July 23, 2020
c/o The Office of the Governor
206 Washington Street
Suite 115, State Capitol
Atlanta, Georgia 30334
Re: Georgia Section 1332 Waiver Application
Dear Mr. Loke,
Thank you for the opportunity to comment on Georgia’s proposal to waive federal rules under the Affordable Care Act (ACA). I am writing on behalf of Georgia Budget and Policy Institute to provide our feedback about the ACA Section 1332 waiver.
We appreciate your team’s work to make several positive updates to the Georgia Access phase of the waiver plan, including maintaining the structure of the federal premium subsidies to ensure there is not a cap on subsidies available to Georgians and no longer allowing these subsidies to be used on non-qualified health plans. However, we are concerned about the plan to remove an option for Georgians to enroll for individual health insurance plans.
In our September 2019 analysis of 1332 waiver options, we outlined several approaches to utilize these waivers to help more people get enrolled in coverage – which is critical because 838,563 uninsured Georgians have incomes that could qualify them for subsidized health insurance. The most effective approach to help more uninsured Georgians already eligible for marketplace subsidies get enrolled is to invest in outreach and enrollment assistance. The federal government cut outreach and enrollment assistance by 86 percent from 2016 to 2018, making it harder to reach more people and get them enrolled. Additional outreach efforts must also be paired with assistance to reduce cost-sharing to make sure that coverage is affordable for Georgians with low-to-moderate incomes.
This plan does not create any new paths to enrollment or provide targeted assistance to reach potential enrollees. Georgians can already enroll in health plans through private insurers and web brokers in the existing enhanced direct enrollment program. The Georgia Access plan anticipates a 25,000 increase in enrollment due to web broker marketing efforts. Brokers already market to and enroll people in individual health coverage today and this waiver plan does not make it clear how these efforts will be any different. And evidence from past transitions from federal to state marketplaces suggests that thousands of Georgians might lose coverage in the move away from HealthCare.gov. If the state wants to utilize brokers to increase enrollment as envisioned in the plan, it can do so without taking away the centralized, unbiased platform offered by HealthCare.gov.
Direct enrollment entities have a track record of steering consumers toward substandard plans that expose them to catastrophic costs if they get sick, failing to alert or assist consumers when they are eligible for Medicaid, and making it difficult to compare plans. Limiting enrollment to such private companies while dismantling healthcare.gov’s centralized enrollment platform and consumer assistance will likely cause some Georgians to lose coverage altogether. It additionally gives web brokers and insurers increased opportunity to steer healthy consumers to substandard plans, resulting in adverse selection that could increase premiums for comprehensive coverage.
Despite our concerns related to the Georgia Access portion of the state’s waiver application, Georgia Budget and Policy Institute reiterates our support for the reinsurance phase of the plan, particularly how it is structured to provide greater benefits to rural areas where premiums are often higher.
Thank you in advance for your consideration of our comments on Georgia’s Section 1332 waiver application.
Senior Policy Analyst
Georgia Budget and Policy Institute