Yesterday, in an unusual Sunday afternoon announcement, the Center for Medicare and Medicaid Services (CMS) approved the Georgia Section 1332 waiver to completely alter their individual insurance market.
Georgia’s waiver has two main components. The first piece is a reinsurance program. This will mix state funds into the premium pool to pay for some high cost claims. This will lower premiums and then create a pass-through of federal premium subsidies. It is projected to reduce gross premiums by over 10%. This is meaningful to people who earn over 400% FPL. It won’t buy a lot of enrollment (<1%) but it helps middle and upper-middle class families. This is not an unusual waiver request. However, if the goal is to help families earning over 400% FPL, a better way would be to expand Medicaid and remove a large chunk of the most expensive portion of the ACA risk pool from the ACA risk pool.
I am not opposed to reinsurance waivers. I think there are implementation issues with almost all reinsurance waivers regarding risk adjustment as insurers can get effectively double paid without state specific risk adjustment factors. Double payment is a bad thing. It should be fixed. The Georgia waiver, similar in type but different in degree from Colorado, has significant geographic differences in payments to insurers. This is an invitation for insurers to dance the fine line between clever and fraud. It will also motivate several 2028 dissertations. But overall, the reinsurance portion of the Georgia 1332 waiver is well within normal bounds even if they are pushing the geographic splits really hard.
The big chunk of the Georgia waiver is the decision to scrap any centralized health insurance marketplace. Healthcare.gov and the state based marketplaces serve the states as a central source of trusted and complete information. Georgia, effective in 2022 for the 2023 plan year, will withdraw from Healthcare.gov and not fundamentally replace its shopping functions. Instead, individuals will be told to go find a broker or an enhanced direct enroller or go directly to insurers. These functions exist without a waiver, so I am having a really hard time seeing how the incentives change for brokers to sign up more people with a waiver than without a waiver. My research interests in the past few years has been on insurance choices (zero-premium, auto-renewal, plan domination etc) and the short lesson of that research agenda is that insurance choice is hard even when it is easy. I think that a lot of people will fall through the cracks and of the people who do not fall through the cracks, quality of choice will go down. I am having a hard time seeing how this waiver meets the enrollment guardrail. But CMS disagrees with me.
Eolirin
Can this be re-evaluated by a new administration, or is it a done deal now
Edit: Assuming the ACA survives the Supreme Court long enough for a new administration to weigh in anyway ><
JPL
@Eolirin: Hopefully, because republicans in GA don’t care about the lives of individuals, outside of the womb.
Basilisc
They did this in time to make sure people are confused and fewer people get covered in 2022, so they can say the ACA is a “failure” in time for the midterms. But they made sure to do it too late for someone knowlegeable to ask Loeffler or Perdue if they support it, which would have been embarrassing (since they’re ignorant), unless there’s a debate with a knowledgable emcee between tomorrow and the runoff. Which I’m guessing won’t happen in Georgia. Niiiice.
RaflW
“I am having a hard time seeing how this waiver meets the enrollment guardrail. But CMS disagrees with me.”
I’ll say it: Sema Verma is, like anyone daring to be in the Trump Admin inner ring, is that dangerous combo of corrupt and ideologically blinkered. In her particular case, I can’t call it full on incompetence, but ideological blinders can mimic the effect.
When could a new Admin un-waive the waiver? Or at least tweak it?
dww44
@JPL: exactly right. Never have and never will. They give lip service to the common man but they’ve never believed in his or her existence.
egorelick
Look for the grift.
oldster
Nice work! You have learned from Doug J how to get a good title from a lyric.
Barbara
@RaflW: Seema Verma thought that she would be in charge of HHS by this point. She really thought Alex Azar would have gone by the third year of Trump’s term. She is quite smart, but she is tethered to a rigid ideological position that is untempered by actual experience with the people who benefit from the programs she administers, at least when it comes to Medicaid.
piratedan
well, since it’s coming from Kemp, I have to assume its in bad faith…. and it seems that this taps into the one additional thing that the GOP excels at, not so much about writing legislation, but rather in sabotaging it to make it more cumbersome and unwieldy.
raven
@piratedan: He’s too fucking stupid to have come up with it himself.
JaneE
Approved by the Trump administration CMS. Forgive me if I don’t think that means anything like meeting legal requirements in actual fact.