In July 2020, Governor Brian Kemp asked the federal government to approve a plan that would make several changes to private insurance in Georgia. The Governor’s plan is made up of two parts: 1) Reinsurance—which would help to lower premiums for some Georgians; and 2) the Georgia Access model—which would force consumers to enroll in coverage through for-profit insurance companies and web brokers instead of the unbiased and centralized enrollment platform that consumers know and trust (healthcare.gov). Federal health officials are asking Georgians like you to weigh in on the Governor’s plan. The deadline to comment is September 16, 2020. Don’t miss your chance to say how this plan will affect you, your loved ones, and Georgians across the state. After you read this short blog, tell health officials what you think.

What’s in the plan

Reinsurance

Reinsurance is a tool that some other states have used to lower premiums for consumers and attract more insurers to their marketplaces. Georgia’s proposed reinsurance program is designed so that it would lower premiums more in regions that have higher insurance premiums. Southwest Georgia consistently has some of the highest premiums in the U.S. Georgia’s plan predicts that premiums may drop by 10% across the state, with rural areas seeing bigger drops than urban areas.

Georgia Access Model

In the second part of his plan, Gov. Kemp proposes to dismantle the Affordable Care Act’s (ACA) health insurance marketplace (healthcare.gov). Georgians would no longer be able to enroll in health coverage through healthcare.gov. Instead individuals would be forced to enroll through a health insurer, web-broker, or a traditional broker.

Healthcare.gov is the most widely used and only unbiased place that consumers can shop for comprehensive health coverage. Consumers know all available plans will cover their health needs and they are offered financial help if they qualify and notified of their eligibility for Medicaid or other public coverage programs.

Under the Governor’s plan, Georgia consumers would be the only people in the U.S. forced to go without healthcare.gov, and instead rely on private entities for shopping and enrollment. For-profit insurance companies, online brokers, and even some insurance agents will display comprehensive, ACA-compliant plans alongside short-term plans or plans that do not cover all health services (like mental health and substance use services).

Impacts on Georgians with mental health & substance use conditions (and those in recovery)

Reinsurance: Could help make treatment & recovery services more affordable

The expected drop in premiums from the proposed reinsurance program will help to lower premiums for comprehensive health coverage (which cover mental health (MH) & substance use (SU) services), especially for rural consumers and consumers with incomes too high to qualify for the ACA’s financial help (>400% FPL). For consumers who need their coverage to access treatment services or to support their recovery, lower premiums will make it easier to afford their premiums and to cover their deductibles and other costs.

Georgia Access: Leaves consumers without access to treatment or recovery services

Under this plan, Georgia consumers will lose access to the most widely used enrollment pathway and its attached consumer assistance but will gain no additional enrollment options. Georgians are already permitted to enroll through insurers, web brokers, and agents.

Under an existing enrollment program run by the federal government, insurers and web-brokers have developed 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. Because these companies are allowed to show substandard plans alongside comprehensive plans, the Georgia Access model will encourage Georgia consumers to enroll in substandard plans. Substandard plans are dangerous for Georgians with mental health and substance use needs because most do not cover mental health, and many do not offer substance use or prescription drug benefits. On top of that, substandard plans are allowed to exclude coverage for pre-existing conditions and charge more for people with pre-existing conditions like a history of mental illness or substance use.

The Georgia Access model puts Georgians at risk of getting lost in a confusing new enrollment process and becoming uninsured altogether. Georgians with little or no experience buying or using health insurance (e.g. young people), those with limited English proficiency, Georgians with low health literacy skills, and people with intellectual or cognitive disabilities would be at greatest risk of experiencing adverse consequences from the outlined plan.

Governor Kemp’s plan to change private health insurance in Georgia turns back the clock for Georgians with mental health and substance use conditions. Under this plan, Georgians would be at risk of enrolling in plans that do not cover their health needs and leave them to manage their recoveries with no help. As mental health and substance use issues rise as consequences of COVID-19, this plan moves Georgia in the wrong direction.

For what is likely the last time, health officials are asking for comments from Georgians about the Governor’s plan. The deadline to comment is September 16, 2020. Don’t miss your chance to say how this plan will affect you, your loved ones, and Georgians across the state! Tell health officials what you think today!

