1332: Time to Start Planning

There’s been some talk about the ACA this cycle. Some folks have even decided that the ACA is the issue to run on or against for candidates. The ACA has been the subject of some 40ish repeal attempts in the House and countless hours of wasted dialogue. Quite frankly it is here to stay because of simple political math. We aren’t going to see a House and Senate with enough votes to overturn the President’s veto anytime soon. And why would a sitting president sign a law ending his program.

In Georgia we passed HB 707/943 this past session which severely limited the implementation of the ACA in Georgia. I worked for several legislators that were authors and cosigners of HB 707 and did some of the research to determine which programs were affected by the ACA, including reading a good bit of the ACA. We even have a cosigner of the bill now on Peach Pundit.

Even though I did work for several individuals that were very keen on this bill passing, it wasn’t something I was really in favor of. I have benefitted from several provisions of the ACA, and my girlfriend with type 1 diabetes is now able to get health insurance at a cost that is not a mortgage payment. Oh and she doesn’t get a subsidy either.

This all being said, there are some serious problems with the ACA and we should address them. One unique approach that is happening in Arkansas is to take advantage of the innovation waiver provision.

From Governing Magazine:

“But the additional waiver, known as the section 1332 or state innovation waiver, would allow Arkansas and other states starting in 2017 to drop major portions of the law, including the individual mandate or the insurance exchange requirement, if they have a viable plan that maintains at least the same level of coverage at the same cost to the federal government. As long as states can do that, which is no small feat, they can take the federal money they would have received and use it how they see fit.”

Given the already rampant distaste for the ACA amongst Georgia politicos (talking heads, bureaucrats, elected officials, and party leaders) it may behoove us as a state to look into this option. Some states will likely go with a more blue option, others more red meat.

Taking advantage of the 1332 provision, Georgia would be able to remake many provisions of the ACA. We’d presumably be able to get rid of various mandates as long as we met certain federal requirements. We’d also, presumably, be able to coerce more price transparency between providers and insurance companies. There’s a whole laundry list of options that Georgia could utilize to reform the ACA, and 1332 is the route to take.

The ACA is the law of the land regardless of your opinion on it. We had HB 707/943 last session which was a great red meat politics kind of bill, but it doesn’t do much to make Georgia better off than it was before. We’ve still got a couple years before this provision would be able to be fully utilized by Georgia, but we should start looking into it this coming session so we can be ready to lead and show what sort of innovation a state can have.


  1. Expand Medicaid and have the insurance commissioner do his d*mn job and put some oversight into the plans sold on the exchange.

    HSA bronze plans here have $6,300 deductibles. For the same premium in a lot of other states, you get lower than $2k. There’s no reason to be on an HSA plan here when a platinum plan (for a 35 year old) costs only $100 more per month and has a $1,000 deductible.

  2. And I could really care less whether we expand Medicaid the traditional way or the Arkansas way, but ultimately Medicaid is the best option of a lot of bad options. Yeah I know – reimbursement rates are too low yada yada, but how else are we supposed to cover poor people without paying a lot more money?

    • FranInAtlanta says:

      First, Georgia is usually a donor state but turning down the Medicaid makes it definite and substantial. I see no reason to send money to Washington DC and not get back all that we can.
      However, if Medicaid patients currently have problems finding a doctor, what happens if we add many more people to Medicaid.

      • objective says:

        this is a concern. perhaps a waiver could provide a solution- like extra assistance/reimbursement to doctors for the administrative work which Medicaid requires.

      • Doctor problem is essentially the Charlie argument. I reject it for two reasons: 1 – what’s the better solution at the same price? There is none. 2 – the market in America seems to have no problem serving government assistance customers at any other level, both non-medical (food stamps) and medical (just look at the ABUNDANCE of peachcare dental options out there, i am positive peachcare pays less than private insurance for dental care the same way medicaid pays less for doctor care).

        Create a giant market (by some estimates nearly 1,000,000 people) who all of a sudden can pay for care – even at rates lower than what doctors currently charge – and I’m sure some doctors/clinics will spring up to meet it.

        Essentially what you’re saying now is that there are billions of dollars that could be spent in Georgia per year and no one wants to take those dollars. I think that’s BS.

