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State Politics

Feds put hold on Georgia’s plan to replace insurance marketplace

By Nyamekye Daniel


(The Center Square) – The Biden administration has initiated a review of Georgia’s plan to replace the Affordable Care Act’s insurance marketplace with a state model.

U.S. Centers for Medicare and Medicaid (CMS) officials sent a letter to Gov. Brian Kemp on Thursday, requesting a detailed analysis of the objectives for the state’s plan to eliminate the federal health care marketplace.

Georgia would like to create a state website where Georgians would have access to a list of insurance and brokerage companies but still would have access to federal subsidies. Georgia would determine the consumer’s eligibility instead of the federal government.

The Trump administration had approved Georgia’s request to waive the marketplace requirement and other ACA rules last fall. President Joe Biden signed in March the American Rescue Plan Act, which expands ACA eligibility requirements and increases premium credits. 

CMS officials have given the Kemp administration until July 3 to provide analyses that would show the plan would still meet coverage and affordability requirements, including a 10-year budget plan that shows it will not cause a federal deficit.

Kemp’s press secretary, Mallory Blount, said Friday his office “is still reviewing” the 10-page letter.

CMS officials said the new ACA expansion could “potentially change market dynamics and reduce incentives for private sector entities to enroll uninsured consumers, as there will be a smaller base of uninsured consumers to enroll.”

“In light of recent increases in individual Exchange enrollment, when the Georgia Access Model begins in 2023, it is possible that Exchange enrollment will be higher than when the state applied for the waiver,” CMS officials wrote.

Kemp’s office said the waivers could cost the state around $200 million less than a full Medicaid expansion available under the ACA. Critics of the plan said it does little to help low-income Georgians.

While Kemp’s administration said the plans would provide health insurance for more than 400,000 uninsured people, Georgia Budget and Policy Institute Senior Policy Analyst Laura Harker said it would cover only 50,000 people.

“This letter from CMS is a step in the right direction to ensure no one loses access to care. The state plan is not clear on how much the private sector would invest in targeted outreach to get more people enrolled or how to ensure enrollees are not steered toward short-term or non-ACA-compliant plans that cover fewer services,” Harker said. “Not only is this risky for individuals who do enroll in these plans, it also drives up the cost of comprehensive plans—shutting more Georgians out of access to affordable care.”

The Georgia Virtue
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