Georgia lawmakers take on health care spending: What to know

Credit: TNS

Credit: TNS

Health care will make news in the Georgia Legislature’s budget hearings this week. For people who want to be on Medicaid and people with a stake in the Georgia’s individual health insurance market, state leaders have decisions to make. Here are some things to know.

What’s happening this week

Lawmakers from the Senate and House who decide Georgia’s annual budget are meeting together to hear from the Kemp administration. Tuesday morning, Gov. Brian Kemp will address the committee first, with a presentation on his budget priorities. He’ll be followed by his director of health strategy and several of his commissioners who oversee health or insurance departments. All will talk about state funding they’re requesting from the lawmakers that affects Georgians’ health and health insurance.


Officials from several offices will talk about “waivers.” Waivers are state-designed programs where the federal government has waived parts of the law so that the state can tailor policy to better fit local circumstances. Kemp has been trying to implement two health care waivers, one for Medicaid and one for the Affordable Care Act’s health insurance marketplace exchange. He’s had roadblocks, but may take a big step this year.

Medicaid expansion “Georgia Pathways” waiver

This year, the Kemp administration hopes to go live with its Medicaid waiver, a partial expansion of Medicaid to some poor adults. Georgia has the nation’s third-highest rate of people without insurance, and one big reason is Georgia GOP leaders have resisted expanding Medicaid to all poor adults, perhaps 400,000 of whom would qualify. Instead, Kemp hopes to expand Medicaid to a smaller number of adults, those who meet certain work or engagement requirements, perhaps 50,000 people. Kemp won backing for it in court and the Biden administration didn’t appeal.

This program may come up in budget hearings, because if it goes live in July as expected, that will cost money. In addition to paying medical bills, it will likely take an expanded bureaucracy to administer. Some occupations would qualify a person for Medicaid, but not all occupations. That could mean more state workers and computer systems to screen applicants to ensure they qualify. Federal estimates of costs for implementing work requirements have previously ranged from $6 million to $272 million. Georgia hasn’t said how much it’s spending.

“Unwinding” swollen pandemic Medicaid rolls

Regular Medicaid will lose patients, but it will cost money to make it happen.

In April, for the first time since the pandemic began, states will resume dropping people off Medicaid rolls once they no longer qualify. Throughout the pandemic, anyone who qualified once was allowed to stay. Experts nationwide expect states to stumble in restarting eligibility screenings, known as unwinding. Kemp’s budget for the Department of Human Services includes more than $8 million in computer and labor costs to restart Medicaid eligibility screening.

ACA Marketplace and “Georgia Access” waiver

Kemp also won a waiver from the Trump administration for the Affordable Care Act health insurance marketplace exchange, formerly known as Obamacare. Its biggest move would have been blocking Georgians from shopping on the federal website, and substituting a website for a state-based marketplace exchange that would promote private insurance companies and agents directly. That move has been mostly suspended by the Biden administration.

However, the Kemp administration is trying to move forward here in Georgia with what pieces of that waiver it can on its own.

The state Office of Insurance has developed a state-run website It includes links to the websites of private insurance companies as well as to web brokers. The state estimates it spent $31 million on the initiative. A spokesman for the insurance department said the state has spent $5 million on advertising the website during open enrollment and that the advertising campaign reached viewers more than 100 million times.

In addition, Kemp is spending more than $90 million annually paying insurance companies to lower premium costs.

University System of Georgia

The University System of Georgia controls the Medical College of Georgia and Augusta University Health, a cluster of Augusta-region hospitals. Cobb County-based Wellstar Health System is negotiating to possibly take over the hospitals. In the meantime, the university system’s budget includes $105 million of state money to pay for a new electronic records system for the Medical College of Georgia.

Credit: TNS

Credit: TNS