In case you missed it, a report recently released by the Georgia Public Policy Foundation examined the health insurance marketplace in Georgia since Governor Kemp took office.

The report acknowledges that Georgia’s health insurance landscape was “dire” when the governor was sworn into office in 2019, but has seen “dramatic improvements” as a result of the state’s decisions and approach towards addressing the need for greater access to healthcare coverage.

Analyzing waivers submitted by Governor Kemp that established both Georgia’s reinsurance program and state-based exchange called Georgia Access which are currently being run by Georgia Insurance Commissioner John King, the report concludes that “other governors should emulate Kemp’s success if they wish to seize power back from Washington, D.C., bring revenue to their states and use the power of the private sector.”

Read more here.

Examining Georgia’s health insurance marketplace

Gregg Conley, Georgia Public Policy Foundation

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When Gov. Brian Kemp was sworn into office on January 14, 2019, the health insurance landscape in Georgia was dire. Since then, that landscape has seen dramatic improvements thanks to decisions that put the interests of our state and its citizens first. One-and-a-half terms later, it is worth highlighting and explaining the Kemp administration’s extraordinary successes in the health insurance world, as well as offering potential next steps in building on that success.

Most Georgians receive their health insurance through employer-sponsored plans. However, approximately 10% of our residents do not have access to an employer-sponsored plan and rely on the individual health insurance market to obtain coverage. In 2018, a Georgian looking for coverage on the individual market faced significant challenges, mainly due to a lack of insurers. A lack of choice creates significant costs for the individual consumer. In 2018, only four health insurance carriers operated on the individual market, and 145 of our counties had only one health insurer, while the other 14 had only two.

Having only one insurer in 145 counties means no significant market competition is taking place. This lack of competition also means providers were forced to accept the terms of the only insurer operating in their county, leading to lower reimbursement rates. This lack of competition resulted in higher insurance rates and consumers paying more than they usually would, or having to go without insurance due to the cost. In 2019, over 1.5 million Georgians eligible for individual market plans were uninsured.

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Gov. Kemp’s 1332 waiver was approved in November 2020. Effective January 1, 2022, through December 31, 2026, the federal government funds two-thirds of the program’s cost, with the state providing the rest. Under the waiver, Georgia reimburses health insurers selling individual market plans for a percentage of claims above a certain amount. This helps control insurer costs and leads to lower premiums.

The reinsurance program stabilized and lowered premiums in the market. In 2023, statewide premiums were reduced by 12.4%. Moreover, in Georgia’s most rural counties, premiums in 2023 were reduced by 34.3%. Besides lowering prices for consumers, insurers were encouraged to come back to the state. The increased competition also led to lower premiums.

These are spectacular successes by any measure. In contrast to 2018, when 145 Georgia counties had only one carrier and the other 14 had only two, now only one county has as few as two carriers. Sixteen percent have at least three, 31% have four and over 52% have five or more. Moreover, in 2018 there were only four carriers participating in Georgia’s individual market, but now in 2024 there are 10. The state reinsurance program has greatly increased citizens’ health insurance choices while dramatically lowering premiums.

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The other equally impressive accomplishment of the Kemp administration has to do with the spectacular growth in enrollments in individual health insurance plans Georgia has seen. This is due in large part to the establishment of a state-based healthcare exchange for the benefit of Georgians. Georgia Access is the first of its kind and utilizes private-sector efficiencies to offer maximum choice to Georgia citizens.

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Georgia Access is a pioneering, conservative way to navigate our current health insurance market – one that takes power back from Washington, D.C., empowers Georgia, brings revenue back to our state and utilizes private business to benefit our citizens.

“Yes, that’s all fine,” one might say. “But does it work?” The numbers speak for themselves. In 2019, approximately 375,000 enrolled in plans on the individual market. In 2024, that number rose to approximately 1.3 million. This means that during the Kemp administration, approximately 1 million more Georgians have enrolled in health insurance plans on the individual market. This astounding statistic means that about 9% of the total population of the state gained health insurance due to the Kemp administration’s Patients First Act.

Kemp’s tenure in office has seen statewide health insurance premium reductions for individual market plans of 12%, with reductions rising as high as 30% in rural areas. Moreover, 1 million Georgians, or 9% of the state’s population that previously did not have health insurance, have obtained it during the Kemp administration. Not only has Georgia carved a path forward for health insurance innovation for its citizens, it has also blazed a trail for other states.

Other governors should emulate Kemp’s success if they wish to seize power back from Washington, D.C., bring revenue to their states and use the power of the private sector. They would also position their states to better weather national elections whether they are contending with a Democratic administration increasingly hostile to state sovereignty or a Republican administration looking to de-emphasize federal bureaucracy. The creation of a state-based exchange puts governors and state legislators back in the driver’s seat of their state health insurance markets.