Gwinnett, metro Atlanta top exchange enrollment

Gwinnett County, in suburban Atlanta, had by far the highest enrollment among Georgia counties in the state’s 2015 health insurance exchange, said a report released Wednesday.

Gwinnett County
Gwinnett County

The exchange enrollment of 73,839 in Gwinnett is more than 14,000 higher than in the second-place finisher, neighboring Fulton County, even though Fulton is the only Georgia county with a higher overall population than Gwinnett’s.

The other three counties in the state’s top 5 were DeKalb, with 52,016 enrollees, Cobb, with 43,958, and Clayton, with 21,764, according to a report on the state’s second year of open enrollment, compiled by Georgians for a Healthy Future, a consumer advocacy group. The five top enrollment counties also happen to be the original “core” counties of the metro Atlanta region.

Counties six through 10 were Chatham (the Savannah area), with 19,190; Henry and Cherokee, each in metro Atlanta, with 12,853 and 12,340, respectively; Richmond (Augusta), with 10,496; and Forsyth, in metro Atlanta, with 10,389.

Overall, Georgia ended up surprising experts with an enrollment in this year’s exchange of 541,080, far outpacing last year’s total of 316,543.

The exchange this year included nine health insurers, up from five during the first open enrollment.  Also, the exchange functioned much more smoothly this year. During the 2014 enrollment, exchanges in much of the nation were plagued with massive technical problems that virtually shut down electronic enrollment.

Of the enrollees this year, nearly nine of 10 qualified for subsidies, or tax credits. The average premium paid for an individual plan after the subsidy was applied was $73 a month, the report said.

The Affordable Care Act provides for exchanges in all 50 states, and this is the second year of operation. More than half of the Georgians signed up for coverage were new enrollees.

Factors behind the increase

Dante’ McKay, of Enroll America, credited several factors in the 2015 enrollment surge, including a computerized system for scheduling appointments with enrollment navigators or other personnel helping consumers.

Consumers “were better informed the second time around,’’ said McKay, “Everybody in the community got better in doing the outreach.”


Still, challenges for signups included “health literacy” problems among consumers. Many did not understand the concept of a high deductible or even a co-pay, McKay said.

Thousands of low-income people fell into the “coverage gap’’: They did not have incomes high enough to qualify for subsidies in the exchange, but they also could not qualify for Medicaid because Georgia has not expanded that program as anticipated by the ACA.  Some enrollment organizations “estimated that over half of the consumers they worked with fell into the gap,’’ the report said.

Immigrants faced language and verification barriers, the report said.  “Enrollment assisters had little or no training on how to properly verify IDs or immigrant forms,”  the report said, also citing technological problems in uploading documents.

Plus, there was political opposition to the ACA, widely known as Obamacare and associated in many people’s minds with the president.

Sarah Sessoms of  InsureGA, which provided navigators in areas outside Atlanta, said, “You’ve got to tell them it’s more about their health [than about President Obama]. That’s the only way we have been successful in rural Georgia.”

The Gwinnett signup boom

The Gwinnett enrollment may have come from a large number of people there qualifying for subsidies in the exchange through higher incomes, as compared with those in impoverished communities, McKay said. The county may also have a higher rate of self-employed individuals, he added.

Cindy Zeldin of Georgians for a Healthy Future also said Gwinnett did a good job with outreach to its large immigrant population.

The U.S. Supreme Court made Medicaid expansion optional for states..

Going unmentioned during a panel discussion on the report Wednesday was the upcoming Supreme Court case on the legality of subsidies in states, such as Georgia, that have the federal government running their exchanges.

The court will decide next month whether it’s legal for customers enrolled in federally run exchanges to get subsidies to defray the cost of the insurance they buy.

Since the exchanges were launched, the federal government has allowed subsidies for consumers in both state-run and federally operated exchanges. But the plaintiffs in the court case say the language of the ACA limits subsidies to state-run exchanges.

Currently most exchanges are federally run. If the court invalidates the subsidies in those exchanges, the effect would be far-reaching.

Asked about the possibility of subsidies being eliminated, Lisa Stein of Seedco, which provided navigators in the state, said, “Over a half-million people have enrolled in Georgia. I’m hopeful they’re able to retain their coverage.”