Georgia enrollment update
480,912 people enrolled in private health insurance plans through the Georgia exchange during open enrollment for 2018 coverage. Open enrollment ended on December 15, 2017, but Georgia residents actually had until December 31 to enroll, using the special enrollment period (SEP) that applied to some states that were hit hardest by the 2017 hurricane season. The enrollment report was current as of December 23, although there were certainly people who dropped their coverage after that date, as well as others who enrolled in the final week of December using the hurricane-related SEP.
Georgia insurance overview
For 2018, the Affordable Care Act remains in effect. That means the individual mandate still applies, as do the rest of the ACA’s provisions. The GOP tax bill that was enacted in December 2017 will eventually repeal the individual mandate, but that doesn’t take effect until 2019. People who are uninsured in 2018 will face a penalty when they file their taxes in early 2019, unless they’re eligible for an exemption from the penalty.
Georgia’s health insurance exchange offers individual plans from four carriers for 2018 — a noticeable reduction from nine carriers in 2016, but only one fewer than the five insurers that offered plans in 2017. Humana was the only insurer to leave Georgia’s market at the end of 2017. Humana exited the ACA-compliant individual market at that point in all of the states where they still offered plans in 2017. But they had already scaled back their participation at the end of 2016, and In Georgia’s exchange, Humana plans were only available in Atlanta, Columbus, Macon, and Savannah in 2017.
Georgia has not expanded Medicaid under the ACA, so 240,000 people with income below the poverty level are in the coverage gap in the state — ineligible for Medicaid, and also ineligible for premium subsidies in the exchange.
Georgia health ratings
The state of Georgia has not fared particularly well in recent state health rankings, in part due to issues such lack of health insurance and poor dental healthcare.
The Peach State placed 41st in overall health among the 50 states and DC in the Commonwealth Fund’s 2017 Scorecard on State Health System Performance, which was an improvement of four spots from the state’s 45th ranking in the previous edition of the Scorecard.
The state ranked in the bottom quartile on four of the five main metrics analyzed, including Access & Affordability, Prevention & Treatment, Healthy Lives, and Equity. But the state ranked in the second quartile for Avoidable Hospital Use & Cost. See Georgia’s scorecard for more details about its ranking on individual health indicators.
Georgia also ranked 41st in the 2017 America’s Health Rankings, down one spot from 40th in the 2015 edition of the ranking. The state performed in the top quintile for pertussis cases and excessive alcohol use, and was ranked 12th in terms of drug deaths, but fared much worse — in the bottom quintile —for physical inactivity, percentage of children living in poverty, and the overall uninsured rate, which was 47th in the nation (due in large part to the state’s refusal to accept federal funding to expand Medicaid.
While the data is not summarized into an overall score, the 2016 edition of Trust for America’s Health scores a range of individual public indicators; see Key Health Data About Georgia.
Finally, you can review county-by-county health rankings for Georgia from the Robert Wood Johnson Foundation and the Population Health Institute at the University of Wisconsin.
How has Obamacare helped Georgia?
Most states that have successfully reduced their uninsured population through the Affordable Care Act have implemented a state-run or partnership exchange and/or expanded Medicaid. Georgia has done neither of these things, which is typically an indication of opposition to the ACA.
The state’s uninsured rate has seen moderate decline from 2013, just before Obamacare plans took effect. Through 2016, the percentage of Georgia residents without health insurance dropped 5.9 percentage points from 18.8 to 12.9 percent (about a 31 percent decrease), according to US Census data. In the same timeframe, the nation’s uninsured rate went from 14.5 to 8.6 percent (nearly a 41 percent decrease).
2018 exchange rates, health insurance carriers
Georgia’s exchange has plans available from four insurers for 2018:
- Blue Cross Blue Shield of Georgia:
- Kaiser Permanente:
- Ambetter from Peach State Health Plan:
With the exception of Kaiser, all of the insurers added the cost of cost-sharing reductions to their silver plan premiums for 2018 (the Trump Administration eliminated funding for CSR in October 2017, just a few weeks before the start of open enrollment for 2018 coverage; insurers are still required to provide CSR benefits to eligible enrollees, but most insurers across the country have added the cost of CSR to silver plan premiums. This has resulted in larger premium subsidies for most enrollees, since subsidies are based on the cost of the benchmark silver plan).
