The Wavering Waver

For a group that says it wants to increase healthcare access for all, the Biden administration has spent much of its early months in office trying to stymie reforms in Georgia.

Now, I’m sure that isn’t how the feds would describe their actions. But it’s the practical effect of working to block changes today, in hopes the state might do tomorrow what it declined to do yesterday.

I refer to the Biden administration’s twin moves – the most recent of which came this past Thursday – to block Gov. Brian Kemp from implementing the healthcare “waivers” approved just last year by the Trump administration. The maneuvers are based on some dodgy rationale.

First, back in February, Georgia learned its approved plan to create new access to Medicaid for some lower-income workers was in jeopardy of being un-approved.

You may recall that plan was to allow some Georgians who earn less than the poverty level (this year, that’s $12,880 for an individual) to gain health insurance via Medicaid. To be eligible, applicants would have a job or meet another qualification, such as job training or volunteer work. Roughly 50,000 people were expected to gain coverage.
Instead, the Biden administration wants Georgia to accept Medicaid expansion under the Affordable Care Act, aka Obamacare, and is holding up the agreement. The main justification offered was that the pandemic made it harder for Georgians to find work. Never mind that Georgia’s unemployment rate has fallen steadily and, at 4.3%, is now less than a percentage point higher than before the pandemic.

Then, this past week, another pillar of Georgia’s proposed healthcare reform was thrown into doubt.

This wavering waiver relates directly to Obamacare. Kemp had obtained approval to remove Georgia from the federally run health-insurance exchange and instead allow Georgians to shop for subsidized plans from a variety of private brokers and websites. This would put more options before consumers, including some non-subsidized plans that might be more affordable than subsidized ones. (A second part of the waiver, to subsidize the care of the sickest and costliest patients through a program known as reinsurance, was unaffected and remains on track.)

Again, the justifications for the Biden administration’s sudden change are questionable. For starters, there’s the assertion that enrollment by Georgians on the federal exchange was 11% higher for the 2021 plan year than for 2020.

While true, that figure masks the fact that the increase was wholly due to a higher rate of re-enrollment by people who had previously bought plans on the exchange; the number of new consumers enrolling actually declined for the fifth time in six years. So it’s not clear that is attracting more applicants. Another explanation is that the population that needs or wants these plans has simply stabilized.

The feds also point to data from a special, Covid-related enrollment period this spring, when more than 67,000 Georgians bought new plans. It’s possible that this higher enrollment reflects a greater appeal of plans that now offer more generous taxpayer subsidies because of the latest Covid relief bill.

But there are two problems with that. First, the new subsidies last only two years, whereas Georgia’s waiver would have lasted five. What’s more, the new subsidies may attract some additional buyers in the short term, but soon enough they’re likely to discover the same problem encountered by many consumers on Their premiums are cheaper on the front end, but in many cases their out-of-pocket costs are too high to make the plans worthwhile. That’s one of many remaining structural problems with the Obamacare plans, which Georgia’s waiver would have addressed by presenting consumers with a wider range of options.

The Kemp administration still has an opportunity to present evidence its waivers should move forward after all. But it’d be a lot better if the state and the feds could focus on the future, not re-litigating the past.

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