Georgia's state government will for the first time run its own marketplace for individual health insurance under a law that Gov. Brian Kemp signed Tuesday.
The Republican governor said during a ceremony at the state Capitol that the law would create a better way of people “knowing and comparing their health care insurance options” and bring “further competition to the field.”
“Georgians know their needs and those of their families best,” he said.
The law is one of three big changes that could affect hundreds of thousands of Georgians who get subsidized health insurance through the state and federal government.
Kemp's administration also plans to launch in July a partial expansion of Medicaid to insure some able-bodied adults who have incomes below the poverty line but are working or attending school. And like all states, Georgia is reviewing the eligibility of all its 2.4 Medicaid recipients as a pandemic-era rule ends that blocked the state from removing any beneficiaries.
Senate Bill 65, allowing the state marketplace, took effect with Kemp's signature. It reverses an earlier law which blocked the state from establishing its own health care exchange. That law was part of an effort to blockade Georgia from participating in the Affordable Care Act under then-President Barack Obama. However, the federal government has been providing coverage through the Healthcare.gov website, and nearly 900,000 Georgians signed up for individual coverage during the yearly enrollment period that ended Jan. 15.
Many Georgians with incomes above the poverty line can buy the policies at little to no cost because of federal premium subsidies, although copayments can be substantial. People with higher incomes can also buy policies on the individual market.
Georgia has not embraced the Obama-era changes. Kemp continues to refuse a full Medicaid expansion without work requirements, a step that could provide insurance for hundreds of thousands. But having Insurance Commissioner John King run a marketplace aimed at Georgians dials down the total disdain state Republicans once had for the Affordable Care Act. The state has also been spending hundreds of millions to subsidize high-cost claims, a step credited with lowering premiums on the individual market and enticing more insurers to offer coverage outside metro Atlanta.
Insurance Department spokesperson Weston Burleson said Georgia officials hope to launch the state marketplace as early as this November. However, federal officials could push back Georgia's launch date until 2024. Federal rules usually require states to spend at least 15 months constructing their own marketplace.
The state market will be different from the one Kemp originally envisioned. He had wanted to place insurance offerings in the hands of private brokers who could sell both policies offering the bundle of coverage required under the Affordable Care Act, as well as policies with lesser benefits. Those policies might have been cheaper, but Laura Colbert, the executive director of Georgians for a Healthy Future, said they would have been worse for consumers.
“That would have really rolled Georgia back to the bad old times where insurers really had the leg up on consumers, where it was incredibly hard to compare plans,” Colbert said, calling Kemp's original plan a “non-marketplace.”
President Joe Biden’s administration balked at Kemp's plan, and after a legal wrangle, Kemp agreed to a central state marketplace that would only sell federally approved policies.
Kemp administration officials say they're prepared to launch the marketplace quickly because of all the work they did on the earlier proposal, on which they spent at least $31 million.
A state-based market could have some advantages, Colbert said. For example, she suggested Georgia could extend its enrollment period past the normal Nov. 15-Jan. 15 window. She also suggested offering to let people buy health insurance using their income tax refunds, and a one-stop application for Medicaid, Peach Care insurance for children and the state marketplace.
“Some state-based marketplaces have done some really innovative things. I think it's TBD on whether Georgia will get there or not," Colbert said.