CMS Might Punt on Approving Georgia's Revised Waiver Request

by Jane Anderson

Georgia recently reaffirmed its proposal to make dramatic changes in its individual market, saying it plans to abandon the Affordable Care Act (ACA) marketplace in favor of a new state program despite the widespread disruptions in health care and health insurance brought by the coronavirus pandemic.

In its revised Section 1332 waiver request to CMS, Georgia said it wanted to push back the start date for part of its plan, meaning the proposal’s two parts wouldn’t take effect until 2022.

The first part of the proposal, a reinsurance program, would help insurers pay high-cost claims with the goal of lowering premiums. According to Georgia's calculations, the reinsurance program would reduce premiums for the individual market statewide by 10.2% and as a result would increase enrollment by 0.4% in 2022.

More controversially, the "Georgia Access Model" would make more drastic changes to the individual market, including directing consumers to buy coverage through private broker or insurer websites, rather than via HealthCare.gov.

Tara Straw, senior policy analyst at the left-leaning Center on Budget and Policy Priorities, warned in a Sept. 1 report that "evidence from past, far simpler transitions between federal and state marketplaces suggests that tens of thousands of Georgians might lose coverage simply because of the disruption from the state’s transition away from HealthCare.gov."

The proposal also would "give insurers and brokers new opportunities to steer healthier consumers toward substandard plans that expose them to catastrophic costs if they get sick," Straw wrote. "The resulting adverse selection could make comprehensive coverage more expensive for those who need it, reducing their enrollment as well."

However, Joseph Antos, the Wilson H. Taylor Scholar in Health Care and Retirement Policy at the right-leaning American Enterprise Institute, says that it's not clear whether CMS will move to approve Georgia's revised proposal, or will wait to consider it until after the election. He thinks a long wait is more likely.

"It raises a political question in my mind: 'Do you have CMS approve this thing?' And then get into another court battle with the headline being, 'Trump administration approves taking away good coverage for low-income people in Georgia,'" Antos says. "This doesn't have the feel of a sure approval."

From Health Plan Weekly