Opinion: Georgia can’t afford to delay Medicaid expansion

In the face of a dual crisis — the COVID-19 public health emergency and the resulting economic downturn — it is more important than ever that the 14 states that haven’t implemented the Medicaid expansion, including Georgia, act to extend eligibility to the almost 5 million uninsured people who could gain coverage.

Medicaid expansion will help ensure those who need care have access to it. Uninsured adults may face higher risk of exposure to COVID-19 because of the types of jobs they are more likely to hold. The occupations with the highest number of uninsured workers include cashiers, restaurant servers and cooks and retail sales, which require more contact with the public and do not allow for working at home. Expanding coverage will ensure more of these workers can afford testing and any necessary treatments.

Already, 1.4 million Georgians do not have health insurance, and Georgia’s uninsured rate of 13.7 percent is third-highest in the country. In rural Georgia, the uninsured rate could climb to more than 25 percent by 2026. Economists predict the recession is likely to disproportionately affect low-wage jobs, and the COVID-19 pandemic is expected to result in more Georgians who face layoffs not having insurance. As of April 23, 1.1 million Georgians had filed for unemployment benefits in five weeks. Assuming the state’s new rate of unemployment will fall between 10 percent and 25 percent, the number of uninsured Georgians could increase by 101,000 to 524,000.

Medicaid expansion will not only help prevent people from experiencing severe hardship as the economic downturn worsens, it will even help maintain our health infrastructure. The recently passed Families First Coronavirus Response Act provides coverage for COVID-19 testing for uninsured people, but not treatment. People without health insurance are more likely to delay or avoid seeking care, which jeopardizes their own health and may increase the spread of the virus if they are unknowingly infected. When they do seek care, uninsured people often rely on public hospitals, community health centers, local health departments, and other safety-net providers, which will be under increased strain responding to the public health emergency. People with Medicaid are more likely to have a usual source of care, which can help distribute demand away from the most strained parts of the health care system during the emergency.

The pandemic will also result in steep budget shortfalls. However, the best response to the COVID-19 pandemic requires stronger health care infrastructure and federal assistance to shore up the budget. Expanding Medicaid would bring in millions more dollars to health care providers to care for patients and billions more in federal money to offset state spending increases and lower tax revenues.

The federal government pays 90 percent of the costs for people with Medicaid expansion coverage. This means for every dollar a state spends on coverage for this population, it will bring in an additional nine dollars in federal matching funds. Georgia has already missed out on $21 billion federal health care dollars because of our refusal to expand Medicaid. Georgia cannot afford to keep waiting. This infusion of federal dollars will boost state economies if, as expected, the public health emergency leads to a severe recession. The additional funding is also one of the most rapid, proven ways to deliver fiscal relief to states during an economic downturn.

Georgia can explore several options to expand Medicaid in this moment. First, the governor should consider if his emergency powers would allow him to authorize a full Medicaid expansion by suspending the restrictions from Senate Bill 106 that only permitted the state to pursue a partial expansion. The governor’s public health emergency powers allow him to “suspend any regulatory statute prescribing the procedures for conduct of state business, or the orders, rules, or regulations of any state agency, if strict compliance […] would […] delay necessary action in coping with the emergency.” The Department of Community Health should consider ways to expand coverage through emergency 1115(a) Medicaid waivers and resubmitting the state’s partial Medicaid expansion waiver to remove work reporting requirements. And when state lawmakers reconvene for legislative session, they can amend the legislation that says Georgia can only expand up to 100 percent of the poverty line to allow expansion up to 138 percent of poverty and/or add language to the budget allowing the state health agency to pursue a full expansion.

Georgia has already waited too long to expand Medicaid, and our state’s people are now paying the cost. Georgia, particularly southwest Georgia, has seen the effects of a large number of uninsured Georgians in recent years, and is now particularly vulnerable to the effects of COVID-19. There is no time to waste; Georgia must take immediate action to expand Medicaid and support the health and well-being of our communities.

Laura Harker is senior health care analyst for the Georgia Budget and Policy Institute.