Due in part to the addition of the cost of CSR to silver plan premiums, average premium increases for BCBSGA, Ambetter, and Alliant were all more than 50 percent. Kaiser’s rate increase was still steep, at nearly 31 percent. Premium subsidies climbed commensurately for 2018, keeping coverage affordable for people who are eligible for subsidies. But people who aren’t eligible for premium subsidies are facing sharply higher premiums in 2018.
Georgia and the Affordable Care Act
Georgia politics are dominated by Republicans at the federal and state levels, and the Affordable Care Act has generally been deeply unpopular with local lawmakers.
When the Senate voted on the Affordable Care Act on Christmas Eve, 2009, Republican U.S. Senators Saxby Chambliss and John Isakson both voted against the bill. Isakson is still in the Senate, and the current Junior Senator, David Perdue, also a Republican, is opposed to the ACA. Both men voted in favor of repealing the ACA in 2017, although the only measure that Republicans were ultimately able to pass was repeal of the individual mandate starting in 2019.
In the House, seven Georgia Republican and two Democratic representatives voted against the ACA in 2010, while four Democratic representatives voted yes. As of 2018, Georgia’s House delegation includes four Democrats and ten Republicans. During the 2017 legislative session, Representatives from Georgia were split along party lines in terms of their votes for or against ACA repeal.
At the state level, Gov. Nathan Deal and Insurance Commissioner Ralph Hudgens stand out as two of the law’s harshest critics. Georgia defaulted to the federally facilitated health insurance marketplace and did not expand Medicaid. Georgia was among the states that imposed restrictions on navigators, who were intended to help consumers enroll in the marketplace.
During its 2014 session, the Georgia Assembly passed laws that prohibit the establishment of a state-run marketplace, disallow the use of taxpayer money for navigator programs, and forbid government employees from advocating for Medicaid expansion.
Georgia’s decision against Medicaid expansion leaves 240,000 individuals in the coverage gap, meaning they don’t qualify for either Medicaid or the ACA’s premium subsidies to help offset the cost of private insurance.
Despite the state’s lack of Medicaid expansion, Georgia Medicaid enrollment has increased 15 percent from 2013 to November 2017. But nationwide, including the states that have expanded Medicaid, enrollment in Medicaid and CHIP has grown by 29 percent.
Georgia’s Medicaid program is not open to non-disabled adults without dependent children, and is only available for parents of dependent children if their household income doesn’t exceed 34 percent of the federal poverty level. For perspective, 34 percent of the poverty level for a family of three works out to about $579/month in total household income (this chart shows various percentages of the poverty level at different family sizes in terms of total annual income)
Visit the Georgia Department of Community Health website for information about Georgia’s Medicaid programs.
Other ACA reform provisions
The ACA’s Consumer Operated and Oriented Plan (CO-OP) Program encourages the creation of nonprofit, consumer-run health insurance issuers Twenty-three CO-OPs received funding in the form of loans totaling $1.98 billion, and all but four have folded. No CO-OP plans were created in Georgia, so the struggles that the program has faced have not impacted Georgia.
Medicare in the state of Georgia
Georgia Medicare enrollment reached 1.5 million in 2015, about 15 percent of the state’s population compared with 17 percent of the total U.S. population enrolled in Medicare. Historically, in Georgia, 81 percent of Medicare recipients qualify based on age alone while 29 percent qualify for Medicare as the result of a disability.
Georgia Medicare beneficiaries may choose a Medicare Advantage plan instead of original Medicare as a way to gain additional benefits. 34 percent of Georgians enrolled in Medicare have selected a Medicare Advantage plan instead of a traditional Medicare plan, which is very much in line with the national average of 33 percent.
State-level reform in Georgia
Here’s what’s happening at the state level with healthcare reform in Georgia: