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Georgia Access and Health Care Exchange 1332 exemptions



This post is part of a series sponsored by AgentSync.

Georgia is contesting a federal challenge to its 1332 waiver, leaving the 2023 open enrollment period for health care in flux while the state and fed Duke out.

If any of that sounds a little garbled, fear not: We’re here with the basics of what we’re talking about, what the hell a 1332 waiver even is, and how we got to this point.

To begin, let’s do a quick refresher on the Affordable Care Act (ACA) and set the stage for this healthcare drama.

The Affordable Care Act and state health exchanges

Around 2010, Congress voted the Affordable Care Act (ACA) into law, creating a federal exchange, a one-stop shop of ACA-compliant plans that would follow federal guidelines for minimum health care coverage.

The law, also known as “Obamacare,” gave states the ability to start their own health care exchanges with ACA-compliant, locally covered plans. Each state that chose not to start a state-specific health exchange allowed the federal exchange to default to nonemployer-based individual coverage.

The ACA infrastructure also established a system of credits and government rebates to keep costs low for consumers and the federal government. Some of the credits go to subsidize coverage for those with low incomes, and some of them can be refunded to states that find ways to reduce the overall cost of insuring people.

What is an exception to § 1332 for health care?

A Section 1332 health care waiver allows states to waive some of the Affordable Care Act’s guidelines — but not all — and use federal rebates for “innovative” strategies to reduce health care costs. The majority of states that have applied for 1332 waivers have used them for reinsurance programs that transfer insurance risks and provide backup to health insurers.

The general qualifications for an exemption from 1332 are four:

  • Any coverage provided by the state under a 1332 must be as comprehensive as ACA coverage
  • Coverage must be as affordable as ACA-equivalent coverage
  • The same(ish) number of state residents should be covered as an ACA plan
  • The 1332 exemption cannot increase the federal deficit

In addition to using this provision to start state-based reinsurance, Washington state has applied for an innovation waiver to extend ACA-compliant coverage (specifically without federal subsidies) to its undocumented population.

Georgia’s renunciation of 1332

Georgia applied for a waiver in July 2020, with the goal of reforming its market in time for the 2023 open enrollment season. The plan consists of two essential parts:

In late 2020, the Donald J. Trump presidential administration approved Georgia’s Section 1332 State Innovation Waiver, based in part on Georgia’s self-reported data that the state would see increased insurance enrollment as a result of withdrawing from the federal exchange.

Even at the time, Georgia’s waiver request was controversial, with many critics saying the lack of state budget to advertise the private Georgia Access Model would actually have the opposite effect on insurance enrollment.

Georgia Waiver in Jeopardy – Federal Criticism

Criticism at the federal level of Georgia’s waiver application has only increased since 2020. Commentaries from the Brookings Institute and the Center on Budget and Policy Priorities leveled harsh criticism at the state of Georgia’s initial data submission, effectively calling for a complete denial of the waiver. . Shortly after the 2020 election, the administration of President Joseph R(obinette) Biden indicated it would end the waiver retroactively, due to the inconsistencies in the state’s assessment of the Georgia Access Model’s impact.

In April 2022, the Department of Health and Human Services and the Department of Treasury sent a joint letter to the state of Georgia, requesting updated efficacy data by July 28, 2022, or the departments would terminate the state’s 1332 waiver. On July 27, 2022, the state responded by challenging the departments’ ability to request data for a program that has yet to be implemented.

This looks like a case that won’t have an easy resolution, as the federal government’s ability to … well … govern has been challenged by the US Supreme Court. While we here at the AgentSync blog aren’t crime geeks, just insurance geeks, we’ll certainly be keeping an eye on Georgia Access as the back-and-forth between federal authorities and Georgia state officials continues.

New Georgia insurance license withdrawn

Georgia originally planned for the success of their waiver when the state announced the creation of an “Agent – Georgia Access” health insurance license in late July. The license, which would have gone into effect on August 12, 2022, would allow agents to sell Georgia Access plans.

To obtain the new license, applicants would need to have an Accident and Sickness Authority Line (or apply for one at the same time as their Georgia Access application). Both residents and non-residents would be required to pass an exam in addition to having an accident and sickness line to obtain full licenses as Georgia Access agents.

But Georgia quickly withdrew its electronic availability of the “Agent – Georgia Access” license, possibly signaling that the state expected federal recovery again.

In the absence of set answers, those hoping to sell health insurance through the Georgia Access Model will at least apply for health licenses in Georgia and then sit tight to see if things line up in time for the 2023 open enrollment season.

If nothing else, this serves as a good example of the difficulties of complying with varying regulations across states, territories and the federal government. To make it easier, check out AgentSync’s solutions for keeping track of your producer licenses.

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