Nov 1, 2019

How Georgia plans to radically reshape its individual health insurance market

Georgia Gov. Brian Kemp Photo: Kevin C. Cox/Getty Images

Georgia Gov. Brian Kemp released a set of waiver proposals yesterday that would remake the individual market, the Atlanta Journal-Constitution reports.

Between the lines: Kemp's proposal — which must be approved by the federal government — would move more control over ACA dollars to the state while attempting to lower premiums in the individual market.

Details: Controversially, the exchange market would be brought under state control, including how subsidies are structured and distributed. Plans would no longer have to cover all of the ACA's essential health benefits for enrollees to receive subsidies.

  • Small business employees whose employers give them a bonus to buy health insurance would also be eligible for subsidies.
  • The plan also creates a $300 million dollar reinsurance program, which would compensate insurers for high-cost claims that contribute to higher premiums.
  • Georgians would no longer use healthcare.gov to enroll in ACA plans. Instead, those who try to use the site would be routed to a page with options —including private web brokers that could sell skimpier plans.

What we're watching: This is only step one. Kemp is expected to detail on Monday another waiver proposal that could lead to a limited Medicaid expansion, per AJC.

On the other hand, Indiana announced yesterday that it's temporarily halting its Medicaid work requirements because of a lawsuit, per the Wall Street Journal.

  • Arizona has also delayed the program, and other states are reviewing their work requirements.

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Georgia will try partial Medicaid expansion

An Atlanta emergency room in 2006. Photo: Jonathan Torgovnik/Getty Images

Georgia Gov. Brian Kemp — a Republican — released Monday his plan for a partial Medicaid expansion, with work requirements attached. It will apply for partial expansion if the initial request is rejected.

The big picture: If the waiver is approved, Georgia would be the first state with work requirements built into its expansion. Other states have tried to retroactively apply work requirements.

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Grieving widow's slide into depression leads to $22K hospital bill

A grieving widow's slide into depression landed her in a hospital for five nights, which then turned into a $29,894.50 medical bill that her insurance didn't cover, Kaiser Health News reports with NPR. The bill was then reduced to $21,634.55 because her insurance didn't cover mental health care.

Why it matters: The woman had an association health plan. Her story illustrates how these plans can backfire on patients.

Go deeperArrowNov 1, 2019

Tennessee becomes the first state to ask for Medicaid block grants

Tennessee Gov. Bill Lee. Photo: Terry Wyatt/Getty Images

Tennessee is formally asking the Trump administration today to transform its Medicaid program into a block grant — the first real test of an idea that has captivated conservatives for years.

Why it matters: Tennessee's request will test the bounds of what the Trump administration can do on its own, as it seeks to overhaul the Medicaid program. And if it’s successful, it would usher in a new model for a program that covers some 75 million people.

Go deeperArrowNov 20, 2019