Give legislators Medicaid say

Georgians can be proud of their generosity toward the vulnerable and needy of our state. Individuals, churches, non-profits and governments dig deep to give relief to the less fortunate.

In fact, state taxpayers provide $3 billion annually in health care services through Medicaid to one in six Georgians. From covering 60 percent of the births in Georgia, to serving as de facto long-term care insurance for many, to providing end-of-life care in hospice, the state offers 117 categories of mandated and optional Medicaid services from cradle to grave.

Fighting for people, though, does not mean Georgia should increase the income threshold to expand Medicaid. The aftereffects would hurt far more people than they would help.

Last year, Gov. Nathan Deal wisely declined to expand Medicaid to those earning up to 138 percent of the federal poverty level. Under expansion, 650,000 individuals earning up to $16,000 a year could enroll, as well as any family of four earning up to $32,500.

Expanding Medicaid represents a major deviation from the intent of the program, which was to provide a safety net for the neediest households with children, those in nursing homes, and the disabled. Medicaid has never before covered able-bodied individuals based on income alone since its inception 49 years ago.

Georgia is one of the few states that do not require their legislatures to approve a decision of such financial magnitude. House Bill 990 would correct that. It will also make clear to Washington, D.C., that our state views unsustainable and unwise proposals with a healthy dose of skepticism. Without a comparable law, the governors of Florida and Virginia, a Republican and a Democrat, respectively, would have already expanded Medicaid. The South Dakota legislature rejected expansion just this week.

In the past 10 years alone, prior to any contemplation of Medicaid expansion, Medicaid’s price tag has increased 43 percent, far outstripping state revenue growth and the inflation rate. Obamacare will only exacerbate this trend.

If the state were to increase eligibility for Medicaid, it would hobble our state budget by costing upwards of $500 million annually in coming years, inevitably leading to reductions in funding for public education, colleges and universities, and other programs for the needy. With Medicaid, these functions already account for more than 80 percent of the state budget.

Proponents of expansion have yet to volunteer which of these vital services should be cut to fund Medicaid expansion, or what taxes should be raised to pay for it. Without stiff budget cuts, the higher income or sales taxes it would take to pay for expansion would affect Georgia’s ability to attract and retain jobs.

At an individual level, the expansion produces perverse results. If someone works 40 hours per week, making $7.50 per hour, this person would qualify. If he applies himself and is rewarded with a raise to $8 an hour, he would face an unpleasant choice: quit, work fewer hours, decline the raise, or lose health coverage through Medicaid. Expansion would trap the poor into entry-level or part-time jobs with fewer opportunities. A Republican-majority Congress and President Bill Clinton rejected that design with welfare reform almost 20 years ago.

Medicaid reimburses hospitals and health care providers for far less than the cost of care. Providers and patient advocates characterize the existing system as inadequately funded and with insufficient access to care. A recent Oregon study showed that Medicaid enrollees were 40 percent more likely to inappropriately use the emergency room. What will happen when even more people show up expecting services from even fewer health care providers willing to accept Medicaid?

Rather than doubling down on a flawed program, why doesn’t Washington allow Georgia to construct a more effective health care solution for those who truly need a helping hand?

We should continue to fight for people to have brighter, more productive futures through a targeted safety net complemented with education, innovation and job creation. Medicaid expansion is not the answer, and the Georgia Legislature should have a say in the matter.

Jan Jones, R-Milton, is speaker pro tem of the Georgia House or Representatives.