Ga.’s disgraceful ban on Medicaid expansion

You’re the chief accountant for a company that desperately needs financial help to survive. You’ve discovered one solution involves a ton of money – $9 million a day, $35 billion over 10 years – that is available immediately. This isn’t a loan, mind you. It’s money available from the federal government to companies just like yours all over the country.

But your chief executive officer tells you that solution is off the table. “We can’t afford it,” he declares. So meekly you go. Back to the drawing board.

Apparently, this is exactly what a group consisting of the Georgia Chamber of Commerce, Georgia Hospital Association, doctors and insurance executives has decided to do while looking at ways to expand health care access around the state. They have blindly accepted the dubious claim by Gov. Nathan Deal and others that the state can’t afford to cover hundreds of thousands more low-income Georgians under Medicaid even if the federal government pays for it.

The group, like the governor himself, is not interested in discussing the available evidence to the contrary. It also seems unwilling to examine why 30 other states have wisely chosen to jump on board the expansion.

Since January 2014 when the Affordable Care Act was fully implemented, Georgia has turned its back on more than $5 billion in revenue available by expanding access to Medicaid through the ACA. These billions could have stabilized the financial status of dozens of rural hospitals at risk of closing and helped to shore up the economies of the communities they serve, the very task the chamber group says it wants to address.

As it stands now, we are well on our way toward forfeiting $30 billion more – money collected from taxpayers, including Georgians, that will return to the federal treasury.

It’s worth asking: If Georgia decided to forego $35 billion in federal money to expand the Port of Savannah, would the chamber and business executives be so sanguine about it?

While our state leaders continue to make good on their vow to obstruct Obamacare, Indiana, Arkansas and other conservative, Republican-led states have received permission to create their own versions of Medicaid expansion allowed under the law. Yet such innovative efforts to utilize federal money have failed to penetrate Georgia’s anti-Obamacare radar.

More recently, Grady Memorial Hospital and a consortium of nonprofit primary care clinics created a plan to extend Medicaid to several thousand chronically ill, uninsured adults living below the poverty level in the region. Predictably, the state again rejected the idea as too costly. Since it was Grady that assumed the financial risk for the plan, it strains credibility for the state to suggest it can’t afford such a modest, targeted expansion of Medicaid.

By way of contrast, Illinois got permission to implement Medicaid expansion in 2013, a year early. That allowed John H. Stroger Hospital of Cook County, Grady’s equivalent in Chicago, to begin enrolling about 100,000 previously uninsured residents under a plan similar to what Grady wanted to implement. By all accounts, the plan has been wildly successful – for the patients and the public hospital.

Georgia now ranks behind only Texas and Florida, two other non-expansion states, in the number of residents who have no health insurance. Georgia’s current enrollment rules are so restrictive that parents with a minor child can’t earn more than $7,600 a year and still qualify for Medicaid.

We also are 50th in Medicaid spending per enrollee. That dismal ranking tells you how low a priority the poor are in Georgia, and how badly we shortchange the doctors and hospitals who care for them.

If you are a company looking to relocate to Georgia, are you willing to pay higher health insurance premiums for your employees because the state refuses to use the money available to cover those without it? If your company is already here, should you put up with this hidden state tax on your group health plan?

Unfortunately, tapping the federal treasury to pay for bricks, mortar, concrete and asphalt has always trumped using federal funds to pay for direct health and social services for the poor of our state. This attitude goes all the way back to the New Deal, when Democrats ruled Georgia. But the Republicans now in power have perfected the old canard that the poor have only themselves to blame, and government programs aimed at helping them are too costly and ineffective.

It’s way past time to call out the state’s malfeasance on this vital issue. Rather than cowering, the chamber and hospitals ought to be forcing the state to prove what it claims it can’t afford to do.

Mike King is the author of the soon-to-be-published book, “A Spirit of Charity: Restoring the Bond Between America and Its Public Hospitals.” His Failure to Thrive blog can be found at

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