        BONUS: oh i forgot obama phones, somehow AT&T etc seem to be able to turn a profit on $7 phones even though they want to charge me $100……

  3. FranInAtlanta says:

    Repeal and replace or repair? I tend toward repair, but I suspect that doing it at the state level will be difficult.

  4. Ellynn says:

    The insurance provider issue and cost MAY be starting to be affected by the market place. If I’m reading this govobable correctly, the price for perminiums for the 27 age group is going down and more insurance companies are becoming involved.


    Again, I state MAY, since this a government memo and all government memos are ment to make the party in power behind the memo look good.

    Take it as whatever grain of salt you wish.

  5. saltycracker says:

    Repeal it – not going to happen
    Repair it – not if it is a compromise involving folks with no skin in the game but able to get care,that is more of the same –

    we must have an individual mandate for all and if no coverage, stabilize them and send them to a charity hospital –

    Fix it – yes – individual mandate, privatize it, open competitive doors – best idea on the table is Avik Roy’s Manhattan institute paper “transcending Obamacare “

    • from his summary…
      But the ACA’s critics, in seeking to repeal Obamacare, would not necessarily address the underlying problems that predate the ACA.

      And they still aren’t ready too, hence you’re wasting your time reading this plan, the Price plan, or any other alternate plan. Not gonna happen.

      • NoTeabagging says:

        The critics aren’t bothering to see what is wrong with ACA and how it is adversely affected those that have been in private insurance for years. That’s my big gripe. The Repubs just say repeal it without making any statements as to what is bad. Four years, and they still haven’t bothered to understand it or offer a better solution. Currently, they don’t even listen to those with problems. Neither does the other side. Obviously, nobody read the bill to see what was really happening as the ACA phases go live.

        ACA is great for those that never had insurance or had a regular doctor. I know people that have found great deals and are happy. I am happy for them.

        I have escalating rates for one policy in my family +20% a month jump to keep a grandfathered plan even though that is still cheaper than the ACA rate for a similar deductible plan. Another is losing their insurance plan because a $10K deductible is no longer allowed. This person will be forced to pay more than double in monthly premiums (a jump from$139 to $361) for the catastrophic plan which will have no pharmacy co-pay, no emergency room coverage, only preventive screenings covered and a $6350 deductible. Comparable coverage to receive prior benefits will cost $549 a month. They did receive an extension to keep this plan for one year due to the chaos that occurred last year. Remember the promise that you could keep your old plan? Ain’t happening.

        It is very difficult to shop for services from doctors, hospitals, labs, and pharmacies if you are trying to manage your costs and keep your out of pocket costs down. Especially if the same vendor charges different people different rates depending on your policy and your insurance company.

        The 1332 waiver sounds great if states are willing to do the work to take on issues that affect their citizens. Unfortunately, I do not see Georgia taking on the work required to make it happen.

          • John Konop says:

            Some good but much can be implemented in a state portal….Also I saw nothing on what to do about preexisting conditions, young adults on parents plan, uninsured who used emergency rooms as an tax payer subsidized health care policy and no real cost reduction ideas…

            The biggest cost is end of life care…why not require end of life wills?

            Drugs are second….why not use VA pricing up to 66 percent less?

            Why not give away birth control to the poor?

            Emergency rooms used as general treatment centers…..why not implement dial a doc for non emergencies?

            Above are real dollar savings…..not just more bs….l

            • TheEiger says:

              Those are all great ideas. HR2300 gives states the flexibility to implement those types of things. Not every thing needs to be mandated down upon us from Washington DC.

            • NoTeabagging says:

              Look at this scary scenario, link below. I have seen those mystery charges on elderly family member bills. But hey, Medicare covers it so after the exhausting period of caring for our family most people don’t have the energy to fight for the fraud charges or alert the insurance company of the questionable charges.
              I have experienced similar bills for “out of network” charges. Luckily, I got my “in network” hospital to waive the bill for these “out of network charges. I simply told them I came to my “in network” hospital, I expected all services to be in network. My Insurance company would not help. Their customer service told me I was responsible for “Out of network” charges. They would not investigate, nor would the GA Insurance Commissioners Office or Gov’s Office of Consumer Affairs. This is why Insurance companies take your money and then try to deny service as soon as you need your benefits. They know there is no enforcement in this state on the consumer side. (hint: My former Insurance has BS in their name and BS is what you get from their customer service.) And yes, I dropped them for another company. (Free Market)


          • NoTeabagging says:

            I don’t see any specifics in this document that would help me or reassure me of fair health insurance reform. Our own Sen. Isakson has not offered any recent solutions to ACA in his weekly emails. Thankfully, he stopped promoting the scoreboard for the number of times he voted it down.
            The standard MO of all political parties these days is to sell the biggest lie to the most people. Political media is no longer about truth, but relentless promotion of false ideas. Keep promoting it until it sticks.
            I am not deliberately promoting falsehoods. I am stating my experience based on what I read (or can’t find) from local and national leaders.

