ATLANTA _ The federal government will approve Georgia Gov. Brian Kemp's plan to reshape Medicaid and individual insurance in Georgia under the Affordable Care Act, the governor and a top Trump administration health official announced on Thursday.
Kemp says the proposals aim to create a pathway along several steps _ for those who qualify _ from being unemployed and uninsured, to eventually having insurance and being engaged in the community.
To do that, Kemp plans to expand Medicaid coverage to about 50,000 of the state's 408,000 uninsured, extremely poor adults. To qualify, recipients would have to meet work or activity requirements the state would impose, according to the state's initial proposal.
People who don't qualify would include those whose work was unofficial, such as caring full time for an elderly relative, or the disabled who aren't declared disabled by the government, for example a mentally ill homeless person who doesn't complete the process.
Kemp also plans to pour public money into the private insurance market, a move that is likely to reduce premium prices for upper-income people who shop for individual healthcare plans but who make too much money to get much help from the current federal subsidies.
"While Georgia is a battleground state, divided by politics and ideology, there's one thing we can all agree on: Health insurance is too high," Kemp said.
He would also block access in the state to the federal healthcare.gov website, where about 400,000 Georgians buy their individual insurance plans. Instead he would divert them to contact information for private insurance agents, web brokers and insurance companies.
The plans now face rollout and any possible court challenges. Critics, who have sued against some waiver plans and won in other states, have called Kemp's plans illegal and the claims of increased enrollment baseless.
If it passes court muster, the Medicaid plan would go into effect next summer, and the changes to the ACA insurance market, also known as Obamacare, would roll out over the following two years.
The announcement triggered a wave of criticism from liberal groups, who said Kemp should instead have fully expanded Medicaid to all the state's very poor, as the ACA envisioned and 39 states have done. If he did that, all of the very poor uninsured adults would automatically be covered without having to go through added bureaucracy that may be difficult to navigate, and more expensive to implement. In addition, under the Affordable Care Act, if a state fully expands Medicaid the federal government would pay $9 to every $1 the state put in.
State GOP leaders said Georgia still cannot take the financial risk. A fiscal note prepared for the Georgia Legislature last year estimated the cost of that to the state budget would be about $150 million this year and $200 million annually in following years.
Kemp's office released documents Thursday claiming that "Georgia Pathways and Access" _ Kemp's names for the Medicaid and ACA insurance waiver programs _ "will cost the state an average of $218 million per year compared to $547 million annually for a full expansion of Medicaid." It is not clear what the source of that Medicaid figure was, and Kemp's office did not immediately respond.
Other states that have expanded Medicaid to all their poor and then implemented work and activity requirements had the requirements struck down in federal courts. Medicaid waivers are supposed to advance the mission of Medicaid, and the judge found that the waivers didn't do that.
However, Kemp insists that Georgia's plan is "fundamentally different," according to spokesman Cody Hall, because in Kemp's case, the plan would impose the work and activity qualification at the same time as expansion, not knocking anyone off coverage who already had Medicaid.
Legal critics disagree, saying Congress, created Medicaid with its mission, and Kemp and Trump would be modifying it.
The other big controversy in the plan surrounds changes to shopping for individual private insurance under the Affordable Care Act.
Kemp's office claims that by diverting Georgians from shopping on healthcare.gov to private brokers, he will increase the range of plans they are able to see.
That is true. Healthcare.gov only promotes plans that offer robust coverage compliant with the ACA. Critics say that's the problem: Private insurance agents can make a bigger profit by promoting skimpier plans, and the customer may not understand what they're paying for.
About 400,000 Georgians currently buy their insurance on healthcare.gov, and those critics estimate that after it's blocked perhaps 60,000 more Georgians would be uninsured. In contrast, Kemp's aides say it would expand coverage by about 25,000.
There is little doubt about the effect of Kemp's most expensive plan, however: the plan to subsidize private insurance companies, called "reinsurance." It is legally tested and unlikely to be challenged. By paying some of the more expensive claims the companies face, the insurance companies are likely to pass some of that windfall through to customers, who will see their premiums lowered. Kemp estimates they will lower by an average of 10% statewide. The biggest benefits would be in rural areas, which could see decreases of 25% or more. Atlantans might see decreases of 4%.
Currently, people who make, for example, $105,000 or more for a family of four, get no ACA subsidies and pay the full, astronomical price for insurance. Kemp's plan would help them.
Questions remain about costs of the plans: Kemp's office was required to estimate costs such as the level of insurance subsides, but not administrative costs like advertising or building a new website.
A General Accounting Office report estimated the cost of imposing a work requirement at potentially tens or hundreds of millions of dollars.
