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Inside Georgia’s latest attempt to change how people access Obamacare

In Georgia, a new health insurance proposal could upend the Affordable Care Act exchange. While proponents see the changes as a way to increase health insurance enrollment, critics warn that tens of thousands of Georgians could lose healthcare coverage. NewsHour Weekend's Christopher Booker reports.

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  • Hari Sreenivasan:

    Healthcare is almost always a top issue for voters, and this year, as the U.S. remains the center of the coronavirus pandemic, access to health insurance has taken on even more importance.

    Georgia has had more than 300,000 confirmed coronavirus infections and 6,900 deaths. It's also a state with one of the highest rates of uninsured people in the country.

    In response to so few people being covered, state officials are trying to change the way Georgians find health insurance under the Affordable Care Act or Obamacare. But will the proposal, which needs approval from the federal government, help more Georgians get covered or have the exact opposite effect?

    As part of our ongoing "Roads to Election 2020" series, NewsHour Weekend's Christopher Booker has the story.

  • Christopher Booker:

    When Steven Crayne thought about starting his own web design business seven years ago, after a career in merchandising and marketing, one of the biggest concerns was health insurance.

  • Steven Crayne:

    And I was always deathly afraid of it because, one, you know. You know, I need healthcare benefits.

  • Christopher Booker:

    Over the past four years, the 62-year-old, who lives in Gainesville, Georgia, has had skin cancer removed from his face twice. He's on routine medication for underlying health conditions and he provides health insurance for his wife and son.

    So when Crayne launched his business in 2014 he eventually started looking to get insurance on his own. He turned to the federal marketplace created by the Affordable Care Act or ACA the 2010 healthcare law commonly known as Obamacare. He was nervous, though, since all he had heard were negative things about the marketplace.

  • Steven Crayne:

    So when I called ACA, I was like, wow. They were really, really helpful. We went through the deductibles and everything. And together we found the right plan.

  • Christopher Booker:

    So it came as a shock to Crayne when he found out via a tweet only last month that the state of Georgia was trying to change how people access health insurance under the ACA.

  • Steven Crayne:

    When I first saw it, I was like, what? I didn't hear anything about it. It was like, completely blindsided, OK. And, you know, that was scary. OK. And I was like, well, what is it?

  • Christopher Booker:

    What it is is a set of two proposals that were submitted to the federal government in July for approval. The proposals would, one, create what's called a reinsurance program to help offset the cost of policyholders with high medical bills. The second and more contentious initiative would eliminate access to the federal healthcare marketplace, Healthcare.gov. Instead, Georgians shopping for healthcare coverage would be steered to private brokers and insurance websites in what's called the Georgia Access Model.

    Georgia Governor Brian Kemp's administration declined PBS NewsHour Weekend's interview request.

    But in the states' application, it contends that moving to this more decentralized model could increase enrollment in health insurance by 25,000 people in five years, through "improved customer service, outreach, and education provided by the private market."

  • Laura Colbert:

    The estimates that the governor's plan will increase the number of Georgians who choose to enroll in private health insurance are frankly a little unbelievable.

  • Christopher Booker:

    Laura Colbert is Executive Director at Georgians for a Healthy Future, a non-profit consumer health advocacy organization.

  • Laura Colbert:

    The transition from one system to another is going to be difficult, even for consumers who know it's happening. We know that not all consumers will know that this change is taking place. So some of those consumers are going to need to catch up. Some of them may not get through the process at all. It's much more likely that consumers are going to become uninsured in this process rather than having more consumers brought into the private insurance system.

  • Christopher Booker:

    The Kemp administration's proposal argues that moving away from the federal marketplace will give Georgians more options for healthcare plans at lower prices. But opponents argue that the cheaper plans that Georgians may be steered to by a broker or insurance website may not cover pre-existing conditions and all of the essential health benefits that the ACA plans do.

  • Tara Straw:

    Nearly all of these plans exclude pregnancy care. Many exclude mental health. Some exclude prescription drugs.

  • Christopher Booker:

    Tara Straw is a senior policy analyst with the Center on Budget and Policy Priorities.

  • Tara Straw:

    Consumers have become accustomed to the idea that their health insurance is going to cover pre-existing conditions and important health benefits. And so consumers don't know that they may have been hoodwinked into plans that don't offer comprehensive coverage.

  • Christopher Booker:

    Straw authored a report earlier this month that estimates that tens of thousands of Georgians could lose access to health insurance under the Kemp administration's proposal and that ending access to the ACA's exchange will also reduce access to Medicaid.

  • Tara Straw:

    Just during open enrollment in 2020, 38,000 people started at Healthcare.gov and then received Medicaid coverage. So we can expect that many of those people would just never find their way to Medicaid because brokers, web brokers and insurance companies have no incentive to enroll them. There's no financial benefit to them to help see people through that process.

  • Christopher Booker:

    Straw and others point out that expanding Medicaid, which the state has not done, could provide health insurance to as many as 500,000 low-income Georgians.

    But it's perhaps the exclusive use of brokers and insurance websites that has critics most worried about the plan. Under the Affordable Care Act, consumers can already use brokers and insurance websites.

    In fact, for the 2020 enrollment period close to 90,000 Georgians used this approach to sign up for individual insurance. But about 380,000 Georgians used healthcare.gov.

    Steven Crayne worries about what it might mean to go directly to a broker working on commission.

  • Steven Crayne:

    I would be concerned about their impartiality. OK. And am I paying additional costs for that broker?

  • Christopher Booker:

    Tara Straw says there's a reason to be concerned. She points to an audit released this month by the nonpartisan Government Accountability Office. GAO had undercover agents call 31 insurance brokers posing as customers with pre-existing conditions looking for health care coverage.

  • GAO Special Agent:

    Now, this is going to cover my diabetes, right, and my insulin and all that I need?

  • Sales Representative:

    Yes, absolutely, because you have that prescription coverage in there.

  • Christopher Booker:

    The agency concluded that a quarter of the brokers, "engaged in potentially deceptive marketing practices," including this one, which signed the undercover agent up for a plan where "…pre-existing conditions and prescription drug costs were not covered…"

  • Tara Straw:

    This is definitely an issue that's been flying under the radar but it is a real threat to the ACA and could serve as a model for other states that have been trying to dismantle the ACA through the courts and that have been trying to, to attack the ACA in death by a thousand cuts.

  • Christopher Booker:

    As the U.S. reached another grim milestone earlier this week with the death toll from COVID-19 passing 200,000, Laura Colbert worries that this proposal couldn't come at a worse time.

  • Laura Colbert:

    This plan would roll out next fall. Hopefully at that time, the country is going through kind of a massive vaccine campaign. Hopefully we're all, you know, kind of getting back to work and the economy is kind of accelerating again. And there's a sentiment expressed in some of the comments that, that feel like this would really just pull the rug out from under families at a time when, when hopefully people are getting back on their feet.

  • Christopher Booker:

    The Trump administration, or potentially a brand new Biden administration, will decide on Georgia's plan by February of 2021.

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