ATLANTA (AP) — The 2010 federal health insurance overhaul, commonly called the Affordable Care Act, expands access to health insurance in two major ways. The first is through insurance exchanges where individuals can shop for policies from private insurance firms. Secondly, the law gives states the option to expand the Medicaid insurance program that provides coverage to low-income Americans. A third factor is a requirement that businesses with at least 50 employees offer health insurance or pay a penalty.
Here's a look at the basics for Georgia.
Q: How many people are uninsured in Georgia?
A: According to various analyses, at least 2.1 million Georgians have no health insurance. Nearly all of them are working-age adults. Most children are covered by private insurance or Medicaid. Older Americans are covered by Medicare and, in some cases, also get Medicaid benefits. The uninsured number does include children and older adults who are eligible for government insurance coverage but have not accessed the benefit.
Q: What would the uninsured number be with full implementation of the Affordable Care Act?
A: Gov. Nathan Deal has said he has no plans to expand Medicaid. But if all three expansion avenues were in place, the Urban Institute and the Kaiser Family Foundation estimate that almost 1.1 million Georgians would find a new path to health insurance coverage.
Q: How is the exchange going to be set up in Georgia and which agency will be responsible for overseeing it?
A: Gov. Deal has declined to set up a state-run exchange. That means the U.S. Department of Health and Human Services will oversee exchange services in Georgia, with consumers shopping for coverage online. Secretary Kathleen Sebelius's agency has not disclosed detailed plans, but the law calls for exchanges to be live by Jan. 1, 2014. Open enrollment is set to begin Oct. 1, 2013.
Q: How many people could end up using the exchanges?
A: An Urban Institute analysis estimates that nationally, exchanges would benefit about 19 percent of U.S. residents who don't have insurance now. That would be about 400,000 people in Georgia. It's not possible to predict, however, how many people who are eligible would seek insurance. Some may simply opt to pay a fine imposed by the IRS. Another variable is how businesses who now offer insurance will react. If those businesses drop coverage, it would drive more people to exchanges.
Q: How many people in Georgia are currently served by Medicaid?
A: Georgia's Medicaid program serves more than 1.5 million people at a cost of about $5.8 billion to federal taxpayers and $2.6 billion to the Georgia treasury. The ACA makes it optional for states to raise income eligibility requirements to cover more people. The federal government would cover 100 percent of the new costs initially, with the match rate settling at 9-to-1, meaning the state would be responsible for 10 percent of the new costs. At the same time, the government would ramp down a separate program that uses state and federal hospitals to treat the uninsured. Deal says Georgia can't afford Medicaid expansion.
Q: How many residents would qualify for Medicaid if Georgia accepted the expansion?
A: Analyses by the Urban Institute, Kaiser Family Foundation and Georgia Budget and Policy Institute have estimated an initial increase ranging from 600,000 to 700,000 people.
Q: How much money has the state received so far from the federal government to do the initial work in setting up an exchange?
A: Before Deal announced his decision not to run an exchange, Georgia accepted a federal exchange grant of $1 million.