Most Americans get their health insurance from one of two providers: either through the government or from commercial health plans. While the government provides taxpayer-funded health insurance to seniors (Medicare) and to the low-income and disabled population (Medicaid), commercial health insurance is typically a benefit provided by employers or acquired by families and individuals on health insurance exchanges.
Despite the growing popularity of other methods to pay for healthcare, such as direct primary care, health care sharing ministries and utilizing price transparency platforms for the best cash pay rates, the government and commercial health plans remain the primary payers for providers.
Which brings us to Georgia.
In 2019, Gov. Kemp signed the Patients First Act into law, which authorized the Department of Community Health to pursue two waivers from the federal government to address both Medicaid and the private health insurance marketplace.
While the political and media discourse typically centers on the Medicaid waiver, immediately followed by appeals for a full expansion of Medicaid under the Affordable Care Act, not enough attention is paid to what Georgia has achieved when it comes to commercial health insurance.
The 1332 waiver, known as Georgia Access, allowed the state to establish and operate its own health insurance exchange as the replacement to HealthCare.gov, the federal marketplace established under the Affordable Care Act. It also established a reinsurance program that “insures the insurers” by mitigating the financial impact of high-cost claims which drive up the cost of health insurance for everyone on the health plan.
The Foundation recently published “Examining Georgia’s Health Insurance Marketplace,” a policy brief authored by Gregg Conley, former Executive Counsel to Georgia Insurance and Safety Fire Commissioner John King. This brief analyzes how Georgia’s health insurance landscape has improved since Gov. Kemp took office in 2019, specifically with the strengthening of the private health insurance market.
As the author notes, in 2018, 145 Georgia counties had only one insurance carrier and the other 14 had only two. Now only one county has as few as two insurance carriers. Sixteen percent of Georgia’s counties have at least three carriers, 31% have four and over 52% have five or more. Overall, there were only four carriers participating in Georgia’s individual market in 2018, but in 2024 there are now 10.
Choice and competition in the health insurance market are not only good for consumers, but providers as well. That one insurance carrier that operated in 2018? It was reimbursing hospitals and physicians on average 50 cents for every dollar, forcing many providers to drop out of the plan altogether.
What we pay providers is important to sustaining a robust healthcare community. For example, as manufacturers migrated out of the country in recent decades, healthcare providers suddenly had to deal with patients who lacked commercial health insurance – which reimburses providers at the highest level – and were subsequently underinsured or uninsured completely.
Which brings us back to Medicaid, a health insurance program that reimburses providers 80 cents on the dollar; as such, only 60% of Georgia physicians accept new Medicaid patients.
The 1115 Medicaid waiver, known as Georgia Pathways, allowed the state to tailor its Medicaid program. It offers coverage to those who did not previously qualify if they submit a minimum of 80 hours of “qualifying activities” each month. This includes employment, job training, community service and certain educational programs – best of luck finding anything other than a blanket referral of these as “work requirements” in coverage of the program.
July 1 marked one year since the launch of the program. As frequently noted, enrollment has been lower than expected. Opponents of the waiver cite the low enrollment figures as justification for that full Medicaid expansion, which would cover Georgians up to 138% of the federal poverty level, as opposed to the population at 100% or below that it covers now.
What is woefully unreported is that people earning up to 200% of the federal poverty level are eligible for fully subsidized health insurance coverage on Georgia Access, which not only offers better plan options, but ensures providers are reimbursed at commercial rates.
The purpose of both these programs is how best to provide health coverage for Georgians. Our end goal should not be more able-bodied individuals on Medicaid, a payer that does not guarantee access to primary care and underpays providers.
Instead we should emphasize the fact that better health insurance options are available for beneficiaries and providers alike.