMS approval for its plan to privatize its Obamacare exchange in 2023, after the agency requested more information on how the changes could affect access to care.
CMS Administrator Chiquita Brooks-LaSure ordered Georgia to study access and health equity issues, according to her letter to Gov. Brian Kemp (R-Ga.) on Thursday.
The new analysis is needed to ensure that the Trump-approved waiver supports recent changes in federal healthcare priorities, policies and law, Brooks-LaSure said in the letter. Those changes include President Joe Biden's executive orders instructing the federal government to advance equity and strengthen the Affordable Care Act in addition to March's pandemic relief package, which increased health insurance subsidies for two years.
Brooks-LaSure suggested that CMS might revoke Georgia's waiver later this year.
"The departments have authority to request information for an approved waiver as part of their continued monitoring and oversight authority and retain discretion to 'amend, suspend, or terminate the waiver ... as necessary to bring the waiver ... into compliance with changes to existing applicable federal statutes enacted by Congress or applicable new statutes enacted by Congress.'"
The state has until July 3 to submit its report to CMS.
The Trump administration approved Georgia's waiver to lower individual market insurance premiums by establishing a reinsurance program and allowing people to buy coverage directly through web brokers or insurance companies instead of HealthCare.gov. According to CMS, the state would ensure that people are eligible and enrolled correctly in coverage under the Georgia Access Model. But private organizations would be responsible for consumer outreach, customer services, plan shopping selection and enrollment.
However, many providers, patient advocates and independent experts worried the state's plan to privatize its marketplace would cause many Georgians to become uninsured. In addition, critics claim the lack of a public exchange would confuse consumers, especially those most at-risk for being uninsured, and create a conflict of interest among brokers and the coverage they sell.
The waiver would also allow web brokers and insurance companies to sell plans with fewer benefits next to plans that meet the ACA's essential health benefits requirements. Experts worry that many people would mistakenly buy less coverage than they need because plans with lower premiums are usually most attractive to consumers, especially people with low incomes.
The Trump administration in January approved a rule that would allow other states to privatize their ACA marketplaces. The Biden administration is reviewing that plan.