Over the weekend, the Centers for Medicare & Medicaid Services (CMS) approved a harmful policy waiver in Georgia that will limit residents’ access to information about their health care options. This approval comes despite widespread alarm about the dangers the waiver would pose for thousands of Georgians. The Medicare Rights Center, along with over 1,800 other individuals and organizations, submitted comments in opposition to this waiver in September, while the Trump administration received a total of eight comments in support.
The waiver, called a 1332 waiver, is not legally permissible if it will lessen coverage. For various reasons, the Georgia waiver is likely to do just that, and neither CMS nor the state have provided a convincing argument otherwise. Georgians can currently see their individual insurance options by using HealthCare.gov. This one-stop shop gives unbiased information about Affordable Care Act compliant plans and triggers Medicaid referrals for people with low incomes. Georgians have always been free to use insurance brokers and agents, but in 2020 most people (79%) chose to use HealthCare.gov for its ease and objective information.
Starting in 2023, Georgians’ access to HealthCare.gov will be taken away, and the website will not be replaced by any publicly available, unbiased source for information. They will, instead, be forced to rely solely on brokers and agents, an often less popular, less accessible, and less convenient option that risks bias and conflicts of interest. CMS and the state argue, without support, that having less access to information, no single source of high-quality information, and fewer ways to enroll will increase enrollment rather than decreasing it.
The reliance on agents and brokers is risky for enrollees. Unlike HealthCare.gov, these entities can have incentives to steer people into specific plans, including “junk” plans that do not cover pre-existing conditions and do not meet other quality requirements for inclusion on the HealthCare.gov marketplace. These brokers may also be less likely to help people connect with Medicaid.
Perhaps most importantly, Georgians will likely be confused about where to turn. Instead of a one-stop shop, they will face a fractured market. This could lead to many people being overwhelmed and unsure what to do. In our experience, it is important for people to have a single, clear, unbiased source of coverage information, not a jumble of biased sources.
In response to these concerns, Georgia argues that they will do statewwide outreach and will streamline Medicaid eligibility. These are good policies, in theory, but they should already be in place, used in conjunction with HealthCare.gov rather than as a replacement. Advocates have long urged states to do more to educate and inform residents about their health coverage options and to ease enrollment into Medicaid.
This is a very disappointing decision from CMS and Georgia. Comments on the waiver reveal overwhelming opposition and demonstrate how the application failed to adhere to the legal requirements of a 1332 waiver. Litigation appears likely.