How Georgia is ‘Amazon-izing’ Healthcare and Fixing What’s Wrong with the Affordable Care Act

By Randy Pate

While Republicans nationally struggle to agree on solutions in healthcare and Democrats push for more government control, Georgia is taking a major step forward in altering key aspects of the Affordable Care Act (ACA) to empower consumers and put them at the center of their own healthcare.

Like many other states around the country, Georgia’s individual health insurance market fell into crisis under the ACA. From 2016 to 2019, total health insurance exchange enrollment in Georgia dropped by 22%, while premiums for benchmark exchange plans jumped by a whopping 70%. In response to the dire market situation under the ACA, a number of states have used Section 1332 State Innovation Waivers to stabilize their markets and provide relief from unaffordable premiums.

Most Americans want healthcare to look more like Amazon or Travelocity, where transparency, straightforward comparison shopping and customer service are paramount. Yet, Washington, D.C., seems hell-bent on making it look more like the IRS or the DMV. We know that when key decisions are made by government bureaucrats, choice is inevitably taken away and patients are treated like nameless, faceless numbers.

Under the leadership of Gov. Brian Kemp, Georgia is the first state in the country to use the ACA’s waiver authority to “Amazon-ize” healthcare and make it more responsive to consumer needs. Besides creating a robust reinsurance program, which promises to lower premiums in the state’s individual market by 10% in 2022, the waiver creates an entirely new way for Georgians to shop for health insurance coverage called the Georgia Access Model. Under this model, Georgia would eliminate HealthCare.gov in 2023 and would instead rely on private-sector brokers and insurers to provide the consumer shopping experience, much like Amazon and Travelocity do today.

While a similar concept was successfully implemented during the Trump administration, it has been largely kept under wraps by the national media. Under the wrongheaded conviction that only the government can sell health insurance, the Obama administration carried out the ACA’s health insurance exchange using federally funded “navigators” and a centralized government website, HealthCare.gov. Not surprisingly, this one-size-fits-all approach had the effect of squeezing out private-sector investment in health insurance advertising and outreach. As a result of this and other federal policies, commissions paid by health insurers to licensed insurance agents and brokers plummeted, leading many to abandon the market to focus on selling other lines of insurance. All of this contributed to the ACA’s falling fall short of the Congressional Budget Office’s initial enrollment projections, and the law continues to lag behind in reducing the number of uninsured.

But the Trump administration opened up a new pathway that allows private-sector partners to market and sell health insurance directly to consumers without forcing them to go through the government website. This new pathway has worked remarkably well. During the open enrollment period last fall, over 1 million people enrolled through these private-sector partners. Not only that, but partners using the pathway have attracted a higher percentage of new enrollees than the government website.

Georgia’s waiver builds on this success by allowing private-sector partners to serve as the primary means for Georgians to shop for and enroll in coverage. Without having to take a backseat to HealthCare.gov or being crowded out by ineffective federally funded navigators, web brokers, insurers, and licensed agents and brokers who live and work in the communities they serve will have more incentive to go out and enroll the uninsured. Web brokers will have increased incentive to design a more appealing, consumer-centric shopping experience that will simplify the daunting task of buying health insurance.

While the waiver’s detractors are focused on the fact that the Georgia Access Model “takes away” HealthCare.gov, they fail to recognize that many private-sector partners today provide everything HealthCare.gov provides and more – and that consumers by the millions already are turning to private-sector partners as they shop for coverage.

Through its Section 1332 State Innovation Waiver and the Georgia Access Model, Georgia is leading the nation in putting consumers, rather than bureaucrats, at the center of healthcare. Republicans and Democrats alike who care about getting more people covered should take notice.


Randy Pate, former CMS Deputy Administrator and the Director of the Center for Consumer Information and Insurance Oversight, wrote this commentary for the Georgia Public Policy Foundation.  Established in 1991, the Foundation is a trusted, independent resource for voters and elected officials. The Foundation provides actionable solutions to real-life problems by bringing people together. Nothing written here is to be construed as necessarily reflecting the views of the Georgia Public Policy Foundation or as an attempt to aid or hinder the passage of any bill before the U.S. Congress or the Georgia Legislature.

© Georgia Public Policy Foundation (June 11, 2021). Permission to reprint in whole or in part is hereby granted, provided the author and his affiliations are cited.