On May 28, 2018, the Georgia Public Policy Foundation published a study examining the potential benefits for Georgia of 1332 healthcare waivers under the Affordable Care Act.
This study, Healthcare Innovations in Georgia: Two Recommendations, was conducted by Anderson Economic Group (AEG) in conjunction with Wilson Partners. The Foundation published the report in the interests of furthering public discussion.
It proposes one way Georgia might use a 1332 waiver to lower the cost of healthcare, empower more Georgians to purchase private insurance, restore the primacy of the doctor-patient relationship, and ultimately blaze a trail for other states to follow.
The study can be accessed here.
The AEG report recommends Georgia adopt two policy innovations:
- A reinsurance program that would apply to all large insurers in the state and “reimburse accumulated claim costs that exceed a set threshold within a given year.” According to AEG, it would have the goal of “stabiliz(ing) rates for individual health insurance plans and provid(ing) greater financial certainty to health insurers and health insurance consumers.” AEG estimates a claims threshold of $50,000 per plan member would yield annual savings of more than $550 each for members of an individual-market plan, totaling more than $250 million in the first year.
- A Georgia primary care access option, which would require large insurers to offer at least one plan that includes a direct primary care model. Plan members would select a primary care physician, who would receive a fixed monthly fee rather than the traditional fee-for-service model. Because direct primary care eliminates the need for physicians’ offices to track and code services and file for reimbursement by the insurer, the provider avoids large overhead costs for compliance. This arrangement allows physicians to have a profitable practice with a much smaller number of patients, which could make it a particularly effective option for rural Georgia. Assuming 5% of those eligible enroll in these plans, AEG estimates this option would lower premiums on the individual market by $42 per member in the first year, totaling almost $42 million. The savings would be larger – about $800 per member in the first year – for those who chose a plan with direct primary care benefits.