Georgia House Republicans looking at full Medicaid expansion

Credit: Miguel Martinez for The Atlanta Journal-Constitution

Credit: Miguel Martinez for The Atlanta Journal-Constitution

For the first time in a decade, high-ranking Georgia GOP legislators on Thursday convened a meeting to hear testimony on full Medicaid expansion to all the state’s poor people.

At the hearing Thursday, the idea was floated over whether to expand Medicaid in exchange for a political deal to roll back regulations that restrict who can open a new health care business. Those regulations are called Certificate of Need, or CON.

Medicaid is the government health insurance for low-income people, and the center of what may be Georgia’s most intense policy debate. Georgia is one of ten U.S. states, all Republican-led, that use Medicaid to insure children but have not expanded it to all poor adults. Georgia instead gives Medicaid to poor adults, but only those in certain categories: for example, those who are pregnant or who volunteer for a nonprofit organization at least 80 hours a month.

That leaves perhaps 300,000 Georgia adults, who don’t meet the requirements, uninsured.

There have always been scattered Georgia Republicans who favor full Medicaid expansion. But the issue has never gotten close to a majority or high-level approval.

Thursday’s hearing was remarkable for the high-level Georgia House members who made it happen and invited the speakers. House Speaker Jon Burns dropped by and sat in the front row audience next to the speakers. As a reporter stepped up to take his photo, he reached over and shook the hand of one of the speakers, state Sen. Missy Irvin of Arkansas, who helped lead Medicaid expansion in that state.

Thursday’s discussion took place in the Study Committee on Certificate of Need Modernization. But on Thursday, every speaker on the agenda spoke about Medicaid expansion.

Credit: Ariel Hart

Credit: Ariel Hart

An analyst hired by a nonprofit group testified on where Medicaid expansion and CON help other states financially and where they don’t. A North Carolina lobbyist explained the political deal that state just struck to expand Medicaid: Medicaid expansion in exchange for diminishing CON rules.

And the committee hosted three people involved in Arkansas’ long-running Medicaid expansion to explain the successes and problems there. Arkansas’ uninsured rate has plummeted, according to the speakers, and of 57 rural hospitals that closed in Arkansas and its surrounding states in recent years, only one of those was in Arkansas.

“This sounds incredibly good and sensible,” Rep. Lee Hawkins, R-Gainesville, said to the Arkansas officials. Hawkins both sits on the study committee and chairs a House Health Committee focusing on regulatory and market issues.

Burns told a reporter afterward he was just there to check in.

“I happened to be here,” he said. “I’m focused on CON and what this committee brings back on CON.”

Georgia has the third-worst uninsured rate in the nation.

Instead of full Medicaid expansion, Gov. Brian Kemp recently launched a limited Medicaid expansion in Georgia to poor adults who perform specific activities for at least 80 hours a month. Those activities can include working, volunteering for a nonprofit, or other occupations. However, caring for children or family members, or being disabled but turned down for federal disability, does not count toward the requirements.

Republicans have balked at the federal plan for full Medicaid expansion, calling it unsustainable.

Many Republican states were eventually drawn to Medicaid expansion by the health coverage benefits for citizens and the massive federal subsidies that come with expansion. Forty states from Arkansas to North Carolina have now voted to fully expand Medicaid to all their poor.

Georgia’s limited expansion plan, “Pathways to Coverage,” went into effect on July 1, but has had a rocky start. As experts predicted, the requirement for enrollees to file heavy amounts of paperwork has been a barrier to enrollment, according to recent reporting by the AJC. Since Pathways’ began, it has enrolled fewer than 2,000 people out of the 370,000 it eventually hopes to offer coverage to. That’s the most recent enrollment number available, as of early October.

Advocates of Pathways have pointed out the years-long delays and said to give it time to ramp up.

One of those is Georgia Lt. Gov. Burt Jones, who heads the Senate. He told the AJC through a spokeswoman that it was a “multi-pronged approach” drawing strong interest from consumers.

Jones has had a different priority for health care recently: rolling back CON.

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