The Trump administration has taken a step to weaken the Affordable Care Act in a key battleground state, with only weeks to go until Election Day as well as Supreme Court arguments that could determine the landmark law’s future.
The administration this week approved Georgia’s waiver request to provide Medicaid coverage to certain low-income residents if they work or participate in other qualifying activities for at least 80 hours a month. It’s the latest state to receive permission to require work as a condition of coverage, though implementation elsewhere has been halted by federal courts or state officials.
Also, the Centers for Medicare and Medicaid Services announced it had completed its review of Georgia’s more controversial request to make fundamental changes to the state’s Affordable Care Act exchange. The agency, which opened the door for states to create alternatives to Obamacare in 2018, is still finalizing the terms for approval.
The Peach State, which has the nation’s third highest uninsured rate at 13.4%, is the first to seek this enhanced power to reshape its individual market.
Georgia and federal officials say that these efforts will make coverage more available and affordable to residents, but consumer advocates say they are the latest attempts to undercut the law.
“It’s a road map of what they would allow were the ACA to be struck down and were they to win election again,” said Judy Solomon, senior fellow at the Center on Budget and Policy Priorities.
These moves come as health care takes center stage in the 2020 presidential campaign. Former Vice President Joe Biden’s campaign has hammered Trump for trying to take down the landmark health reform law and its protections for those with pre-existing conditions. Trump has repeatedly said he has a replacement plan that would continue those safeguards but has yet to produce one.
Also, Trump’s Justice Department is backing a coalition of Republican-led attorneys general, who argue that Obamacare’s individual mandate was rendered unconstitutional after Congress reduced the penalty for not having insurance to zero as part of the 2017 tax cut law. As a result, the entire health reform law must fall, they argue. The Supreme Court will hear oral arguments in the case on November 10.
The administration has pursued multiple avenues to overturn the Affordable Care Act in its first term. After efforts to repeal the law in Congress failed in 2017, officials started undermining it from within, including shortening the annual enrollment period to obtain coverage on the exchanges and slashing the budget for outreach and assistance. It also broadened the availability of alternative plans, primarily short-term health insurance policies that typically have lower premiums but are allowed to base coverage and premiums on people’s medical histories.
Also, officials took the unprecedented step in 2018 of allowing states to institute work requirements in Medicaid, a longtime Republican goal. However, the effort has been set aside by federal courts in four states, prompting the six others that had received approval (prior to Georgia) to stop implementation. Another eight states are awaiting permission from the Centers for Medicare and Medicaid Services.
What Georgia wants to do
Georgia is not looking to expand Medicaid under the Affordable Care Act. The waiver only applies to those earning up to the poverty level, or $12,760 for an individual. Many will also have to pay monthly premiums.
The federal approval also allows the state to pick up part of the tab for employer coverage if eligible residents have access.
Implementation will begin July 1. Nearly 65,000 Georgians will gain coverage, according to state estimates.
Nearly 650,000 residents could enroll if the state fully expanded Medicaid to those earning up to 138% of the poverty level, according to an Urban Institute estimate, which does not take into account changes wrought by the coronavirus pandemic.
The administration did not approve the state’s request to receive the more generous federal match that comes with full Medicaid expansion.
Georgia is also seeking to make two changes to its individual market. It is looking to implement a reinsurance program, which typically reduces premiums by protecting insurers from high-cost patients. More than a dozen states have received federal approval to do this.
But the Peach State also wants to shift the platform used for enrollment in the Affordable Care Act individual market from the federal exchange, healthcare.gov, to a private sector one called the Georgia Access Model in 2023.
State officials argue that the move will give residents access to a broader array of options from web brokers, health insurance companies and traditional agents. Advocates, however, fear that it could shift healthier people to less comprehensive, non-Obamacare plans and leave those with pre-existing conditions facing higher premiums for Affordable Care Act policies.