          • Sorry, I can’t take any plan seriously that only provides $1/person for high risk pools per year.

            Even conservative scholars (writing before Obamacare of course) estimated it would cost somewhere north of $20 billion to have true high risk pools operating. That’s 66x the amount this plan provides.

            Hey everyone, Tom Price wrote a bill that says everyone can buy a Mercedes – here’s the $600 that you will need for your base model!

            Of course, the ultimate point of Republican proposals and why you shouldn’t take them seriously is that on matters like high risk pools and many others, they don’t even approach a reality-based understand of the issues and are full of unserious proposals. It’s easy to pick holes at the reality of Obamacare (of course it has issues), it’s a lot harder to offer a true alternative that exists in the same reality space.

            • TheEiger says:

              If you would take a minute and read the plan there is more to it than the tax incentives to get everyone insured. Everything you and most other Democrats talk about is health care is expensive and we should expand medicaid to to cover those rising costs. We should also be attacking the cost drivers. I feel Dr. Prices’ bill does that.

              I know we have argued the points in the past on this bill. I’m not trying to start another two day argument. Not sure when or where the link is where we had the lengthy discussion is, but I’ll refer you back to that post. I was mainly making the point that there are alternatives to the ACA.

  6. saltycracker says:

    Missing something with dropping the individual mandate if you have a viable program….guess that is akin to it being ok to be an uninsured motorist. Don’t mind subsidies for those that qualify but do mind public monies being used for those taking the uninsured risk route. Absent an individual mandate our healthcare providers should be given the right to kick the (stabilized) patient to the curb.

    • Harry says:

      That’s one reason why ACA as presented will never work in this country. There are too many people willing to find a way to let themselves fall through the cracks. Eventually the inequity and unaffordability in premium payments will cause Medicaid to suck up all the private plans except for the chosen few Masters who can afford or are granted higher level plans. Just like in most other countries healthcare becomes a two-tier system, and the serfs will line up for medical services and hardly even know that the higher level exists.

      • NoTeabagging says:

        I have to agree there is an incentive to just stay out of the system, stay poor, then rely on indigent care.

    • One idea that could work would be auto-enrollment in Medicaid (or some sort of other fund) using either the subsidy you would get if you bought insurance or a bill on your taxes if you don’t want to have healthcare.

      But at the end of the day, so much contorting will be going on by conservatives for ideas that “could work” to produce roughly the same results. Why bother? Why build your own car when you can buy one that already works, even if its not perfect.

      • TheEiger says:

        Because the car you want everyone to have is the same piece of crap Pinto. Not everyone wants the same piece of crap car. They want different things and should be allowed to have different choices. Thanks for the metaphor. I’ll be using this in the future.

        • benevolus says:

          Of course you don’t have to have a Pinto. It’s just that everyone gets at LEAST a Pinto. No more Yugos. You can still customize your Pinto and you can even have a Nova or even a Malibu if you want. Maybe even a Cadillac. Just like before.

      • Harry says:

        “bill on your taxes”…yeah right. Do you realize how many people are in the underground economy or on welfare and don’t bother to file a return, and IRS has no way to enforce compliance and collection?

  7. Three Jack says:

    Gotta love the ‘what’s in it for me’ tude about government healthcare. As long as I get something then I’m fer it.

    Since there are limted jobs for college grads who generally owe an excessive amount on college loans, then the government has a self created market to generate support for more government like ObamaRobertsCare. Win-win for the bureaucrats, lose-lose for those who believe in self reliance and the old fashioned idea of individualism.

    It should be repealed, not repaired, not tweaked, not celebrated. It was and will always be a burden on those who choose to live a healthy lifestyle vs. the rest who become more and more dependent on others for their existence as they wait for their turn at the Golden Corral chocolate champagne fountain.

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