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CMS approves Georgia waiver to transition to a non-ACA private sector marketplace

Democratic opponents say the "unlawful waiver" will expose consumers to greater financial risk by encouraging the use of junk plans. 

Susan Morse, Managing Editor

The Centers for Medicare and Medicaid Services and the Department of the Treasury have approved Georgia's request to implement a Section 1332 waiver that will transition the state's individual market from the federally-facilitated exchange to a private sector platform called the Georgia Access Model, beginning in 2023. 

Under the model, consumers will shop for available plans through one-stop shopping for plans offered by web brokers, health insurance companies and traditional agents.  

The Georgia Access Model gives incentives for private entities to conduct marketing and outreach, CMS said. Allowing multiple, private web brokers to participate will facilitate competition and provide market incentives to offer improved plan and product selection and enrollment assistance, CMS said.

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The state's reinsurance program, to be implemented in 2022, will reduce annual premiums in the individual market by an average of 10%, CMS said.
 
Democratic opponents say the waiver undermines the ACA as it does not transition to a state-based Affordable Care Act platform. 

The "unlawful waiver request will significantly reduce access and enrollment in comprehensive health insurance and will expose consumers to greater financial risk by encouraging the use of junk plans," said Ways and Means Committee Chairman Richard E. Neal (D-Mass.), Energy and Commerce Committee Chairman Frank Pallone Jr. (D-N.J.), and Education and Labor Committee Chairman Robert C. "Bobby" Scott (D-Va.). "Georgia now has a green light to eliminate residents' access to HealthCare.gov without meeting its legal obligation to maintain the benefits, affordability, and coverage required under the ACA."

The waiver will take away coverage from as many as 90,000 Georgians, they said.

CMS claims that more Georgians, especially those in rural areas, will gain coverage at a lower cost for premiums.

Between 2016 and 2019, total individual market enrollment on the exchange in Georgia declined 22%, with over 129,000 consumers leaving due to high premiums and out-of-pocket expenses, as well as low carrier participation in the individual market in certain parts of the state, CMS said. About half of Georgia's uninsured population qualifies for federal subsidies under the ACA, but did not sign up for coverage, the agency said.

Georgia continues to have one of the highest uninsured rates in the country at 13.7%, leaving approximately 1.38 million people uninsured across the state, CMS said.  

WHY THIS MATTERS

The Trump Administration has been working to dismantle the ACA since President Donald Trump took office.

On November 10, the Supreme Court will hear oral arguments from Texas and other Republican-led states that the ACA is unconstitutional now that there is no longer an individual mandate to have health insurance.

CMS under the Trump Administration, has been allowing waivers for both individual and Medicaid expansion coverage.

Under section 1332 of the ACA, states are able to waive certain provisions as long as the waiver meets specific statutory "guardrails." The guardrails require that people retain access to coverage under the waiver that is at least as comprehensive and affordable as would be available without the waiver, that the waiver covers a comparable number of individuals, and that the waiver does not increase the federal deficit.
 
THE LARGER TREND

The waiver builds on President Trump's executive order that directed agencies to take action to minimize the economic burden of the ACA and provide greater flexibility to states, CMS said.

It also builds on earlier CMS approval of a Georgia Medicaid demonstration that allowed the state to expand Medicaid, with work requirements.

ON THE RECORD
 
"Since implementation, the Obamacare Exchanges have not worked for Georgians, leaving them with fewer options and skyrocketing premiums," said CMS Administrator Seema Verma. "Today's approval of the state's waiver will usher in a groundswell of healthcare innovation that will deliver lower costs, better care, and more choice to Georgians in the individual market."
 

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com