Georgia Edition: Trump’s Attack on Health Care

In 2016, Donald Trump claimed that “everybody’s got to be covered” by health insurance and promised that “those with pre-existing conditions [would] always get the quality coverage they need” under his leadership. But since taking office, his administration has instead worked relentlessly to strip health coverage from millions of Americans and gut protections for those with preexisting conditions. After failing to repeal the ACA in a Republican-controlled Congress, the Trump administration has taken its war on health care to the courts and the state level.

The Trump administration has already increased health care costs for Georgia families — To finance tax breaks for corporations and the wealthiest Americans, President Trump signed a law eliminating the ACA’s individual mandate, which raised premiums for working families who purchase coverage on their own. Due to this action, the average family of four in Georgia was estimated to have paid an extra $4,010 in marketplace premiums during 2019.

Governor Kemp’s Trump-inspired assault on health care — Inspired by the Trump administration, Georgia’s Republican Governor Brian Kemp recently announced his own plan to sabotage the ACA at the state level by seeking federal waivers. Already, Georgia has refused to opt into the ACA’s federally-funded Medicaid expansion, leaving 490,000 eligible low-income residents without Medicaid coverage — even as the state holds the country’s third-highest uninsured rate and has recently experienced a significant increase in the number of uninsured children.

Waivers proposed by Gov. Kemp will:

  • Cost the state more than full Medicaid expansion under the ACA, but provide coverage to fewer people
  • Leave 90% of uninsured, expansion-eligible Georgians without Medicaid coverage — While Governor Kemp’s plan is estimated to expand coverage to 50,000 people, it would not reach nearly 90% of the low-income residents who would be eligible under Medicaid-expansion. The governor’s plan adopts the punitive work requirements promoted by the Trump administration. This decision will disproportionately harm Georgia’s rural communities, where employers are less likely to offer health insurance and incomes are generally lower. Rural Georgians’ access to care is already in jeopardy — the state ranks third in the country by number of rural hospital closures over the last decade.
  • Promote enrollment in ‘junk plans’— Governor Kemp’s plan would allow federal subsidies to apply to short-term ‘junk plans’ that do not comply with the ACA’s rules for individual market coverage. Junk plans can exclude coverage for preexisting conditions and often lack essential health benefits such as prescriptions drugs and emergency care. Some of these plans spend as little as 9% of premiums toward medical care.
  • Put a cap on coverage subsidies — Governor Kemp’s plan would cap total spending on individual market subsidies, so if more people are eligible for subsidies than expected, they will be placed on a waiting list. The plan may eliminate the ability of subsidy-eligible Georgians to access financial assistance for coverage in the future.
  • Offer no centralized site for enrollment — Because Governor Kemp’s plan would eliminate enrollment through the federal website, individuals would have to purchase health care plans through a web broker or directly with insurance companies. This will make it more difficult for Georgia consumers to identify reputable resources for health insurance enrollment, and brokers may be more likely to steer consumers into plans that lack comprehensive coverage and protections for pre-existing conditions.

Full ACA repeal on the line — Having failed to repeal the ACA in Congress, the Trump administration’s Department of Justice threw its weight behind a lawsuit seeking to repeal the ACA in its entirety, and a court decision is expected soon. Below are several ways Georgians would be harmed if the court fully repealed the ACA:

  • 461,000 Georgians would lose insurance coverage, increasing the state’s already-high uninsured rate by 29%.
  • 4.4 million Georgians with preexisting conditions could face higher premiums or be denied coverage altogether in the individual market — a discriminatory practice that the ACA outlawed.
  • As many as 817,000 Georgians could face annual limits on employer-based coverage.
  • Georgia would lose $2.3 billion in federal funding for Medicaid and marketplace coverage.

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