Georgia wanted to shut down Healthcare.gov. It did not want to replace Healthcare.gov with a State Based Marketplace like how California or Idaho, for example, implement their ACA individual market. Instead, Georgia had a waiver, called the Georgia Access Model, approved during the end of the Trump Administration that would place all of the outreach, assistance, plan display and enrollment activity in the hands of profit seeking entities including insurance agents and insurance companies. Georgia contended that the profit motive would be sufficient to drive enrollment up in plans that are at least as good in terms of benefits and premiums at no greater cost to the federal government. The Trump Administration bought this argument. The Biden Administration thought it was suspect, so after the passage of the American Rescue Plan, the Center for Medicare and Medicaid Services (CMS) asked for more information and had an extended public comment period. I wrote and submitted a very long comment. I also referenced a working paper that my colleagues and I had written that was relevant to the request for comments.
CMS sent a notice to Georgia suspending the waiver while requesting more data in April 2022. Georgia responded at the end of July without any new analysis. Last week, CMS suspended the implementation of the Georgia Access Model for 2023.
the Departments are upholding their determinations that: (1) the State materially failed to comply with the STCs by repeatedly refusing to provide the Departments with the information requested as part of the Departments’ monitoring and oversight authority;8 and (2) the State has not demonstrated that the Georgia waiver, with the Georgia Access Model in place and absent corrective action, meets the statutory coverage guardrail in light of changes in federal law, policy, and other circumstances that materially affect the without-waiver baseline scenario. In addition to these findings, the Departments have also determined, based on readiness reviews conducted to date, that Georgia has not satisfied certain operational readiness requirements for a novel state program such as the Georgia Access Model. Nor has the State provided an adequate outreach and communications plan. These operational and planning deficiencies are an additional basis for suspending implementation of the Georgia Access Model under the applicable STCs. For all of these reasons, suspension of the implementation of the Georgia Access Model will go into effect August 9, 2022.
Now, I get to read some interesting, to me and a few co-authors, analysis by CMS on Georgia’s argument about advertising starting on Page 8: