Georgia is asking the federal government to greenlight a new financial assistance program for people with an Affordable Care Act Plan.
The request comes in the form of a waiver amendment to the state’s reinsurance program and would need to be approved by the Centers for Medicare and Medicaid. State officials from the Office of the Commissioner of Insurance and Safety Fire are asking for an implementation date in time for open enrollment in late 2027.
Right now, most people shopping for an Affordable Care Act plan choose from monthly premiums that reflect federal subsidies paid to insurance providers to lower costs.
Credit: Ellen Eldridge/GPB News
Under Georgia’s new plan, those shopping during open enrollment would instead see the full cost of a premium, and once enrolled, the state would deposit money every month into a special account for subsidy-eligible Marketplace enrollees. That money would be designated for premiums, and anything left over could be applied to some health expenses, similar to a health savings account.
The state is hoping to increase transparency, according to its proposal sent to CMS, and to give Marketplace enrollees better control over their monthly spending.
But health policy analyst Whitney Griggs with the nonprofit Georgians for a Healthy Future worries this might complicate enrollment.
“It’s a lot of onus on the consumer,” she said. “The risk that this places for folks to not know how something works, or to suddenly be overburdened with trying to enroll in health insurance, is pretty high.”
Griggs said it’s also possible that people would be tempted to enroll in a cheaper plan with a higher deductible, in order to save money for other health expenses. And because the waiver amendment would terminate the state’s Navigator Program, it may be harder for people to find nonpartisan, independent assistance when looking for a Marketplace plan.
Georgia has one of the highest rates of people without health insurance, compared to national figures.
Just over 90% of Georgians with a Marketplace plan received a subsidy in 2024. At that point, enrollment peaked at 1.3 million people, and reached 1.5 million the following year.
But after Congress allowed for the expiration of enhanced premium tax credits, an estimated 5 million Americans either dropped or were disenrolled from their Marketplace plans. Stateside, Georgia saw a 12% decrease in enrollment. That’s about 180,000 people who dropped their plans.
Instead of basing subsidy amounts on the rising cost of premiums, Georgia’s insurance office is proposing tying them to a standard rate of medical inflation. It says that will ensure predictability for consumers.
To implement the program, the state would use the federal pass through dollars it already receives for subsidies under the current model to cover the cost of the tax credits and additional administrative costs. Over $100 million in state funds set aside for reinsurance will remain in place.
Virtual public comment on the state’s proposal runs through Nov. 13, with some opportunities for live comment.
