Leverage 1332 Waivers to Make Healthcare More Affordable

The Affordable Care Act of 2010 has made healthcare more affordable for Georgians by creating small and individual group markets. Nearly 800K people in Georgia access their health insurance through the ACA Marketplace. Back in 2010, the uninsured rate in the state was 20 percent but it dropped to 13 in 2017.

It’s a significant accomplishment seeing individuals and families that didn’t have insurance before being able to buy coverage through ACA. But not everyone is eligible for assistance, and Georgia is still the fourth-highest uninsured rate. Unfortunately, cuts to outreach programs it’s making it somewhat difficult to get people enrolled. Some simply can’t keep their coverage or afford to enroll due to the rising premiums and deductibles. Federal health could be the answer as it helps eliminate some of the current challenges.

In 2019, the Georgia Legislature passed legislation to allow the state to consider two kinds of health care waivers. The 1332 waiver is linked directly to the marketplace while the 1115 waiver is focused on Medicaid.

Several states have successfully used 1332 waivers to fund programs that will reduce premiums in the individual market. Yet under new federal guidance, some states may pursue policies that could be harmful. Georgia can take a step to improve health by using the 1332 waiver to lower premiums in the individual marketplace, provide financial and outreach support so that individuals that make less can afford healthcare, and strengthen the market so that plans cover essential health benefits.

Background on the Patients First Act

The Patients First Act (Senate Bill 106) was passed on March 25, 2019. The first portion of the bill allows the state’s health agency to submit an 1115 waiver to advise changes to Medicaid. The second portion of the bill authorizes the governor to submit one or more 1332 waiver requests. This part of the bill is used to make changes to the small group and individual markets under the Affordable Care Act. The bill doesn’t mention any requirements about what must be included in the 1332 waiver, but it specifies what the states are expected to do with the waiver, including reinsurance programs, any changes to the premium tax credits, and the redefinition of benefits. The state is authorized in the bill to implement 1332 waivers on January 1, 2020, or thereafter once approved. While the bills were intended to work together, they will have independent processes for submission.

Affordable Care Act’s Section 1332 Waiver

The Section 1332 waiver will let the state change some regulations linked to both the small group and individual insurance market. The waiver plan must cover a similar number of people as would be covered without the waiver, and the coverage must be affordable as it would be without the 1332 waiver. Businesses with 100 or fewer employees can buy plans from the small group insurance market. Presently, there are about 350,000 Georgians in the small group market. The individual marketplace can be found online. So far, nearly 450,000 Georgians have purchased their health insurance through the marketplace.

In a nutshell, the Patients First Act was intended for the 1332 waiver and 1115 waiver to work together so that the needs of Georgians below the poverty level are addressed. These individuals should be covered under the full Medicaid expansion. However, since the expansion is not financially viable, Governor Kemp’s team is more interested in the 1332 waivers. Overall, Georgia lawmakers are working to create a plan that increases access to care and promotes better health by following recommendations for the 1332 waiver.

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