The Biden government reportedly wants to take steps to expose recent federal health care decisions.
If these steps continue, they could have a significant impact on Georgia’s Medicaid and private insurance waivers recently approved by the Trump administration.
The Washington Post reported this week that President Biden may take executive action to reopen the insurance exchanges that offer health insurance to those who do not have employer or state health insurance plans.
And it could also target the waiver plans of states that impose work requirements for Medicaid eligibility.
It’s unclear whether a Biden executive order will repeal a Trump-era rule that allows states to impose work requirements or simply instruct federal health officials to review the rules to make sure they’re reporting on that Expand Medicaid program, the Post reported.
The Medicaid 1115 waiver in Georgia is designed to increase eligibility for low-income adults under certain requirements, including work, education, and volunteering. This plan, sponsored by Governor Brian Kemp and recently approved by the Federal Centers for Medicare and Medicaid Services (CMS), is slated to begin July 1.
However, job requests in Arkansas, Kentucky and elsewhere have been blocked by federal courts and the US Supreme Court is expected to take a case on the matter.
A second waiver of private insurance allows Georgia to adopt a reinsurance program to lower health premiums in exchange. In addition, the state can scrap the healthcare.gov registration page and replace it with a system that connects consumers directly with insurers and brokers.
Such federal government exemptions allow states to experiment with their health programs.
“Given the Georgia Pathways and Access [waivers] We present new, innovative approaches to increasing access, reducing costs and providing better care for the citizens of our state. We remain confident that both proposals will stand up to legal scrutiny and expect their approval by the previous government to be honored. “Mallory Blount, press secretary for Governor Kemp, said in a statement on Tuesday.
The Georgian Medicaid waiver plan is expected to add an estimated 50,000 Georgians to the program’s list. Critics point out that this number is well below the increase in enrollments projected from a full Medicaid expansion. Georgia is one of a dozen or so states that have not expanded, which has been rejected by Republicans who control the state government.
The state has the third highest rate in the nation of people without health insurance – 13.4 percent.
Reopening of exchange registration
Reopening insurance exchanges for enrollment for at least a few months would attract people who haven’t gone through open enrollment and are uninsured, said Bill Custer, a health insurance expert at Georgia State University.
The exchanges created by the Affordable Care Act have narrow registration windows. These exist, Custer said, to prevent people from signing up only when they have immediate medical needs, which would put pressure on insurers.
However, people in special circumstances, such as those losing their jobs and health insurance, were always entitled to register outside of the regular window on the exchanges.
One group who could benefit from a reopening are people whose incomes have dropped enough that they could qualify for significant discounts. Another group would be people who did not think they needed insurance but later found out that coverage was needed because of medical expenses.
A new registration deadline could extend coverage to more people, he said. “We’re economically and medically in an emergency,” said Custer.
He added that the reopening could also increase insurance premiums for the plan years of 2022 if many people with medical needs suddenly sign up.
The loss of jobs during the pandemic has resulted in a large coverage deficit, said Laura Colbert of consumer protection group Georgians for a Healthy Future.
“It’s really encouraging to see the Biden administration reopening the ACA marketplace so people have another chance to enroll,” she said. “The decision to promote and commercialize the reopening is especially important as many Georgians who are eligible for ACA coverage are unaware that they will qualify or may receive financial assistance to help them cut their costs.”
Work rules may not simply be deleted
Imposing job requirements on Medicaid reporting has been an approach many Republican-led states have tried.
By the end of December, the Trump administration had approved 12 state work experiments for Medicaid, and proposals from seven more were pending, according to Sara Rosenbaum, a Medicaid expert at Georgia Washington University.
Rosenbaum writes in a Commonwealth Fund publication that the Biden government would be expected to ensure that work experiments that endanger health and life – especially during a pandemic – neither promote Medicaid’s goals nor are legitimate.
With litigation pending over the pending exemptions, Biden’s Department of Health and Human Services needs to act quickly and strategically regarding the Bloomberg Law reasons for revoking Trump administration’s approvals.
Republican-led states like Georgia that have sought these program changes are unlikely to accept the U-turn without a fight. And those litigation could be harder to win, according to the Bloomberg article.
“Everything the Biden administration does is scrutinized by a judiciary made up of hand-picked, conservative judges who put procedural security first,” said Nicholas Bagley, law professor at the University of Michigan Law School. “At the same time, there is an urgent need to actually change government policies to help the people, and it’s a difficult balance,” he said.
Seema Verma, who was CMS administrator under Trump, may have made this balancing act even more difficult when she changed the terms of the Medicaid exemptions before stepping down from office last week.
CMS has the power to lift exemptions if a program no longer promotes the objectives of the law under which it was enacted.
“There’s not much priority given to administrations revoking incoming approvals,” said MaryBeth Musumeci, assistant director of the Kaiser Family Foundation’s program for Medicaid and the uninsured, according to Bloomberg Law.
In general, to roll back a regulation, an agency must issue a new proposed rule justifying the change and accepting public comments. To end a Medicaid waiver, the Biden government would have to notify each state, provide a reason for their resignation, and give the state an opportunity to request a hearing under the terms of the waiver.
However, Verma urged states on Jan. 4 to sign a letter agreeing to new terms that would prevent the agency from suspending, ending or withdrawing a waiver within nine months of being notified of the state of the reversal.
Colbert of Georgians for a Health Future said Tuesday, “It is not logical, compassionate, or constructive to discourage low-income adults from getting health insurance because they cannot find work during a simultaneous pandemic and economic downturn. I hope that the expected rule change will cause Georgian leaders to rethink the job requirements included in our state’s plan to partially expand Medicaid this year. “
With Georgia foregoing private insurance, a provision can make redemption even more difficult.
The AJC reported in November that action by an administration to “suspend, amend or terminate the waiver” in a manner not provided for in the Trump administration’s treaty would constitute “a material breach” of the treaty. And when that happens, it says, “The parties agree that legal damages” – a financial payout – “would not provide an adequate remedy.”
However, two Georgia healthcare providers are suing over the Trump administration’s approval for the state to get rid of the Healthcare.gov registration website.
They argue that Georgia’s plan to encourage Obamacare insurance buyers to buy plans through third-party brokers will make it difficult for people to choose the coverage that fully meets their needs, WABE reported.
“Our intention should be that people have as much information as possible about their options rather than comparing things and doing extensive research just to feel better,” said Kwajelyn Jackson, executive director of Feminist Women’s Health Center.
The Atlanta clinic is supported by Planned Parenthood Southeast in its lawsuit against top US Department of Health officials, WABE reported.