Georgians are losing access to, and with it impartial assistance in comparing, and choosing healthcare coverage. Instead, 430,000 users will be forced to rely on for-profit insurers and private brokers for vital information–driving up the number of uninsured among the state’s most vulnerable in the process. 

More than 400,000 Georgians use to purchase coverage for themselves and their families. Earlier this month, however, Republican Gov. Brian Kemp’s plan to close the state’s access to the federal platform was approved by the US Department of Health and Human Services. 

Georgia is the first to enact such a course with no state-based marketplace set up to replace it. Instead, when the shift takes effect in 2022, Georgians will have to wade through private websites and brokers to shop for health insurance, with no centralized direction or assistance.

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“The Obamacare Exchanges have not worked for Georgians, leaving them with fewer options and skyrocketing premiums,” Medicare administrator Seema Verma said in a statement. “Today’s approval of the state’s waiver will usher in a groundswell of healthcare innovation that will deliver lower costs, better care, and more choice to Georgians in the individual market.”

But, as Vox points out, Georgia’s uninsured rate at 13.7% is five points lower than it was in 2013, before the ACA was put into full operation. More than 430,000 Georgians buy their health insurance through, and that number would likely be higher had Republican state leaders not refused to expand Medicaid, freezing an additional 240,000 people out of coverage.

A waiver under Section 1332 of the ACA mandates states wishing to go on their own to help residents obtain health insurance must satisfy four basic requirements:

  • comprehensive coverage meeting or exceeding that provided by 
  • affordability; or cost protections at least equal to that of the ACA
  • the number of residents covered must be comparable to what the ACA would provide
  • the proposal must not add to the federal deficit 

Thirteen other states have ended use of the ACA’s site and designed their own health coverage programs that follow these “guardrails.” Kemp’s plan, however, leaves several of the criteria unmet, forcing consumers to navigate Byzantine policies without the power of the federal government on their side. As a result, the likelihood of lower enrollment, higher premiums, and placing more people in substandard plans when they’re eligible for comprehensive coverage will increase.

Psychiatric coverage is under particular scrutiny. Georgians for a Healthy Future, an advocacy group, said the plan leaves those needing mental and behavioral health support “exposed and in danger.” 

“Insurers and web-brokers, who would be in charge of helping Georgians find health insurance, have developed a track record of steering consumers toward substandard plans that expose them to catastrophic costs if they get sick … most substandard plans do not cover mental health services, and many do not offer substance use or prescription drug benefits,” the group told the Atlanta Journal Constitution.

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Georgia’s proposal isn’t even offering anything new, Center on Budget and Policy Priorities (CBPP) analyst Tara Straw pointed out. Consumers already had the option to enroll in marketplace coverage through insurers or brokers under policies called direct enrollment and enhanced direct enrollment. But in 2020, only one in five marketplace enrollees chose that option. The other 79% chose to enroll through

Those numbers will almost certainly fall when that preferred platform is taken away. With the health insurance market decentralized and spread across brokers and private insurers, many people may find researching and comparing plans to be more complicated. Even states that developed their own platforms, such as Nevada, saw dips in enrollment as consumers transitioned between federal and state programs. 

“Evidence from past, far simpler transitions between federal and state marketplaces suggests that tens of thousands of Georgians might lose coverage simply because of the disruption from the state’s transition away from,” Straw wrote.

Georgia’s proposal also has far less oversight, and consumers must pick from sellers before even selecting specific health plans to compare. Online brokers can give unfair placement preference to plans that pay commissions. If they do include non-paying plans, they don’t have to include all of the pertinent information—including premiums and other vital items. And brokers and agents can market plans that don’t meet the ACA rules for individual market coverage. 

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Consumers would also lose access to impartial assistance in navigating the enrollment process.

This loss of impartiality greatly impacts Medicaid enrollees, whose applications currently guides to right-sized programs determined by family size, income, and other factors. 

Another concerning impact of the recently approved waiver is that the uninsured rate may actually rise. Christen Linke Young and Jason Levitis at the Brookings Institution pointed out that 25% of people in Georgia who get their insurance through the ACA don’t actively shop for coverage; they are simply re-enrolled in the same plan or a similar one each year. The state is betting on 90% of them suddenly researching dozens of options without neutral help to choose a new plan, an assumption the health policy experts call “unreasonably optimistic.” 

Instead, those families and individuals will likely rely on for-profit brokers, who could shunt them toward plans with lower premiums but less comprehensive coverage or worse, fueling a drop in coverage altogether for the most vulnerable Georgians. The state already has one of the highest uninsured rates in the country—largely due to the GOP’s lack of action on expanding Medicaid to cover all of its residents living in poverty.

READ MORE: Need Health Insurance? The ACA Marketplace Is Now Open Until Dec. 15.