"Right now in our state, there are thousands of people working, training, volunteering, or getting an education who cannot afford employer-sponsored insurance or a plan on the open market," Kemp said. "These Georgians need coverage, but they have run out of realistic options. The Georgia Pathways Waiver addresses this challenge by providing 408,000 Georgians with access to obtain affordable health insurance.

"Georgia Pathways is innovative, cost-effective, and tailored to meet the health care needs of individuals and families in every part of the Peach State. Together, Georgia Pathways and Georgia Access encompass the entire health care delivery system, showcase our priorities, reflect our values and put patients first.”

“The process of conservative leadership rolling out meaningful health care reform continues to gain momentum for hardworking Georgians and their families through the Georgia Pathways program,” Lt. Gov. Geoff Duncan said. “This program is laser-focused on solving the issues of affordability and access by further stabilizing the health care markets and connecting real career opportunities with Georgians to generate an accelerated rate of prosperity. It’s encouraging to go to work down at the Capitol every day knowing that Georgia is leading the national conversation on health care reform.”

“From the beginning, we have sought a Georgia-designed solution that serves our citizens and empowers them through access to quality, affordable healthcare,” Speaker David Ralston, R-Blue Ridge, said. “Georgia Pathways is an innovative plan that speaks to that goal. I commend Gov. Kemp and his team for their work, and I trust our federal partners will work expeditiously to review this proposal.”

Georgia Pathways & Georgia Access

Creating New Pathway to Affordable Healthcare, Lower Insurance Premiums

The Georgia Pathways Waiver (1115) and Georgia Access Waiver (1332) will enhance access to quality health care and affordable insurance for Georgians.

Georgia Pathways (1115 Demonstration Waiver)

Georgia is experiencing historic job growth and unmatched economic opportunity in every corner of the state. Participation in the job market is at record highs, unemployment recently dropped to a twenty-year low, and Kemp continues to announce economic development projects totaling thousands of new jobs and billions in investment. 

But while wages continue to rise, hardworking Georgians making less than 100% of the federal poverty line struggle to afford health insurance.

Through the Georgia Pathways Waiver that Kemp will submit to the federal government in December, Georgia will create a new opportunity for individuals who are working, training, pursuing educational opportunities or volunteering for at least 80 hours a month to earn access to an Employer-Sponsored Health Insurance Plan or Medicaid, whichever option is more cost-effective for the state. 

Just like commercial insurance, the new enrollee will be required to pay a nominal premium based on a sliding fee scale, and he or she will have the ability to use their premium – and points acquired through healthy behaviors – to purchase health care necessities like eyeglasses, prescription drugs and hygiene products.

Unlike Medicaid Expansion, which would undermine access to care and cost Georgia taxpayers over $1.5 billion in the first five years, the Georgia Pathways Waiver enhances eligibility for thousands of Georgians by honoring hard work, protecting families, and championing individual responsibility.

Features 

• Enhances access to healthcare for Georgians making less than 100% FPL — of which there are 408,000 adult Georgians 
  
• Requires “skin in the game” with a monthly premium payment 
  
• Enrolls working, training, or volunteering Georgians in Employee-Sponsored Insurance or Medicaid - depending on cost 
  
• Rewards healthy behavior through expense account for prescription drugs, eyeglasses 
  
• Uses conservative reform that reflects our values, champions individual responsibility
  

Benefits 

• Gives more Georgians access to health care 
  
• Honors hard work, community engagement with enhanced employer-sponsored insurance or Medicaid eligibility 
  
• Strengthens the employer-employee relationship 
  
• Creates a pathway to higher pay and prosperity
  

Georgia Access (1332 State Relief and Empowerment Waiver)

Since the inception of the Affordable Care Act, the individual insurance market in Georgia has experienced a significant level of instability. Between 2017 and 2019, the average individual insurance plan in Georgia increased between 27% and 41%. 

For many Georgia families, private-sector health insurance coverage is the largest – and most volatile – expense in their budget. Many are forced to compromise coverage for affordability while others seek new employment opportunities or take another job to foot the bill.

The Governor’s 1332 Waiver — Georgia Access — will launch a state reinsurance program to create more choice, foster competition and lower insurance costs for Georgia families. Just like in other states with similar programs, Georgia families will see a noticeable reduction in their insurance premiums – some upwards of double digits in certain parts of the state.

To generate a customer-focused and intuitive purchasing experience for Georgia families who qualify for health insurance subsidies (100%-400% FPL), the state — if approved by the federal government — will no longer force Georgians to use Healthcare.Gov as the sole insurance enrollment portal. Instead, shoppers will use services from Direct Enrollment Brokers or purchase a plan directly from insurance providers. 

Through this waiver, Georgians will have access to more insurance options, like Association Health Plans, that cover those with preexisting conditions. Georgia families will have more choices to ensure optimal coverage at the right price.

We know that small businesses are the backbone of the Peach State’s economy — employing millions of Georgians. Employers have tried to take care of their employees and their families, but with rapidly rising health care costs, many can no longer afford to offer full coverage. Under current law, employers cannot offset the cost of an employee’s health insurance plan purchased through the federal exchange. Georgia Access waives that provision and allows employers to invest in the health and well-being of their employees.

Features 

• Establishes a reinsurance program where the state assumes part of the insurance claim to reduce risk, exposure 
  
• Lowers private sector insurance rates — upwards of double digits 
  
• Allows Georgians shopping for insurance to bypass Healthcare.gov and use industry leading websites to find the best coverage at a lower price 
  
• Allows employers to offset healthcare costs for their employees
  

Benefits 

• Makes health insurance affordable for Georgia families 
  
• Fosters competition, grows choice, ultimately lowers premiums 
  
• Creates a customer-focused experience for shopping, enrollment 
  
• Empowers employers to provide more benefits to their employees
  

By crafting two unique waivers that work in tandem to create a pathway to affordable healthcare for Georgians and reduce private-sector insurance premiums for families, Governor Brian Kemp is shaking up the status quo and putting patients first with a Georgia-centric approach that meets the healthcare needs of those who proudly call the Peach State home. The submission of Georgia Pathways and Georgia Access is a huge step in the right direction and will lead to a safe, prosperous, and healthy future for Georgia.