By Leslie Small
More than a year after
the Trump administration issued controversial new guidelines for the Affordable
Care Act’s Section 1332 waivers, Georgia became the first state to take CMS up
on that increased flexibility by unveiling a draft waiver proposal that would
make some major changes to its individual insurance market.
The state's waiver
proposal has two primary phases: first is a reinsurance program to help
insurers pay high-cost claims (and thus lower premiums), set to go into effect
in 2021. Then there's the "Georgia Access Model," which starting in
2022 would:
- Direct consumers to buy
coverage through private broker or insurer websites, rather than
HealthCare.gov;
- Put the state in control of ACA
subsidies; and
- Allowhealth plans that don’t cover all 10 of the ACA’s
essential health benefits (EHB) categories to be sold alongside qualified
health plans (QHPs).
David Anderson, a
research associate at the Duke-Margolis Center for Health Policy, says the
basic idea is to exclude select EHB categories which would create a lower
actuarial value in exchange for cheaper premiums. In his view, the population
that stands to lose the most in such a scenario is people who don't qualify for
subsidies but have significant medical conditions. "Their premiums are
going to skyrocket because they’re still going to need all the EHBs," he
says.
Anderson predicts
insurers will "love the reinsurance" portion of Georgia's proposal
and be able to handle the other individual market changes. "The biggest
challenge will be projecting relative risk and market share between the full
EHB and the limited EHB plans," he adds.
But Joel Ario, managing
director of Manatt Health, points out that "health insurers are generally
risk averse; this seems to have a lot of risky dimensions to it." Some
unanswered questions, he says, include how the state will implement a system
with alternative enrollment channels and what type of non-QHP health plans will
actually be rolled out.
From Health Plan Weekly
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