A screenshot for healthcare.gov, the federal enrollment website for health insurance under the Affordable Care Act, also known as Obamacare, on Nov. 9, 2019.
Photo: Hart, Ariel (CMG-Atlanta)
Photo: Hart, Ariel (CMG-Atlanta)

Opinion: Ga. should be all in on Medicaid expansion

Georgia is submitting a waiver to the Affordable Care Act; comments to the state are due by Dec. 3. However, instead of significantly expanding coverage to the half-million uninsured Georgians who could be covered by the ACA, the state is choosing to cover only 10% of them.

I’m the increasingly rare Georgia bird: a proven fiscal conservative and a social liberal. Take a picture before we go extinct.

I’m OK with expending tax money, but it has to be for a good cause — and we must budget for it. That’s why I support full Medicaid expansion as it was envisioned in the Affordable Care Act of 2009, along with the identification of increased state revenue sources.

Many Georgians are not aware that Georgia originally refused to accept federal money to expand health insurance via Medicaid. It was a major mistake on the part of both the legislature and the governor, especially in view of the fact that there was no matching requirement for the first 3 years.

The short-sighted, ideological views of our politicians caused our federal tax money (billions) to be spent in New York, California, and other states, rather than here. According to www.HealthInsurance.Org: “From 2013 to 2022, $152 billion in federal taxes will be collected from residents in states not expanding Medicaid and will be used to fund Medicaid expansion in other states”.

Here’s the current situation. Despite the extreme efforts of the Trump administration to sink the ACA, it has succeeded. In 2018, only 8.5% of Americans were uninsured all year long versus a much higher figure in 2009. It should be noted that, due to the administration’s efforts, 8.5% is a rise from 7.9% in 2017. The number of people on Medicaid dropped 0.7% in 2017.

Georgia has the third-highest rate of uninsured in the nation, 13.7%. Medicaid expansion caused the rate of uninsured to go down dramatically in two-thirds of the states while ours has not. Only Oklahoma and Texas have higher uninsurance rates.

Why are we among the worst? The short answer is partisan politics; all of the 17 states that have refused to expand are red, including every Deep South state. However, a number of them are now reconsidering.

And, it’s not too late to change the situation in Georgia. In early 2019, Georgia’s legislature and governor finally made a commitment (SB 106) to apply for a Medicaid waiver to expand here. Kemp and the legislature are to be commended for seeing our crying need.

However, despite their pledge, the waiver appears headed in the wrong direction. The purpose of Medicaid expansion is to provide insurance coverage, but the overly complicated waiver proposed by the governor doesn’t do that to the extent it should. It would cover only 52,000 more, while full expansion could possibly cover 10 times that number.

The ACA calls for everyone under 133% of the poverty level to be covered, while Georgia has reduced that to 100% of the poverty level. Utah asked to do the same earlier this year and was rejected by CMS (Medicare/Medicaid).

Georgia also intends to have a work requirement of 80 hours a month. Again, there’s not mention of a work requirement in the federal law, which is not designed to decrease unemployment but only to provide insurance coverage for the poor. The courts have therefore blocked the work requirement in other states.

I view healthcare as a right. Georgia should have full Medicaid expansion. But, 10% of the cost is on the state and it must be funded. Here’s how:

  • Move to a more progressive state income tax whereby the very wealthy pay a higher percentage of their earnings
  • Legalize and heavily tax marijuana, as did Colorado and others
  • Legalize and heavily tax casino gambling, as did Alabama, North Carolina, Louisiana and others
  • Increase our gas tax (for example, Florida is a third higher)
  • Increase our very low state sales tax (for example, Mississippi is 50+% higher)

Georgia is currently a low tax state compared to many others. Even after implementation of these recommendations, it will still be a relatively moderate tax state overall.

It’s not possible in this short commentary to go into great detail as to costs and funding sources. But funding full Medicaid expansion is financially feasible, if we have the will. Our choice is to let lower-income people go without needed healthcare. Is that what we really want?

Send your comments on the inadequacy of the state waiver before 12-3-19 by clicking here: medicaid.georgia.gov/patients-first-act-public-comment

Jack Bernard is a former hospital executive and Republican county commission chairman.

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