LISTEN: Shopping for health insurance will be slightly different come November with the final approval for Georgia Access, a piece of Gov. Kemp’s Patients First Act. GPB's Sofi Gratas has more.
Georgia is moving forward with a state-based health insurance exchange following the Centers for Medicare and Medicaid Service’s approval.
This means things will look a little different this fall for people looking to buy health insurance coverage during open enrollment. For one, thousands of Georgians will be redirected from Healthcare.gov to GeorgiaAccess.gov come November.
In 2019, Georgia Gov. Brian Kemp signed the Patients First Act in part to move Georgia away from the Federal Health Insurance Marketplace established under the Affordable Care Act.
In doing so, it needed approval from the federal government, which it received conditionally last year. Final approval came last week. There are 19 other states with state-based exchanges.
The Patients First Act also paved the way for Georgia’s reinsurance program and for the state to implement Kemp’s Pathways to Coverage program, though soon after that program became embroiled in court battles. Enrollment in Pathways has been ongoing since last summer, years after its intended start date.
Georgia Access also faced its share of resistance from the Biden administration. But Georgia’s move to the state-based exchange marks a major milestone in health care policies championed by Kemp, who campaigned on the issue during his run for governor.
“I'm proud to say that we rejected the top-down, one-size-fits-all approach,” Kemp said during a public meeting with health care leaders Monday.
Insurance and Safety Fire Commissioner John King said that a state-based exchange gives Georgia more options to adapt.
“We no longer rely on the federal government for technology outreach, enrollment assistance, and plan oversight,” King said. “This is a matter of scale."
On Georgia Access, private sector health care plans will be featured equally alongside subsidized plans. The site will also direct people to insurance navigators and brokers to help shop for insurance. Some of those navigators may be from care management organizations, the idea being to emphasize a variety of coverage options. Executives with Peach State Health Plan, Amerigroup and CareSource were included in the meeting Monday.
King said a state-based exchange also redirects user fees from the site to Georgia, rather than to the federal government.
Georgia saw an almost 50% increase in people enrolling in marketplace plans during the last enrollment period, higher than the national average which had already broken records. It’s expected that enhanced subsidies and Medicaid redeterminations contributed to that growth.
But Georgia leaders also take credit, pointing to a major marketting campaign and saying they’ve been able to double the number of marketplace insurance carriers through upped reimbursement rates and lowered insurance premiums, the cornerstones of Georgia’s own reinsurance program. That means users could see more options in rural Georgia, previously found to have inadequate coverage.
A recent study refuted some of those claims, however, showing that people with incomes between 300 and 400% of the federal poverty level saw premiums go up slightly, resulting in a slight decrease in enrollment.
Meanwhile, Kemp announced a change to how many people his administration expects to cover under the Pathways to Coverage program.
Previously the administration announced around 240,000 people would be eligible for the program. Pathways is open to people up to 100% of the federal poverty level, but requires those enrolled to prove 80 hours of work, volunteer time or education each month in order to receive coverage.
Now, leaders say it’s more like 168,000 people. That’s because more people have private health care coverage, Kemp said, touting job growth in the state.
Still, just over 4,000 people had enrolled in Pathways as of July, a fraction of even the most recent update to those expected to be eligible.
“We've had a tremendous amount that the agency has had to fight through,” Kemp told the press. “We're just now on the other side of that. So you're going to see a 100% effort going into Pathways and Access continue.”
The program has come under fire for its slow start, and has been tied in with an unwillingness by Georgia lawmakers to fully expand Medicaid, which would reach people up to 138% of the federal poverty level.
Laura Colbert, director of health care advocay group Georgians for a Healthy Future shared a statement following the Monday meeting.
“The statements and numbers presented at today’s round table discussion paint an incomplete picture of Georgia’s health coverage landscape," Colbert wrote. "We cheer the meaningful increases in private health insurance enrollment among Georgians, but that does not resolve the larger issue at hand. Hundreds of thousands of Georgians remain uninsured and without meaningful access to health care until Georgia leaders fully close our state’s coverage gap."
To get more people enrolled in Pathways, the Department of Community Health has launched a new marketing campaign in Atlanta and other parts of the state. Commissioner Russel Carlson said that’s included sending text messages to 160,000 parents with kids on Medicaid who could be eligible for the program, and an effort to reach out to 17,000 recipients of the Supplemental Nutrition Assistance Program, which also has its own eligibility requirements.
Upcoming in-person events can be found on Pathways webpage.
The Georgia governor was quick to point out that Pathways has always been intended as transitional.
“The goal of Georgia Pathways is not, and has never been, to keep hundreds of thousands of Georgians on government-run health care forever,” Kemp said. "Georgia Pathways was meant to be exactly that: a pathway to an education, a job, a career and a better life without government assistance."
Pathways remains the only Medicaid program with work requirements in the country.
Kemp said that 400,000 people have been moved from Medicaid to private sector insurance through the Medicaid redetermination process, in which state agencies checked the eligibility of all 2.7 million people with Medicaid in the state and either kept them on, removed them from the rolls or redirected them to other insurance coverage.
