On December 23, 2019, the Georgia Department of Community Health (DCH) submitted Governor Kemp’s 1332 private insurance proposal to federal health officials.

The plan consists of two parts:

1. A reinsurance program to lower premiums; and
2. A dramatic erosion of the ACA’s rules and structures, including provisions that privatize insurance enrollment; cap the financial assistance available to low- and middle-income consumers; and erode consumer protections in private insurance

DCH’s submission of the proposal to the Centers for Medicare & Medicaid Services (CMS) comes after a 30-day public comment period, during nearly 1000 Georgians weighed in with their opinions on the plan. Despite the overwhelming opposition to the second part of his plan, Governor Kemp and DCH sent the proposal to federal officials with no meaningful changes.

On February 5, 2020, Governor Kemp wrote a letter to requesting that the reinsurance program be considered separately from the second part of his proposal, and that CMS’s consideration of the second part of the plan be paused. CMS responded to Governor Kemp on February 6 in a letter that deemed the reinsurance program application complete and requested more information about the remaining parts of the Governor’s proposal.

CMS’s response began a 30-day public comment period on the proposed reinsurance program, allowing Georgians, health advocates, and any other interested party to weigh in.

GHF, along with several partner organizations, submitted a comment communicating our support of the reinsurance program, while noting our deep concerns about the remainder of the Governor’s proposal. You can read the full comment letter here.

Sean “Saifa” Wall is an Atlanta-based intersex justice activist. He is currently enrolled in a health plan with Ambetter through the Affordable Care Act’s health insurance marketplace (also called healthcare.gov).

As an activist, Saifa’s income is generated exclusively through contractual work, which means that his employers do not provide health benefits. He talks to people about issues that affect the intersex community. He also serves as a public health researcher that consults with racial justice and domestic violence organizations.

Saifa enrolled in coverage in 2016 with the help of a GHF health insurance navigator after being uninsured for over two years. (He was also able to purchase dental coverage.) Saifa pays a premium of $63 per month after a $500 tax credit helped to lower his costs. His coverage allows him access to hormone therapy and behavioral health services, among other essential health benefits. He loves his medical provider and receives high quality treatment as an intersex person who is hormone dependent.

Saifa was recently diagnosed with osteopenia, which means his bones aren’t as dense as they need to be to prevent breaks and other injuries. Saifa will need comprehensive medical care as he works to build bone mass; much or all of that care will be covered by the comprehensive insurance plan he purchased through the ACA.

Like Saifa, 450,000 Georgians rely on the ACA marketplace to access comprehensive, affordable health coverage. Many more Georgians are eligible for marketplace coverage but remain uninsured for a variety of reasons.

Georgia’s new law, called the Patients First Act or SB 106, may bring changes to private health insurance in the state but Georgia leaders have not yet spelled out what changes they plan to seek. An effective way to use their new flexibility would be to maintain the protections and financial help that Georgia consumers enjoy while building a “reinsurance program” to bring down premiums for everyone. (This approach has been successfully tried in seven other states.) If premiums fall or remain steady, this could attract more Georgians to the marketplace and get more people covered.

When Saifa was asked what he would tell legislators about having health coverage, he replied: “As an intersex activist, I believe health care is a human right.” While this belief isn’t yet reflected in Georgia’s state health laws, the ACA allows consumers like Saifa to take advantage of comprehensive, affordable coverage options and protections from discrimination in the health system, among many other advances.