Open enrollment in the new state health-insurance marketplaces begins in a matter of days. With less than three weeks to go before the Oct. 1 start date, Georgia’s Republican governor and insurance commissioner are doing everything in their power to make it hard to attract people to Georgia’s exchange. And the state’s big health insurers have been chipping in with well-timed donations.

Georgia is one of 22 mostly Republican-led states that are opting out of Medicaid expansion altogether, despite the federal subsidy that goes with it. In Georgia, that leaves 650,000 of the state’s working poor in limbo, without any subsidy to help them buy insurance on the exchange.

But that’s old news. Georgia is also participating in the next wave of resistance to the Patient Protection and Affordable Care Act.

In a speech last month, Ralph Hudgens, Georgia’s insurance commissioner, reassured an audience of Republican Party faithful that he’s solving the “problem” of Obamacare in Georgia by doing “everything in our power to be an obstructionist.”

The health-care law does not allow states to require that navigators -- who help people find insurance plans on the state exchanges -- be licensed insurance agents. But Hudgens has an alternative strategy: He’ll simply subject navigators to the same test that insurance agents must pass.

“Basically, you take the insurance agents’ test, you erase the name, you write ‘navigator test’ on there,” Hudgens said to howls and cackles from his delighted audience in the tiny town of Rome.

Straining stability

The public rationale for setting the bar so high for exchange navigators is that it increases “consumer protection.” The real reason is to limit the number of navigators, thereby obstructing Obamacare.

The health-care law protects Georgia insurance buyers by requiring that all plans meet minimum quality standards. And there’s no requirement that consumers enlist a navigator to help them use the insurance-exchange website. Navigators are meant to help disadvantaged and nonnative consumers who might have trouble selecting plans for themselves and their families. There’s no practical reason these helpers should be able to pass tests designed for insurance agents, who have a markedly different and more complex job.

In order for the state exchanges to work well, a broad and diverse population needs to enroll. Uninsured and poorly insured people who desperately need immediate health care are sure to sign up in droves, straining the fiscal stability of individual insurance plans -- unless many, many healthy people sign up as well.

So who, exactly, are Georgia’s top officials really fighting for? Perhaps it is the donors to Real PAC -- a political action committee named after Governor Nathan Deal’s campaign slogan (“Deal. Real.”) and funded by some of the state’s biggest health insurers, hospitals and nursing home associations. Recent reports by independent investigative journalist Jim Walls and the Atlanta Journal-Constitution have pushed Real PAC to disclose that it has received almost $1 million in donations since late 2011, most of it from the health-care industry, according to an analysis by Better Georgia, an organization that advocates for progressive government policies.

What’s funny is that Georgia’s governor was for state-based health-insurance exchanges before he was against them. In the summer of 2011, when Deal started an exploratory committee to investigate how Georgia could set up its own exchange, he declared that it was his “hope” that the committee would find a way for the state to so. His change of heart came in November 2012, after Real PAC started raking in large donations from the health-care industry.

Bandwagon leader

These days, Deal is leading the bandwagon of largely Southern state leaders in blocking implementation of the health- care law. This past spring, he told Fox Business News commentator Neil Cavuto that he subscribes to the conspiracy theory that the law is a Trojan horse full of socialists. Rolling Obamacare over the Georgia line is “one way to get to a one-payer system,” Deal said, because it will “set up a system that fails miserably.” After Obamacare implodes, the story goes, Democrats will be able to claim that only total federal control can make the health-care system work effectively.

It’s an absurd claim. Nathan Deal is the one doing everything in his power to ensure the law’s failure in Georgia--even though almost 20 percent of the state’s citizens lack any kind of health insurance.

(Ford Vox, a doctor at the Shepherd Center for brain and spinal-cord injury in Atlanta, writes about health-care policy. Follow him on Twitter @fordvox.)

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