CMS allows Georgia to rely on private sector for ACA signups starting in 2023

Sign that reads "Welcome to Georgia"
CMS gave Georgia approval to leave HealthCare.gov in 2023 to create its own private sector insurance platform. (Image: Getty/suesmith2)

The Trump administration allowed Georgia to leave HealthCare.gov and rely on the private sector to get ACA exchange signups in 2023.

The state will also be allowed to create a reinsurance program.

The Centers for Medicare & Medicaid Services (CMS), which approved the waiver on Sunday, said it hopes the moves will stop mounting enrollment losses in the state.

“Between 2016 and 2019, total individual market enrollment on the exchange in Georgia declined 22% with over 129,000 consumers fleeing the market,” CMS officials said in a release.

Starting in 2023, Georgia will create a new model where consumers shop for ACA plans through a series of web brokers, insurers and traditional agents and brokers as opposed to going through HealthCare.gov, which is used by residents in 38 states to buy ACA exchange plans.

“Increasing traffic to these private sector entities will not only incentivize these partners to increase their marketing and outreach to the uninsured, but will also drive improvements in the consumer shopping and enrollment experience as the market innovates to meet consumer preferences,” CMS said in a release.

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The state will also employ a reinsurance program starting in 2022. CMS will give the state federal funding based on the projected amount of advanced premium tax credits Georgia would have spent without the program in place.

The reinsurance program is expected to lower premiums on the individual market by 10%. The agency added it will target savings to rural areas that have faced high premiums due to a lack of choice.

So far CMS has given approval to 16 states including Georgia to set up a reinsurance program, according to data from the Kaiser Family Foundation.

But Georgia will be the first to rely solely on the private sector for consumers to choose plans.

There are 12 states and the District of Columbia that run their own exchanges and the rest use HealthCare.gov.

“Allowing multiple, private web-brokers to participate will facilitate competition and provide market incentives to offer improved plan/product selection and enrollment assistance, as well as local, customized customer service to attract uninsured individuals into the individual market,” CMS said.

Georgia also has one of the highest uninsured rates in the country at 13.7%, CMS noted in its release. The agency attributed the high rate to factors that include fewer insurers participating in the exchanges and high premiums. 

But some experts say the move towards a private sector platform will not help to spur enrollment in the state.

“The ACA created an exchange to make buying insurance easier,” tweeted Larry Levitt, executive vice president for health policy for the Kaiser Family Foundation. “This doesn’t give people more options. It just makes getting insurance harder.”

Open enrollment for the ACA's exchanges started on Nov. 1 and runs through Dec. 15.