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What’s up in Arkansas?
The Affordable Care Act of 2010 called on the states to undertake a massive expansion of Medicaid, the government health program for the poor, to take in millions of people who have no insurance. The law provided that the federal government initially would pay 100 percent of the cost, with support gradually declining to a permanent level of 90 percent.
The U.S. Supreme Court in 2012 upheld the constitutionality of the Affordable Care Act, but the justices also ruled that Congress lacks the authority to compel the states to expand Medicaid.
Given the choice, roughly half the states refused to expand Medicaid, while roughly half the states thought it was a good idea. And then there’s Arkansas. The state this year proposed to take the new Medicaid money from the feds and use it to help uninsured, low-income people buy their own insurance on the private market. The federal government approved this approach a month ago.
So new Medicaid recipients in Arkansas will be able to shop on the federal Health Insurance Marketplace — once it actually starts working — and acquire their own insurance with the money the feds intended for Medicaid. The state says it expects to be able to extend coverage to nearly 200,000 uninsured people. Iowa has applied for a similar waiver.
Now Georgia’s doctors, as members of the Medical Association of Georgia, are on record as advocating the Arkansas approach.
Georgia said no to the Medicaid expansion. Gov. Nathan Deal believes the state cannot afford the expansion, even with the federal government paying most of the cost. A study earlier this year found that a Medicaid expansion would create 70,000 new jobs in the state and bring in more than $30 billion in federal funds over 10 years.
Georgia’s hospitals and now its powerful association of doctors say the state should expand Medicaid to cover hundreds of thousands of people who won’t otherwise have health insurance.
Gov. Nathan Deal has ruled out the Medicaid expansion, called for by the Affordable Care Act, as a way to provide health care to more low-income Georgians. Deal says the state can’t afford it, even though the federal government will cover much of the cost.
The more than 7,000-member Medical Association of Georgia recently voted to endorse the expansion, but with a twist: the doctors want Georgia to use the new Medicaid money to buy private insurance for the poor on the Health Insurance Marketplace. The federal government has approved such an approach in Arkansas.
The medical association has long supported seeing more patients get insurance through the private market versus Medicaid, Donald Palmisano, the group’s executive director, said Thursday.
“Medicaid basically pays less than the cost for providing the care, so why expand a program that has not shown to be successful?” said Palmisano, adding that many Georgia doctors have stopped accepting Medicaid because it pays so little.
Georgia Hospital Association spokesman Kevin Bloye said this week that a larger Medicaid program is critical.
“We need Medicaid expansion in the state,” Bloye told Atlanta radio station WABE. “We need some sort of relief that will help address some of the financial challenges that the health care provider community is facing. These issues are real. They’re not going to go away and we trust leadership that they’re going to work with us on this.”
Bloye said later, however, that the association isn’t planning a public campaign to push for Medicaid expansion as some advocacy groups have. Instead, the group will continue its more low-profile approach of having conversations with the governor and state leaders, he said.
Expanding the public health program would extend coverage to an estimated 650,000 low-income Georgians, including many single adults. The program currently covers mostly children, pregnant women, the elderly and the disabled.
Without an expansion, advocates argue, a large number of Georgians will continue to go without insurance, creating higher costs for patients who can pay in the form of increased insurance premiums and hospital bills.
Expansion supporters Thursday praised the doctors and hospitals, saying their support is critical to influencing policymakers to move forward on expansion.
The medical communities in Arizona, Ohio and Michigan played an important role in getting those states to jump on board, said Tim Sweeney, a health care analyst with the Georgia Budget & Policy Institute.
Half of the states, as well as the District of Columbia, are moving forward with expanding their Medicaid programs, according to the nonprofit Kaiser Family Foundation.
In Georgia, the governor has long said that the state can’t afford to expand the already over-burdened program. That fact remains unchanged, Deal spokesman Brian Robinson said in response to the provider groups’ public stances on the issue.
“About half the states are saying the exact same thing: The money is not there,” Robinson said.
Deal has estimated an expansion would cost Georgia an additional $4 billion over 10 years. Expansion supporters say the cost would be closer to half of that and bring in more than $30 billion in federal dollars to the state.
Robinson called for the Obama administration to adopt a “block grant” approach for Medicaid, where states would receive a lump sum amount of money but have more flexibility in how to spend it.
“Sadly, they seem to prefer the stranglehold method, thereby hurting the very people they say they want to help,” he said.
Deal enjoys ample support in the Legislature.
State Sen. Judson Hill, R-Marietta, said he sees the Arkansas approach to Medicaid expansion as a temporary fix to a government health care system that is fundamentally flawed.
“This all comes with a price tag that taxpayers can’t afford to pay,” Hill said. “There is no free money.”
Consumer advocates and providers remained hopeful Thursday that the support of the hospital and medical associations would spur state leaders to embrace Medicaid expansion. States can opt to expand at any time, though those that wait will forgo millions — and in some cases billions — of dollars in additional federal funds each year they don’t.
Dr. Jacqueline Fincher, governor of the Georgia Chapter of the American College of Physicians called the medical association’s support for expansion “huge.” Being uninsured is about life and death, Fincher said.
“We have been on an unsustainable path,” she said. “Let’s find a compromise that will work for the state of Georgia.”
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