The State may take over

Health equity advocates are urging Governor Brian Kemp and other health officials to delay implementing a state-based market exchange.

Last month, Kemp signed legislation that gave Georgia’s Office of Insurance and Fire Safety (OCI) the authority to launch a statewide market exchange. This move would allow the state to exit, the federal market exchange. Georgia joins others in launching statewide plans while simultaneously undergoing a mass patient eligibility review, also known as a Medicaid settlement.

With three different state departments—the OCI, the Department of Community Health and the Department of Human Services—each with its own huge priorities for government-sponsored insurance, health equity advocates fear complicated logistics will leave the marginalized communities confused and ultimately at risk of losing their coverage, with black residents likely among the hardest hit due to logistical issues.

This is a huge undertaking and puts a lot of stress on a new, untested system, said Leah Chan, a senior health analyst at the Georgia Budget and Policy Institute. The best path in terms of increasing access to coverage and cost savings for our state would be to fully expand Medicaid and delay implementation of the state market.

Eighteen other states have implemented their own markets, which normally require a 15-month waiting period, along with project approval from the Centers for Medicare and Medicaid Services (CMS). Georgia’s OCI hopes to deflect the waiting period, arguing that work done to exit the market in 2019 should count towards accessing the state-based option.

Simple logistics can keep Black people from getting or keeping government-sponsored insurance. For example, much of the Market Exchange and Medicaid eligibility forms can be accessed online, and in-person access varies. In 2019, only 69 percent of black Georgia residents had access to broadband internet, according to the U.S. Department of Health and Human Services. That number dropped to 62% for black residents with no health insurance

Deanna Williams, the Central Georgia insurance navigator for Georgians For A Healthy Future, says that when she’s out in the community helping people sign up for affordable coverage, consumers simply have a hard time navigating the website. With two new state initiatives underway while Medicaid unfolds, she says more education will need to be offered by insurance navigators.

When they try to self-enroll, they’re having a hard time navigating the system at and are also trying to use filters that match the coverage they might need at, Williams said. With the launch of the state market, it will be difficult for many people to navigate because there would be people who are losing coverage who may not know where their next step is.

Black Georgians are already not insured at a high rate. According to the Kaiser Family Foundation, 30.1 percent of the uninsured under age 65 in Georgia in 2021 were black. This is complicated because more than 40 percent of those in the state’s Medicaid coverage gap are black, meaning they are too poor to qualify for ACA market assistance.

The state has sent a blueprint to CMS that says they will have a program for insurance navigators like Williams to help with their outreach and enrollment efforts. It’s unclear how much money will be available, but the state says a previous plan to exit had a robust outreach program.

Whitney Griggs, a senior health policy analyst at Georgians For A Healthy Future, says a general wariness of rapid change could boost already high uninsured rates for Georgians of color.

We’ve learned through the ACA that the only way to reach people and get them to sign up is to have trusted messengers to be in the community, to really integrate, she said. If the state doesn’t adequately fund certified navigators and application consultants, that’s where the concern is that people may fall through the cracks because they don’t get this community outreach.


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