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For the first time in Georgia, there is widespread and bipartisan agreement among Georgia’s Governor and legislative leaders about the pressing need to provide health insurance to more Georgians. To address the state’s rising uninsured rate, Governor Brian Kemp has put forth a bill, SB 106 (also called the Patients First Act), that would allow the state to submit two kinds of health care waivers:

• A Medicaid 1115 waiver that could be used to extend coverage to more low-income Georgians, among other reforms; and
• 1332 State Innovation waivers that would make changes to Georgia’s private health insurance marketplace.

(Waivers allow a state to set aside or “waive” certain requirements imposed by the federal government and try new models of providing health coverage and care.)

While the legislation’s goal to extend affordable, quality coverage to more Georgians is one with which GHF wholeheartedly agrees, the bill currently falls short by limiting the number of people who would benefit, increasing the likely costs to the state, and leaving to door open to an erosion of critical consumer protections.

SB 106 limits a future 1115 Medicaid waiver to cover only adults making up to 100% of the federal poverty line (FPL) ($12,490 for an individual and $21,330 for a family of three per year). While this would cover 240,000 more Georgians than are currently eligible for Medicaid, the cut-off leaves out an estimated 200,000 uninsured Georgia adults making just more than poverty-level wages (up to 138% FPL). These Georgians make up to $17,296 for an individual and $29,435 for a family of three.

The Affordable Care Act envisioned that all adults making up to 138% FPL would be covered by Medicaid and provides states with an incentive to do so. States that extend coverage to these newly-eligible adults pay only 10% of the costs and the federal government picks up the rest (90%) in perpetuity.

If Georgia’s leaders approve SB 106 in its current form and leave out the adults just above the poverty line, our state will miss out on the ACA’s “enhanced match rate”. Wisconsin is the only other state that has opted to take this route, and as a result, has paid $1.1 billion more to cover 80,000 fewer people.

A small change to the language in SB 106 would give the state the flexibility to increase coverage to people up to 138% FPL, allowing the state to cover an estimated 440,000 Georgians at a lower cost.

The second part of SB 106 allows Georgia to submit at least one 1332 State Innovation waiver. These innovation waivers were created by the ACA to allow states to test different approaches for providing primarily private health insurance to their residents. At the same time, the law established “guardrails” for 1332 waivers to ensure consumers were sufficiently protected. Unfortunately, these guardrails have been greatly weakened in recent months leaving consumers at risk.

So far, all eight states with approved 1332 waivers have carried out plans that benefit consumers—and Georgia could too. However, the broad language in SB 106 as currently written allows for proposals that could also create sizable and risky changes that harm consumers. For example, Georgia could allow the ACA’s financial help that is now available to consumers to buy coverage to be used instead for the purchase of junk insurance plans. This would likely draw healthy consumers out of the ACA Marketplace to cheaper, low-quality plans and send insurance premiums into an upward spiral for consumers with pre-existing conditions who need comprehensive coverage.

Georgia’s legislators could narrow the scope of allowable 1332 waivers by specifying that the waiver must be used for a specific beneficial reason, like establishing a reinsurance system to lower insurance premiums, or by laying out a set of principles that the waiver must meet to ensure Georgia consumers are fully protected. (GHF’s Executive Director proposed a set of consumer-friendly principles when she testified to the Senate Health & Human Services Committee in February.)

Georgia’s leaders have taken an encouraging step forward by proposing changes to state law that aim to increase access to care and address affordability concerns for Georgia families. A few small, meaningful changes to SB 106 would assure a path to affordable, quality health coverage exists for all Georgians.

Want to learn more? Here are a few resources that you may find helpful:

• Georgia Left Me Out fact sheet
• Understanding Medicaid in Georgia and the Opportunity to Improve It: A chart book
• What you need to know about waivers and Medicaid expansion by Georgia Watch
• What you need to know about 1332 waives and Georgia’s health insurance marketplace
• Getting Georgia Covered: What we can learn from consumer and assister experiences during the fifth open enrollment period

Follow changes and updates about SB 106 in GHF’s weekly legislative update emails.