Peach Pulse: July 6, 2012

Special Post SCOTUS Edition


Last week, the United States Supreme Court upheld the constitutionality of the Affordable Care Act, a major victory for health care consumers in Georgia and across the country. Now, all eyes turn to the states for implementation of two of the most critical pieces of the law: the expansion of the Medicaid program and the establishment of health insurance exchanges.


The Medicaid Expansion
The Affordable Care Act (ACA) expands the Medicaid program by creating a new eligibility category for people with incomes at or below 133% of the federal poverty level (approximately $14,856 for a single adult or $25,389 in annual income for a family of 3). While the ACA, as written, made this expansion mandatory for states, the Supreme Court ruled that it was effectively optional for states. Because a large portion of Georgia’s uninsured population stands to gain coverage only if Georgia moves forward with the Medicaid expansion, it is critically important that state policymakers implement this piece of the law. Here is what you need to know about the Medicaid expansion:

  • If the state does not expand Medicaid, approximately 684,000 Georgians who would have gained coverage through the Medicaid expansion would likely remain uninsured.
  • The Medicaid expansion is financed entirely with federal dollars in the first three years and 90 percent federal dollars thereafter. This means that, for every ten dollars Georgia invests in Medicaid, the state will draw down ninety dollars in federal funds, a major infusion of resources into the state’s health care delivery system.
  • The Affordable Care Act provides substantial tax credits for people with incomes between 100% of the federal poverty level and 400% of the federal poverty level to help purchase private health insurance. Because the law envisioned people with incomes below 100% of the federal poverty level obtaining health care coverage through Medicaid, these low-income Georgians will not be eligible for tax credits and will be without any affordable options for health insurance unless the Medicaid expansion is implemented.

Georgia policymakers have an unprecedented opportunity to improve the health of Georgia consumers and communities, address the state’s high number of uninsured, strengthen our state’s health care delivery system, and bolster the state’s economy by moving forward with full implementation of the Medicaid expansion authorized by the law.

Health Insurance Exchanges
The Affordable Care Act (ACA) authorizes state-level health insurance exchanges for individual consumers and for small businesses. States can choose to design and implement their own exchanges within the basic framework outlined by the ACA or they can opt for a federally facilitated exchange. Governor Deal and key legislators have not yet announced a decision on which route Georgia will take.

Below is a summary of Georgia’s work and progress to date on making this choice:

  • In June 2011, Governor Deal issued an executive order establishing an advisory committee to study the issue and report back at the end of 2011. The committee’s final report did not recommend moving forward at that time with a state-based exchange due to uncertainty pending the Supreme Court decision.
  • The Governor’s Health Insurance Exchange Advisory Committee did, however, conduct considerable research on the issue. All materials from the committee’s work are housed here.
  • At the federal level, the U.S. Department of Health and Human Services recently announced a new round of funding opportunities for states and has released considerable guidance for states on exchanges.

A health insurance exchange is an exciting concept for consumers. Put simply, it’s a one-stop shop where consumers can access tools and information to select an insurance plan that best meets their needs and can apply tax credits to ensure that plan is affordable.

Now that the Supreme Court has ruled, it is an ideal time for Georgia policymakers and stakeholders to ramp up planning to ensure Georgia consumers have affordable health insurance options available to them through an exchange by 2014. It is also critical that policymakers weigh consumer input throughout the process to ensure the exchange works for Georgia individuals and families who plan to use it to secure meaningful health coverage.

Georgians for a Healthy Future released an issue brief in August 2011 providing additional information and recommendations around designing a consumer-friendly exchange. Georgians for a Healthy Future’s Executive Director, Cindy Zeldin, also served on the Governor’s Health Insurance Exchange Advisory Committee and submitted a minority report advocating for Georgia to move forward right away in building an exchange. The issue brief is available for download here and the minority report is available for download here.

If you or your organization would like to engage in advocacy on either or both of these issues on behalf of Georgia consumers, please contact Amanda Ptashkin, Georgians for a Healthy Future’s Outreach & Advocacy Director, to get involved.