The Trump administration took another step to weaken the Affordable Care Act with Election Day looming, approving Georgia’s controversial request to make fundamental changes to its Obamacare exchange.
The Centers for Medicare and Medicaid Services on Sunday gave the state permission to stop using the federal exchange, Healthcare.gov, for enrollment in the individual market and shift to a private sector Georgia Access Model, starting in 2023.
State officials argue that the move will give residents access to a broader array of options from web brokers, health insurance companies and agents — which will have a greater incentive to enroll consumers in coverage. They estimate the waiver will lower premiums and increase enrollment by 25,000 people.
Advocates, however, fear that it could shift healthier people to less comprehensive, non-Obamacare plans and leave those with pre-existing conditions facing higher premiums for Affordable Care Act policies. Plus, consumers could unknowingly sign up for skimpier policies.
“Consumer could end up in insurance plans that don’t cover everything they think it would cover,” said Tara Straw, senior policy analyst at the left-leaning Center on Budget and Policy Priorities.
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What’s more, the Georgia waiver would eliminate residents’ ability to go to a single website to see all their options. Instead, they would have to navigate a fragmented system of broker and insurers — similar to what existed prior to the landmark health reform law, Straw said. This would likely decrease coverage and raise premiums.
The waiver does not meet the federal requirements for approval, including covering as many people with the same affordable and comprehensive coverage as without the waiver, Straw said. This will open up the approval to legal challenges.
The agency opened the door for states to create alternatives to Obamacare in 2018. The Peach State, which has the nation’s third highest uninsured rate at 13.4%, is the first to seek this enhanced power to reshape its individual market.
About 433,000 Georgians were enrolled in Obamacare exchange plans, as of February, according to federal data.
The approval came on the same day as open enrollment for 2021 began and 10 days before the Supreme Court is set to hear oral arguments in a case that could bring down the law.
The Trump administration is backing a coalition of Republican-led attorneys general, including Georgia’s, who argue that Obamacare’s individual mandate was rendered unconstitutional after Congress reduced the penalty for not having insurance to zero as part of the 2017 tax cut law. As a result, the entire health reform law must fall, they argue.
Health care has taken center stage in the 2020 presidential campaign. Former Vice President Joe Biden’s campaign has hammered President Donald Trump for trying to take down the law and its protections for those with pre-existing conditions. Trump has repeatedly said he has a replacement plan that would continue those safeguards but has yet to produce one.
The administration has pursued multiple avenues to overturn the Affordable Care Act in its first term. After efforts to repeal the law in Congress failed in 2017, officials started undermining it from within, including shortening the annual enrollment period to obtain coverage on the exchanges and slashing the budget for outreach and assistance. It also broadened the availability of alternative plans, primarily short-term health insurance policies that typically have lower premiums but are allowed to base coverage and premiums on people’s medical histories.
Georgia also received permission Sunday to implement a reinsurance program, which typically reduces premiums by protecting insurers from high-cost patients. More than a dozen states have received federal approval to do this.
Last month, the administration approved Georgia’s waiver request to provide Medicaid coverage to certain low-income residents if they work or participate in other qualifying activities for at least 80 hours a month.
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