Several important changes are coming in 2019 to individual health plans that could impact Hall County consumers, but the biggest may have taken place on Tuesday, Nov. 6, when Democrats won control of the U.S. House of Representatives in midterm elections.
That feat stands to end before it begins a new political battle to fully repeal the Affordable Care Act, and the timing coincides with the start of open enrollment, which runs through Dec. 15.
The Trump administration still has wide latitude to implement the ACA, however, and many providers have pulled out of the federal health exchange market in recent years.
Hall County residents were left with fewer and fewer options for individual plans until this year, when only Alliant served the local market.
In 2019, Blue Cross Blue Shield enters back into Hall County, according to Brett Fowler, partner and vice president at Turner Wood & Smith Insurance in Gainesville.
But that comes with major caveat: Blue Cross will only be providing an HMO product that is not in network with the Northeast Georgia Health System.
Laura Colbert, executive director of nonprofit Georgians for a Healthy Future, said health consumers need to be mindful that there has been a growth in the number of short-term plans made available that do not have the same minimum coverage requirements as those plans meeting ACA standards.
She advised consumers to shop on www.healthcare.gov, the official federal exchange, rather than through outside vendors.
The midterm elections also saw voter referendums in three red states – Idaho, Nebraska and Utah – that will expand Medicaid through the ACA to adults with incomes under 138 percent of the poverty line.
Democratic gubernatorial candidate Stacey Abrams had promised to expand Medicaid, but she appears to have been defeated by Republican Brian Kemp.
Even had Abrams won, a state law passed in 2014 mandates that the Georgia General Assembly must give its approval to Medicaid expansion as broadly as the ACA provides.
Colbert said at least 250,000 Georgians could be provided Medicaid coverage if the program were expanded.
A recent study from Georgetown University’s Center for Children and Families and the University of North Carolina’s NC Rural Health Project reports that residents of small towns and rural areas of Georgia have the most to gain if Medicaid coverage is broadened by significantly reducing uninsured rates.
Colbert said her organization would advocate that state lawmakers work to raise minimum coverage requirements and pass protections for pre-existing conditions.
During the campaign, Kemp said he supported federal waivers to help stabilize insurance premiums through a $200 million reinsurance program jointly funded by the state and the federal government, while also protecting patients with pre-existing conditions.
State Rep. Lee Hawkins, R-Gainesville, told The Times in recent weeks that lawmakers may look at additional Medicaid waivers to cover more individuals in need.
But stricter work requirements and eligibility limits could also be on the docket.
“I want to take care of everybody, but we have to be able to afford them,” Hawkins said. “If we’re talking any expansion, we have to be fiscally responsible.”
Georgia is a balanced budget state, and mid-year appropriations to shore up the state’s portion of Medicaid costs are not uncommon.
Hawkins said one way or another, health care is still an issue that’s on voters’ minds.
“I hear from folks when I go to the stores … health care for them is one of the top issues,” he said. “Being (in) health care, I’m very sensitive to that.”