Control carries a cost

Credit: Steve Ansul/NewsArt

Credit: Steve Ansul/NewsArt

Georgia’s decision not to expand Medicaid leaves a half million poor without health insurance. State officials should take a fresh look at ways to increase access in a cost-effective manner.

It was about this time in 2013 that a health policy adviser for Gov. Nathan Deal told a meeting audience that Georgia was closely watching how other states were handling expansion of Medicaid enrollment – a key tenet of Obamacare. At that point, Gov. Deal declined to permanently rule out expansion, describing the state’s refusal to participate as being a “for now” decision.

Last year’s pragmatism has hardened into new laws in 2014. Signed by the governor last month, they throw up perhaps the biggest roadblocks yet for Georgians or straying state officials who wish to participate in the national health care reform law.

These latest moves are risky for Georgia and its citizens, we believe. That’s the case even given the shockingly flawed launch and systemic shortcomings of the ACA.

Put simply, it cannot be ignored that Obamacare remains the law of the land. And Georgia flouts it at potential peril to both her residents’ health and our future prosperity as a state.

Ongoing battles over the ACA shift attention away from the sobering problem of providing basic health insurance coverage for half a million poor Georgians. Leaving them uninsured should not really be an option for a state with big ambitions.

Not fixing this problem also leaves Georgians with the bill for whatever haphazard health care is otherwise administered to our poorest residents. It’s the old adage of you can pay upfront now – or pay later, more inefficiently and indirectly.

All of that should be enough to prime Georgia to take another hard look at Medicaid expansion.

The new state laws make that much less likely. And that should change. House Bill 943 bars state or local governments from advocating Medicaid expansion and forbids the creation of a state-run health insurance exchange. Package that with House Bill 990, which snatches authority to expand Medicaid from the governor and gives it to the General Assembly, and the intent of our elected officials is transparent. No ACA, no way.

It’s hard to imagine a sitting governor signing away a power of the executive branch in a state where governors have at times found themselves forced to be the adult in the Gold Dome and veto troublesome legislation. Gov. Deal rightly did just that recently when he vetoed a bad secrecy bill for private probation providers.

Since the General Assembly has asserted their power over the expansion decision, they now owe it to constituents to seriously explore cost-effective ways to quickly insure the poorest people in our midst.

They should absorb research and real-world experience alike that indicates many Georgians view the ACA differently than do many politicians. A January poll conducted for The Atlanta Journal-Constitution found that 57 percent of respondents indicated Georgia should expand Medicaid. Last week, the AJC reported that 316,000 Georgians have enrolled in new private health insurance under the ACA. This in a state that ceded operation of its insurance exchange to the feds.

The above data shows the ACA – for all its flaws and still-considerable unpopularity – continues steadily toward full implementation.

Yet, Georgia’s leaders ignore all that in their ongoing effort to hew to an ideological ideal.

Our stonewalling sends a message to Washington that’s considerably stronger than “No Thanks.” And it’s likely had unintended consequences. Has our blockade of the ACA, for example, influenced the Beltway’s heel-dragging on the Savannah Harbor Expansion Project — an expenditure of federal money Georgia officials strongly favor.

The longer we keep the ACA at bay, the longer Georgia taxpayers will be in the unenviable position of seeing their dollars collected by the IRS being used to help subsidize the 26 states that have signed on to Medicaid expansion. Realizing that should make Georgia’s ultimate one-tenth share of the cost of expansion seem less onerous.

And it should make it worthwhile to look at places like Arkansas, which has won Washington approval for a plan offering private insurance to the Medicaid-eligible.

Using a public-private partnership to expand coverage to more of the poor seems to have commonsense merit. And it seems within striking distance of Georgia’s idea that Washington remit Medicaid funds in a block grant to be used for indigent coverage as the Gold Dome sees fit.

Another idea’s been proffered by the free market-leaning Georgia Public Policy Foundation. It would use tax credits to pay for the purchase of private health insurance.

These proposals show that there are workable, politically palatable options out there to increase access to health insurance. Doing so will result in a healthier state and work force. And it will aid our ambition of becoming a world-class state in which to live and do business. To do otherwise acts strongly against those audacious goals.