FILE - Medicaid ambulance emergency

The Georgia Public Policy Foundation has been a longtime advocate of market-based solutions to Georgia’s healthcare problems. The Anderson Economic Group (AEG) provided the foundation with the results of a study intended to further public discourse on how the state might use a 1332 waiver to lower the cost of healthcare.

The report is titled “Healthcare Innovations in Georgia: Two Recommendations” and focuses on two specific actions lawmakers in the state could take to reduce costs and increase options. The first is a reinsurance program. The second is a Georgia primary care access option.

The reinsurance program would apply to all large insurers in the state and “reimburse accumulated claim costs that exceed a set threshold within a given year.” According to the report, this would “stabilize rates for individual health insurance plans and provide greater financial certainty to health insurers and health insurance consumers.” AEG estimates that a claims threshold of $50,000 per plan member could yield a possible annual savings of more than $550 of each member of an individual market plan, which comes out to more than $250 million within the first year.

The Georgia primary care access option would require large insurers to offer at least one plan that includes a direct primary care model. Receivers of this plan would select primary care physicians who would pay a fixed monthly rate rather than pay a per service fee. This plan allows physicians to have a more profitable practice with a smaller and more manageable amount of patients. Assuming that 5 percent of those eligible enroll, AEG estimates that it would lower premiums on the individual market by $42 per member within the first year alone. These savings could be even bigger for those who opt for a plan with direct primary care benefits.

The overall goals of the study were to illustrate the way that Georgia could use a 1332 wavier to ultimately lower the cost of healthcare, empower more Georgians to purchase private insurance, restore the doctor-patient relationship, and to pave the path for other states to follow along behind.