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House committee advances bill to let under-65 ALS and kidney-failure patients buy Medigap at 65 rates
Summary
A House committee voted to give House Bill 323 a “do pass” recommendation after hours of testimony from transplant recipients, patient advocates and insurers. Supporters said the bill would prevent medically vulnerable Georgians from spending down into Medicaid; opponents warned of premium increases for current Medicare supplement enrollees.
A House committee voted to give House Bill 323 a do-pass recommendation after hearing testimony from transplant recipients, patient advocates and insurers about access to Medicare supplemental insurance for people under 65 with end-stage renal disease (ESRD) and amyotrophic lateral sclerosis (ALS).
Proponents said the bill would allow Georgians who qualify for Medicare because of ESRD or ALS to buy Medigap (Medicare supplement) plans at the same premiums now charged to people aged 65 and older, instead of the much higher rates younger buyers face. Supporters said that would keep people off Medicaid by preventing the “spend down” that many patients currently undergo to afford care.
The bill’s sponsor described the measure as a change “to allow people 65 to have a Medigap plan so that they can afford a kidney transplant,” and introduced several people with lived experience. Kidney transplant recipient Christie Flynn testified that she remains on Medicaid because she cannot afford private supplemental coverage for her medications and follow-up care; she said being able to buy Medigap at lower premiums would let her pursue part-time work and reduce reliance on Medicaid. Dialysis patient Christopher Richards described using his spouse’s private insurance to cover the 20% Medicare does not pay and said disability-level income left him unable to pay that gap.
Patient-advocacy witnesses gave specific estimates: Elizabeth Lively, eastern-region advocacy director for Dialysis Patient Citizens, cited an independent actuarial analysis (HMA) that identified about 3,800 Medicare-covered ESRD patients in Georgia who would be newly eligible under the bill and estimated a five-year Medicaid savings of about $6.3 million by preventing some patients from spending down into Medicaid. Lively and other advocates used plan examples to illustrate current price differences: they said a Plan A premium that costs about $148 per month for a 65-year-old can run into the thousands—$2,222 per month in one example quoted—when the same plan is sold to a younger buyer without the protections proposed in the bill.
The ALS Association’s Alex Meister said roughly 960 Georgians currently have ALS, about 400 of whom are under 65, and that many younger ALS and ESRD patients face catastrophic out-of-pocket burdens because Medicare covers roughly 80% and patients are left with the remaining share. American Kidney Fund spokesman Richard McDaniel said dialysis and transplant patients frequently exhaust savings and that the current system can trap people on dialysis longer than necessary.
The Georgia Association of Health Plans registered opposition. Jesse Wathington, the association’s president, told the committee that expanding guaranteed-rate access would shift costs into the larger pool of Medicare-supplement enrollees and cited a Washington state analysis that estimated premium increases of up to 16% in that state’s market under some scenarios. Wathington and other insurers said that in certain markets the required cross-subsidy could prompt some older, fixed-income enrollees to drop supplemental coverage, leaving them exposed to higher cost-sharing.
Committee members pressed advocates and insurers on numbers, asking about the difference between community-rated markets and others and about actuarial assumptions. Advocates urged the committee to weigh the relatively small projected increase to the larger Medigap pool—advocates estimated about $2 a month per enrollee—against the patient-level harms of current premium pricing.
After questions, the committee moved the bill forward. The committee chair announced the bill received a do-pass recommendation and recorded the legislative tracking code (LC 46 10 64) for the measure.
Votes at a glance: a motion to pass the bill was made and seconded on the record; the committee chair announced approval and a do-pass recommendation (LC 46 10 64). Specific roll-call vote names and numeric tallies were not recorded in the transcript.