In December 2019, Governor Brian Kemp asked the federal government to approve a plan that would make seismic changes to private health insurance in Georgia. In July 2020, Gov. Kemp revised his plan and released it to the public for comment. The revised plan is made up of two parts: 1) Reinsurance—which would help to lower premiums; and 2) the Georgia Access model—which would force consumers to enroll in coverage through for-profit insurance companies and web brokers instead of the unbiased and centralized enrollment platform that consumers know and trust (healthcare.gov).

Federal law allows states to make changes to the Affordable Care Act (ACA) so long as a comparable number of consumers have coverage that is at least as comprehensive and affordable as they would have under the ACA, and the changes do not increase the federal deficit. Unfortunately, the second part of Gov. Kemp’s plan does not meet this standard and poses real risks to families and individuals in Georgia.

Part I: Reinsurance

Reinsurance is a tool that some other states have used to lower premiums for consumers and attract more insurers to their marketplaces. Reinsurance is a system that pays insurance companies for a portion of the costs of consumers who have unusually expensive health needs. When these outlier costs are shared between the state and insurers, insurers are able to lower premiums for everyone.

Georgia’s reinsurance program is designed so that it would lower premiums more in areas of Georgia that have higher insurance premiums. Southwest Georgia has consistently had some of the highest premiums in the U.S. Georgia’s plan predicts that premiums may drop by 10% across the state, with rural areas seeing bigger drops than urban areas.

If approved by the federal government, Georgia’s reinsurance program would go into effect for 2022 insurance plans.

Part II: Georgia Access model—Georgia consumers at a disadvantage

The second part of Gov. Kemp’s plan would make it more difficult for Georgia individuals and families to shop for comprehensive coverage, understand their options, and take advantage of financial help to lower the costs of their plans. It would put insurance companies in the driver’s seat, leaving consumers in the back seat with little control.

Gov. Kemp proposes to dismantle healthcare.gov and instead force Georgians to use profit-driven insurance company websites, e-brokers, or agents to shop for coverage

More than 500,000 Georgians bought affordable, comprehensive coverage through the ACA marketplace (also called healthcare.gov) in 2021. Nine out of ten Georgians who purchased coverage on healthcare.gov received financial help to lower their premiums and other out-of-pocket costs.

The ACA marketplace is the most widely used and only unbiased place that consumers can shop for comprehensive health coverage. Consumers know all available plans will cover their health needs, they are offered financial help if they qualify, and they are notified of their eligibility for Medicaid or other public coverage programs.

Under the Governor’s plan, Georgia consumers would be the only people in the U.S. forced to go without this resource and instead rely on private entities for shopping and enrollment. For-profit insurance companies, online brokers, and even some insurance agents will display comprehensive, ACA-compliant plans alongside short-term plans or plans that do not cover all services.

Under this system, insurance companies and brokers, who are regularly incentivized to enroll consumers in plans that offer the highest commissions, will push consumers to plans that do not fit their health needs or financial situation. They are not obligated or incentivized to help qualified Georgians enroll in Medicaid or PeachCare, or provide other safety net referrals.

This part of the Governor’s plan does not add any new ways for people to shop for health coverage (consumers can already shop with brokers or insurance companies). Instead, it only serves to shut off the most trusted and widely used path for Georgians purchasing their own coverage.

Likely result: Georgia consumers will struggle to navigate a decentralized enrollment system with numerous websites, translate the sales lingo of insurers, and disentangle conflicting information. For many, it may be harder to find a plan that they feel good about. Others will get lost in the process altogether and unintentionally become uninsured.

Governor Kemp’s plan to change private health insurance in Georgia turns back the clock to a time when consumers were at the mercy of health insurance companies. Under this plan, consumers would have a harder time shopping for comprehensive coverage and run a real risk of enrolling in plans that do not cover the essential health benefits or leave them on the hook for tens of thousands of dollars. It is likely that some Georgians would end up uninsured because of the confusing, decentralized system, increasing Georgia’s 3rd in the nation uninsured rate.