A recent state-funded study reaffirmed what the Georgia Budget and Policy Institute, Georgians for a Healthy Future and other advocates have been saying for years: Georgia is in dire need of better solutions for health coverage.
Georgia currently faces a health care crisis. The aforementioned study found more than 1.5 million Georgians are uninsured, including an estimated 34 percent of Latinos and 15 percent of African Americans. Some rural areas of the state have uninsured rates that exceed 30 percent.
Seven rural hospitals have closed since 2010 — the third-highest closure rate in the nation. Georgia has the highest maternal mortality rate in the nation, and half of Georgia counties have no OB/GYN.
Georgia is often touted as the “No. 1 place to do business.” But a growing economy and low unemployment rate do not paint a full picture. Sixty percent of Georgians without insurance are employed but cannot access employer-sponsored health care. Job-seekers also struggle. Ninety-two of Georgia’s 159 counties still have higher unemployment rates than before the Great Recession.
While the data is stark, we have a clear, affordable, evidence-based solution available. Thirty-six states have fully expanded their Medicaid program, offering health insurance to individuals who earn $16,000 a year or less. This option could cover upwards of 500,000 Georgians. This option is also fiscally responsible, as the federal government will match 90 percent of the cost.
After years of political paralysis and state leaders ignoring the will of Georgians, it’s time to expand. Seventy percent of Georgians support expansion, yet state leaders refuse to act, forgoing billions of federal dollars. As a result, Georgians and rural hospitals are being left behind.
Instead of full expansion, Georgia is exploring a Section 1115 health care waiver that would allow the state to modify federal rules on Medicaid requirements. This is called a partial expansion because the state can only extend coverage to Georgians earning $12,000 or less per year under the law authorizing the waiver.
We now know this plan is not feasible. The Trump administration will reportedly not approve enhanced federal funding for any state that implements a partial Medicaid expansion, per their recent decision to deny Utah’s request for the funding. Now Utah’s likely fallback plan will be to fully expand Medicaid.
This leaves Georgia in a difficult spot, as the state already hired Deloitte Consulting to craft a health care waiver. Prior to the recent decision on Utah’s plan, Georgia leaders anticipated 90 percent of funding coming from the federal government. Now, if Georgia’s waiver is approved, the state will receive less funding and cover fewer Georgians than it would with full Medicaid expansion.
States that implemented waivers have seen mixed results, largely due to additional requirements that prevented access to coverage. For example, work requirements have led to large coverage losses in states like Arkansas. These requirements often disproportionately harm veterans, rural communities and low-wage workers.
Meanwhile, numerous studies from states that expanded Medicaid show clear results. These states experienced “significant […] reductions in uninsured rates, among the low-income population broadly and within specific vulnerable populations,” according to the Kaiser Family Foundation. Expansion states saw increased access to care and reductions in uncompensated care costs to hospitals and clinics. Some states project savings that will offset much of their expansion costs, while others project net budget savings.
The case is as clear as ever: full Medicaid expansion remains the best solution to cover as many Georgians as possible. Full expansion is both the fiscally responsible and moral option. Georgians cannot afford to have state leaders continue to put off this decision.
Taifa Smith Butler is executive director of the Georgia Budget and Policy Institute.
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