By Kyle Wingfield
Bureaucratic arcana from Washington, D.C., hit Georgia’s headlines this week. Governor Brian Kemp announced he will seek federal “waivers” to improve health care in the state.
But what exactly is a “waiver”?
In short, it’s a way for the state to escape stifling federal regulations and provide Georgians with meaningful access to health care that’s affordable – and tailored to the needs and opportunities found all across Georgia.
To understand why this is true, and how it would work, it’s worth learning a bit about waivers.
First of all, what’s being “waived” are some of the strings Washington attaches to the money it sends states to help pay for some people’s health care. In theory, having some standards to ensure money isn’t ill-spent is a good thing. In practice, there are so many rules, going into such great detail, as to doom much of the money to poor use.
Fortunately, Washington has also created a process by which states can customize programs like Medicaid. Most states have sought and received permission to do this, although Georgia is not one of them. Kemp is now proposing to change that.
Still unclear is just what the governor plans to propose to customize Medicaid for Georgia. One option would be to add some kind of work requirement for able-bodied adults under the federal poverty line.
This is not mean-spirited: A study by the Buckeye Institute in Ohio found work requirements could lead to women on Medicaid increasing their lifetime earnings by $212,694, and men by $323,539. The increase could approach $1 million for those who eventually work their way off Medicaid.
Those higher earnings are one answer to the question, “Why not just expand Medicaid?” Here’s another answer: Having a Medicaid card in your wallet isn’t necessarily the same thing as being able to see a doctor.
Estimates vary as to how many doctors in Georgia do not accept Medicaid patients as a result of the program’s low reimbursement rates. What is clear, however, is that it’s significantly harder to see a doctor as a Medicaid patient than with private insurance. That’s why states that expanded Medicaid haven’t necessarily seen a decline in emergency room overcrowding. What matters isn’t just coverage, but access to care.
Kemp intends to limit his Medicaid proposal to those at or below 100 percent of the federal poverty level. The Affordable Care Act, a.k.a. Obamacare, authorized states to expand Medicaid eligibility up to 138 percent of the federal poverty level, but those between 100 and 138 percent are also eligible for subsidized private insurance on the HealthCare.gov exchange.
That’s the better option for them, and here, too, the governor proposes to seek a waiver. The tight regulations on plans offered on the exchange have not only killed competition but made prices soar.
Georgia could do better by using some of the current subsidies to cover more directly the costs of very sick patients on the exchange. Other states that have done so have lowered premiums by double-digits. Then, Georgia could choose to be truly bold and allow recipients to use subsidies not only for premiums, but to pay for out-of-pocket costs and meet their deductibles. Finally, the state could broaden the types of plans eligible for the subsidies, including lower-cost options such as association health plans.
Taken together, Kemp’s proposals could not only help far more Georgians than simply expanding Medicaid, but also given them far more options for better coverage and, via competition, lower prices. That’s better for patients, health providers and taxpayers.
Kyle Wingfield is president of the Georgia Public Policy Foundation, an independent, nonprofit think tank that proposes market-oriented approaches to public policy to improve the lives of Georgians. 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 (February 15, 2019). Permission to reprint in whole or in part is hereby granted, provided the author and his affiliations are cited.