Health equity advocates are urging Gov. Brian Kemp and other healthcare officials to delay the implementation of a state-based marketplace exchange.
Last month, Kemp signed legislation that gave the Georgia Office of Insurance and Safety Fire (OCI) the authority to launch a state-based marketplace exchange. This move would allow the state to exit HealthCare.gov, the federal marketplace exchange. Georgia joins others launching state-run plans while simultaneously undergoing a mass review of patient eligibility, also known as Medicaid unwinding.
With three different state departments – the OCI, the Department of Community Health, and the Department of Human Services – each having its massive priorities for government-sponsored insurance, health equity advocates worry that complicated logistics will leave marginalized communities confused and ultimately at risk of losing their coverage, with Black residents possibly being among the hardest hit because of logistics concerns.
“That’s a huge undertaking and puts lots of stress on a new, untested system,” said Leah Chan, the senior health analyst at the Georgia Budget and Policy Institute. “The best path forward in terms of increasing access to coverage, and in terms of cost savings for our state would be to fully expand Medicaid and delay the implementation of the state-based marketplace.”
Eighteen other states have implemented their own marketplaces, which normally requires a 15-month waiting period, along with a blueprint approval from the Centers for Medicare and Medicaid Services (CMS). Georgia’s OCI hopes to divert the waiting period, arguing that work done to exit the marketplace in 2019 should count toward the accessing the state-based option.
Simple logistics can hinder Black people from obtaining or maintaining government-sponsored insurance. For example, much of the marketplace exchange and Medicaid eligibility forms are accessible online, and in-person access varies. In 2019, only 69% of Black Georgia residents had broadband internet access, according to the U.S. Department of Health and Human Services Department. That number was down to 62% for Black residents without health insurance
Deanna Williams, the central Georgia insurance navigator for Georgians For A Healthy Future, says when she’s out in the community helping people enroll for affordable coverage, consumers are simply struggling to navigate the website. With two new state-based initiatives happening during Medicaid unwinding, she says more education will have to be offered by insurance navigators.
“When trying to enroll on their own, they’re struggling with navigating the system on HealthCare.gov, and also we’re trying to use the filters that cater to the coverage they may need on Healthcare.gov,” Williams said. “With us launching the state-based marketplace, it will be hard for a lot of people to navigate because we’re going to have people who are losing coverage who may not know where their next step is going to be.”
Black Georgians are already uninsured at a high rate. According to Kaiser Family Foundation, in 2021 30.1% of the uninsured under 65 years old in Georgia were Black. That is complicated because more than 40% of those in the state’s Medicaid “coverage gap” are Black, meaning they’re too poor to qualify for the ACA marketplace assistance.
The state sent a blueprint to the CMS that says they’ll 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 HealthCare.gov had a “robust” outreach program.
Whitney Griggs, senior health policy analyst at Georgians For A Healthy Future, says that an overall wariness of the rapid changes could increase already high uninsured rates for Georgians of color.
“We’ve learned through the ACA that the only way to reach people and get them enrolled is to have trusted messengers to be in the community, to really almost embed themselves,” she said. “If the state doesn’t properly fund navigators and certified application counselors, that’s where there’s a concern that people could fall through the cracks because they’re not getting this community outreach.”