Much of the health care debate in this year’s legislative session focused on Medicaid. That’s somewhat understandable: Gov. Brian Kemp’s effort to get more flexibility in how Georgia runs Medicaid had an obvious alternative in the expansion of that program under the Affordable Care Act.

It was understandable, but still frustrating. Along with more flexibility for Medicaid, Kemp seeks to revamp the way Georgians use the ACA’s subsidies for private insurance. While an estimated half-million Georgians might gain coverage through Medicaid expansion, there are more than 1 million uninsured Georgians. A larger group, then, could benefit from the second type of reform.

Perhaps contributing to the relative lack of discussion about private-market reforms was the lack of clarity about just what Kemp might be able to do. Few states so far have sought and received federal approval for these still-new types of reform, so there’s less of a blueprint to follow.

That began to change this past week. My organization, the Georgia Public Policy Foundation, had the opportunity to release a report by two consulting groups recommending a pair of private-market reforms to lower insurance premiums so that more Georgians can buy insurance.

Produced by Michigan-based Anderson Economic Group and Wilson Partners, and available at, the report isn’t a final word on the issue. But it is a good starting point for debate.

The first recommendation is a plan for a public fund that picks up the tab for a covered individual’s health care expenses once they surpass $50,000 for the year. Known as reinsurance, this arrangement helps prevent the especially high costs of a small number of individuals from driving up premiums for everyone else.

The report’s authors estimate this program would cost state taxpayers about $50 million the first year, falling to zero in year five. But the impact on premiums could be substantial — a reduction of about $550 per plan member in the first year. That works out to more than $2,000 for a family of four.

The second recommendation incorporates a concept that has been gaining popularity in recent years: direct primary care, or DPC. Much like a fitness club, members pay a fixed monthly fee to their primary-care physician rather than the paying separately for each service rendered. Members use the service as needed, with DPC practices typically offering a generous menu of services along with specially negotiated rates for things like lab tests, X-rays and, sometimes, specialist visits and prescription drugs.

The report’s authors recommend that Georgia require large insurers to offer at least one plan with a DPC benefit of $70 per month, which is in line with what many such providers charge. They estimate 5% of those in this market would choose this option in the first year. That would mean an average premium reduction across all plans, including non-DPC plans, of $42 in the first year. Those who actually chose DPC plans would see savings in the hundreds of dollars per year. The authors forecast the uptake and savings would increase over time.

Are there caveats here? Of course. For example: Setting a reinsurance threshold at $50,000 could result in prices soaring even higher once they reach that level, although the study’s authors believe insurers would still have incentives to keep prices as low as possible. Another way of accomplishing the same goal of lower premiums would be for reinsurance to apply to a set percentage of claims.

A possible pitfall for the second recommendation is that DPC plans were originally designed to be wholly separate from insurance, so offering such an arrangement as a benefit of an insurance plan could get tricky. The study’s authors believe — with some justification — that it’s worth the risk because consumers will be more likely to buy a product that feels more familiar, and DPC outside of insurance is still new to Georgia.

Whether these are the right reforms for Georgia remains to be seen. They certainly deserve a closer look. Either way, their thoughtfulness and creativity bode well for Georgians.

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