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Georgia Access Model Still Lacks Necessary Federal Support

On July 29, I was quoted in the Atlanta Journal-Constitution article, “Kemp in standoff with Biden administration over plan to block ACA site.” I wanted to add some further thoughts and explanation, but first a little background may be helpful.

The “ACA site” in the AJC headline refers to the federal insurance exchange, Healthcare.gov, where consumers in Georgia can shop for health coverage that is compliant with the Affordable Care Act and eligible for federal subsidies. Georgia’s 1332 State Innovation Waiver under the ACA, which was approved in November 2020, would withdraw the state from Healthcare.gov and allow consumers to purchase such plans, and others, directly from private firms.

In June 2021, however, the Biden administration requested updated actuarial and economic analyses of the waiver. Since then, Georgia and the Centers for Medicare & Medicaid Services (CMS) have engaged in a series of letters regarding the state’s plan to proceed. In April 2022, CMS notified the state it would suspend implementation of the waiver unless the state responded by July 28. The official response by the state prompted the article, which included this from me: 

Supporters of the waiver plan said it would produce more options for Georgians. That should mean more health insurance plans to choose from, said Chris Denson, director of policy and research at the Georgia Public Policy Foundation, a libertarian-leaning think tank. “The state received approval from (the federal government in 2020) to proceed with the implementation,” and the Biden administration has no authority to undo that, Denson said.

Like most policy positions, it’s impossible to explain the nuance of something as complicated as healthcare policy in a sound bite, let alone the subtleties of a 1332 waiver. Let’s break it down:

First, CMS has a legal obligation to follow through and help implement the state’s new plan, known as the Georgia Access Model. There is no legal basis for the Biden administration to demand a corrective action plan for a waiver that has not yet been implemented. CMS efforts to require more information and a corrective action plan are not permissible under the terms of the waiver.

But, even if this were permissible, CMS has not provided any substantive information to support its claim that the waiver won’t meet the coverage guardrail. The response by the state of Georgia shows the Acumen economic analysis cited by CMS is fundamentally flawed and ignored the state’s certified actuarial analysis, which the CMS Office of the Actuary previously determined was reasonable. 

Hopefully, the strength of the state’s response will finally settle this matter and keep CMS on track as a partner to ensure the successful implementation of the waiver. The Georgia Access Model would increase the availability of private health insurance plans offered to Georgians. 

Georgia has presented a strong argument why the Biden administration lacks the basis to deny the waiver and are proceeding accordingly. CMS should fully acknowledge the state’s plan and allow implementation.