Georgia

A couple of weeks ago, Ariel Hart of the Atlanta Journal-Constitution reported that after over a decade of refusing to consider ACA Medicaid expansion for over 400,000 state residents, Georgia's Republican-controlled legislature may finally be warming up to the idea of embracing full expansion of the program:

For the first time in a decade, high-ranking Georgia GOP legislators on Thursday convened a meeting to hear testimony on full Medicaid expansion to all the state’s poor people.

At the hearing Thursday, the idea was floated over whether to expand Medicaid in exchange for a political deal to roll back regulations that restrict who can open a new health care business. Those regulations are called Certificate of Need, or CON.

For ten years, Georgia has remained one of the states which, frustratingly, has refused to expand Medicaid to all adults earning up to 138% of the Federal Poverty Level (FPL)...a bit over $20,000/year for a single adult; roughly $41,000/yr for a family of four.

If the state were to join most of the country, an estimated 434,000 Peach State residents would finally be able to enroll in comprehensive, nominal-cost healthcare coverage: Around 252,000 who earn less than 100% of FPL and another ~182,000 who earn between 100 - 138% FPL (the second batch 

After years of pressure, a few years back GOP Governor Brian Kemp kind of, sort of agreed to a partial expansion of Medicaid...with a pretty big caveat:

Over at Inside Health Policy, Dorothy Mills-Gregg has decided to check in on "Georgia Pathways," the Peach State's new program which partially expands Medicaid to residents earning up to 100% of the Federal Poverty Level (FPL), but with a rather significant string attached: Work reporting requirements:

As noted by Madeline Guth of the Kaiser Family Foundation last year:

...in spite of nearly every state which tried to (or succeeded in) implement Medicaid work requirements having their programs shut down by the courts, one state's work/reporting managed to survive: Georgia. As explained in the Kaiser article:

Georgia's health department doesn't publish their annual rate filings publicly, but they don't hide them either; I was able to acquire pretty much everything via a simple FOIA request. Huge kudos to the GA OCI folks!

Back in July, I compiled the weighted average requested rate changes for 2024 for both the Georgia individual and small group markets. At the time, individual market carriers were asking for rate hikes ranging from a relatively modest 6% (UnitedHealthcare) to a stunning 27.7% increase (Cigna). The weighted average came in at right around 15% even.

On the small group market, meanwhile, only around half the carrier filings were available at all, so I couldn't really run a proper average, although of those which had filed theirs, the average came in at 12.6%.

Earlier today I acquired the most recent rate filings for every carrier in both markets. I don't know for certain whether these are the final, approved rates for 2024, but it seems likely:

Back in February, I wrote about how the state of Georgia, in an eyebrow-raising move, announced that they were moving from the federal ACA exchange (HealthCare.Gov) onto their own state-based ACA exchange.

While numerous other states have already done the same thing (and several more are in the process of doing so as well), Georgia's move to their own enrollment platform was especially noteworthy for two reasons:

First, because it represents as complete 180-degree policy turn from their prior attempts (over the course of several years) to eliminate any formal ACA exchange (federal or state-based) in favor of outsourcing it to private insurance carriers & 3rd-party web brokers.

Secondly, because of the timeframe involved:

Back in February, I wrote about how the state of Georgia, in an eyebrow-raising move, announced that they were moving from the federal ACA exchange (HealthCare.Gov) onto their own state-based ACA exchange.

While numerous other states have already done the same thing (and several more are in the process of doing so as well), Georgia's move to their own enrollment platform was especially noteworthy for two reasons:

First, because it represents as complete 180-degree policy turn from their prior attempts (over the course of several years) to eliminate any formal ACA exchange (federal or state-based) in favor of outsourcing it to private insurance carriers & 3rd-party web brokers.

Secondly, because of the timeframe involved:

Georgia's health department doesn't publish their annual rate filings publicly, but they don't hide them either; I was able to acquire pretty much everything via a simple FOIA request. Huge kudos to the GA OCI folks!

Unfortunately, it looks like less than half of Georgia's small group market carriers have submitted their filings (alternately, it's conceivable that the other have have pulled out of the G small group market, though I highly doubt that). Only four of the eleven carriers offering policies in 2023 have filings included in the package sent to me by GA OCI. Not sure what that's about.

In any event, Georgia's individual market has grown dramatically over the past year (813,000 people vs. 660,000 a year ago), but the requested 2024 rate filings are pretty ugly, ranging from a somewhat reasonable 6.4% to as high as 27.7% for Cigna (ouch). The weighted average overall is just over 15% even.

During this springs Congressional kabuki theater regarding raising the federal debt ceiling, one of the biggest points of contention was House Republicans insistence on tying work requirements (w/stringent reporting) to Medicaid eligibility.

"Work requirements" is as old a saw for Republican politicians as "selling insurance across state lines," and it's just as ineffective and counterproductive (as well as simply being cruel). This debate has been held numerous times before, and the upside of such requirements has been debunked repeatedly, but here he go again:

As Joan McCarter of Daily Kos put it way back in 2015:

A few weeks ago, I reported that both Nevada and Oklahoma had placed insolvent insurance carrier Friday Health Plans under receivership, leaving just two states left to do so (North Carolina and Colorado, which happens to also be the home to Friday's corporate headquarters).

It turned out that I was correct about Oklahoma, but had jumped the gun slightly re. Nevada; the insurance commissioner had petitioned the court to put Friday into receivership, but hadn't actually done so yet.

Well, it turns out my error re. Nevada has been rendered moot as of yesterday; via the Nevada Division of Insurance:

JUNE 21, 2023 - Court orders receivership for Friday Health Plans of Nevada

FOR IMMEDIATE RELEASE – June 21, 2023

Back in February, I wrote about how the state of Georgia, in an eyebrow-raising move, announced that they were moving from the federal ACA exchange (HealthCare.Gov) onto their own state-based ACA exchange.

While numerous other states have already done the same thing (and several more are in the process of doing so as well), Georgia's move to their own enrollment platform was especially noteworthy for two reasons:

First, because it represents as complete 180-degree turn from their prior attempts (over the course of several years) to eliminate any formal ACA exchange (federal or state-based) in favor of outsourcing it to private insurance carriers & 3rd-party web brokers.

Secondly, because of the timeframe involved: