Georgia Public Policy Foundation Releases Study on Healthcare Waivers for Georgia

Benita M. Dodd

Thursday, May 30th, 2019

The Georgia Public Policy Foundation has long advocated for market-oriented solutions to Georgia’s healthcare challenges. As one way of accomplishing this goal, the Foundation supports the use of a Section 1332 State Innovation Waiver under the Affordable Care Act (ACA). The Georgia General Assembly has authorized Gov. Brian Kemp to use this tool to pursue more flexibility in how Georgia administers certain aspects of the ACA.

The Foundation has been provided with a report by Anderson Economic Group (AEG), in conjunction with Wilson Partners, and is publishing the report today in the interests of furthering public discussion. The report, "Healthcare Innovations in Georgia: Two Recommendations," illustrates one way Georgia might use a 1332 waiver to lower the cost of healthcare, empower more Georgians to purchase private insurance, restore the primacy of the doctor-patient relationship, and ultimately blaze a trail for other states to follow.

The AEG report recommends Georgia adopt two policy innovations:

  • A reinsurance program that would apply to all large insurers in the state and “reimburse accumulated claim costs that exceed a set threshold within a given year.” According to AEG, it would have the goal of “stabiliz(ing) rates for individual health insurance plans and provid(ing) greater financial certainty to health insurers and health insurance consumers.” AEG estimates a claims threshold of $50,000 per plan member would yield annual savings of more than $550 each for members of an individual-market plan, totaling more than $250 million in the first year.

  • A Georgia primary care access option, which would require large insurers to offer at least one plan that includes a direct primary care model. Plan members would select a primary care physician, who would receive a fixed monthly fee rather than the traditional fee-for-service model. Because direct primary care eliminates the need for physicians’ offices to track and code services and file for reimbursement by the insurer, the provider avoids large overhead costs for compliance. This arrangement allows physicians to have a profitable practice with a much smaller number of patients, which could make it a particularly effective option for rural Georgia. Assuming 5% of those eligible enroll in these plans, AEG estimates this option would lower premiums on the individual market by $42 per member in the first year, totaling almost $42 million. The savings would be larger – about $800 per member in the first year – for those who chose a plan with direct primary care benefits.

Please click on this link to access the study.

“The Georgia Public Policy Foundation has been at the forefront of the conversation over how to fix Georgia’s healthcare market, ready to propose and promote innovative ideas,” said Kyle Wingfield, president of the Foundation.

“The AEG report outlines two possible options for Georgia. While there may be more policies the Kemp administration could pursue through a 1332 waiver, we find these proposals intriguing enough to place them in the public sphere for study and discussion by Georgia’s citizens, policymakers and lawmakers.”

The Foundation will host an informational call about the report for credentialed members of the news media with Kyle Wingfield, Patrick Anderson, Principal and CEO of AEG, and David Wilson of Wilson Partners on Tuesday, May 28, from 3:00-3:30 PM. For call-in information, please contact the Foundation’s vice president, Benita Dodd, at [email protected] or 404-256-4050.