Part II: GA Access Waiver 1332 Undermines Protections in ACA and Allows Junk Plans

Georgia has a healthcare crisis and it’s getting worse with about 1.2 million Georgians uninsured.  The state has the third-highest uninsured population in the country, according to recent census bureau findings. 

Nine of the state’s 159 counties have no physician, 76 counties have no OB/GYN physician, and 60 counties have no pediatrician, according to a recently released state report.  

Maternal mortality for white women in Georgia is more than twice the national average and for Black women, it is nearly six times the national average.  Georgia ranks 48th in the U.S. in healthcare coverage for women, according to an ACLU of Georgia report. 

Seven rural hospitals have closed since 2013 and many other Georgia hospitals are vulnerable to closure due to so many uninsured patients. 

 Uninsured people often go without care until their medical problems become critical and then they end up in the emergency room.  This is bad for the health of Georgians, bad for the financial health of hospitals and bad for taxpayers. 

Governor Brian Kemp’s Georgia Access Proposal will make drastic changes to private insurance throughout the state for people making above the poverty line.  The State claims the Georgia Access 1332 Waiver will hold down costs, increase competition among insurers, and lead to more citizens having health insurance, and maintain protection for people with pre-existing conditions.  

 “The state’s plan does the opposite, the results are that it will drive up costs for many consumers and it undercuts protections for people with pre-existing conditions,” Laura Colbert, Executive Director with Georgians for a Healthy Future, said.

Here are some of the problems healthcare professionals, advocates and the public see wrong with the state’s Georgia Access Proposal, Waiver 1332 plan for private insurers. 

BUDGET CAP TO SUBSIDIES

The state’s plan will cap the amount of financial assistance available to lower and middle-income consumers.   If too many people apply and the state runs out of money to provide financial assistance to buy private insurance coverage, some people will be put on a waitlist.  

“People with Cystic Fibrosis (CF)  can’t afford to be on a waiting list both financially and for the sake of their health and well being.  Any lost or gaps in health coverage puts the health of people with CF at risk,” Carey Mackesey explained to the Georgia Department of Community Health  (GDCH) at a hearing in Kennesaw. 

Every Georgian who is eligible for a subsidy under the Affordable Care Act (ACA) gets it, but under Georgia’s plan some people may need to wait and they may or may not receive a subsidy even if they qualify.  People with chronic illness may not be able to wait and some may die while waiting.

“I do not trust the State of Georgia to manage subsidy money,” Susan Marling, a taxpayer, said and she is not alone in this belief.

These premium subsidies can be used to purchase associated health plans and short-term plans that don’t have comprehensive coverage of the ten essential health benefits that people with pre-existing conditions need.

JUNK POLICIES

The state’s plan will allow the insurer to offer sub-standard plans that don’t meet the minimum requirements of the Affordable Care Act (ACA) and don’t cover all the ten essential health benefits that comprehensive plans do.

The ten essential health benefits include ambulatory services; emergency services; hospitalization; pregnancy, maternity, and newborn care; mental health and substance abuse treatment; prescription drugs; rehabilitative services; laboratory services; preventive and chronic disease management; and pediatric services. 

These sub-par plans could be deadly for people with chronic illnesses.  “This proposal may send many Georgians living with Multiple Sclerosis over the edge of a financial cliff,” Greg McMilligan said at the Kennesaw meeting.   

The premiums on these short-term and junk plans are lower than the comprehensive qualified health plans.  So healthy people will buy these plans and that may drive up costs for people who need comprehensive plans.

 “We are concerned that the Georgia Access Proposal will jeopardize access to quality, affordable healthcare coverage for patients with lung disease and other pre-existing conditions,” June Deen with the American Lung Association in Georgia, testified at the healthcare hearing in Kennesaw.  

With the 1332 Waiver, “Once again sub-par plans will be alive and well to cause havoc on healthcare consumers of Georgia.  They are designed to skirt the ACA vital consumer protection. These plans don’t have to provide comprehensive coverage and allow insurers to discriminate against people with pre-existing conditions,” Abbie Fuksman, Vice President with Blue Cross/Blue Shield NY, explained to GDCH.  

 “Georgia elected leaders are showing constituents that when it comes to making it easier for people to access quality health coverage all they offer is lip service despite polling showing that 70% of people support ending junk plans,” Fuksman said.    

Groups like the American Cancer Society, Cancer Action Network, American Lung Association, and the Consumers Union have warned against the expansion of these junk plans.   

DISMANTLING HEALTHCARE.GOV 

The state’s plan would require consumers to shop on websites that are run by brokers and insurance companies rather than healthcare.gov.  

 Some of these insurance companies and brokers are often driven by their profits and commissions rather than what is best for the person looking for a plan.   A plan with comprehensive coverage would likely become more expensive for those with pre-existing conditions. 

 “Purchasing health insurance is confusing.  This is why healthcare.gov a centralized unbiased site to compare qualified plans is so important.  Dismantling it to have Georgians visit a series of independent websites belonging to e-brokers and insurance companies whose main motivation is to make profits and not necessarily to provide the best coverage options for consumers,” Lauren Panchley said at the Kennesaw hearing.

Dismantling the healthcare.gov website will lead to confusion, and make it more difficult to navigate resulting in consumers choosing the wrong coverage that does not cover their medical needs and could force some into bankruptcy.  

The marketing tactics these substandard plans use often obscure the fact that they don’t include all the ten essential health benefits like hospitalization, prescription drugs, and specialized services for pre-existing conditions.    

Consumers face challenges in understanding short-term plan benefits and limitations.  This lack of understanding raises concerns that some consumers are enrolling in short-term plans that don’t meet their health needs or financial situation, according to a new report from Kleimann Communications Group.

CONCLUSION AND RECOMMENDATIONS

The state has spent millions of dollars researching Georgia’s health care problems and crisis.  According to many experts in the healthcare industry, the proposals the state created do not address the state’s health care crisis nor will it provide coverage for millions of Georgians who will still be uninsured. 

Georgia ranks at or near the bottom of the barrel on many healthcare issues.  Regardless of what our elected officials say, “they simply don’t have the political will in terms of solving today’s healthcare crisis with proposals that will meet the needs of Georgians,” Taifa Butler, Georgia Budget and Policy Institute, said. 

To conclude, these proposals need more work and the public can only hope that elected officials listen to all the public comments and recommendations from healthcare professionals.  Only time will tell how the Governor’s waivers will work out.

A few of the main recommendations are to remove the work requirements in the 1115 waiver, and expand Medicaid to the one half million Georgians who are eligible.   The 1332 waiver should require insurers to sell quality, comprehensive plans not junk plans, and don’t dismantle the healthcare.gov website. 

by Gloria Tatum