Some things endure. Among them are Medicaid and Medicare, which marked 50 years of existence last week. Even those who might be expected to reflexively decry any large federal programs now acknowledge that this duo have brought a measure of stability to the finances and healthcare of millions of Americans.
Which is worth considering as Georgia remains one of the states that’s steadfastly refused to expand Medicaid under Obamacare. Two successive U.S. Supreme Court decisions have, against the fervent hopes of opponents, upheld the Affordable Care Act as the law of the land.
Given that the deeply controversial, complex law that is Obamacare shows no sign at all of being uprooted into oblivion anytime soon, the debate in Georgia and other holdout states that have refused Medicaid expansion should turn from politics to pragmatism.
As in how to begin addressing that Georgia has the second-highest rate of uninsured residents in this country, according to a recent Gallup survey. As many as 600,000 people here are eligible for health coverage under the ACA. This, even as more than 400,000 Georgians have already bought health insurance through the federal government’s exchange. The state’s already-thin, if not threadbare, blanket of rural hospitals and clinics continues to feel the strain of too many patients who’re unable to pay. Such a situation should be unsustainable as measured by either fiscal cost or human suffering. We can, and should, do better.
Other Southern states have found ways to do so. They’ve acted to address the health care crisis in their states by finding ways to work within, if not around, the massive compilation of bureaucracy that is Obamacare. Arkansas, Arizona and Kentucky number among them.
The states that have shown enough boldness and political courage to act have seen notable improvements in the statistics that count. In the first six months after Arkansas found a way to cover more of its uninsured, the state saw a 46.5 percent drop in hospital admissions of uninsured patients and a 35.5 percent decline in uninsured emergency room visits.
Arkansas found a way to sign onto the system by devising a method of using public dollars to pay for private health insurance for the Medicaid-eligible. This “private option” Medicaid expansion has opened health care access to more than 233,000 poor Arkansans. This Republican-produced take on Obamacare was approved by Washington and has proven politically palatable while achieving an admirable public policy goal.
For its part, it’s tentatively encouraging that Georgia officials have also talked about asking the federal government for permission to “experiment” with Medicaid in a way that could bolster rural and safety-net hospitals. Authorization to pursue a so-called Section 1115 waiver was included in this year’s state budget, even as state leaders insist such a waiver wouldn’t be used to expand Medicaid.
We should not think small. If Georgia is successful in obtaining such a waiver, it should, like Arkansas and others, not limit itself in thinking broadly about ways to aggressively and responsibly reduce the number of uninsured residents. Doing so would yield societal health benefits and help make Georgia a more-competitive place to live and work.
Finding a fiscally workable way to insure more of the poor is hard, politically risky work, but our state’s leaders should not flinch from the task. The experience of other states with the ACA shows we’re far from alone.
Health care in America is a costly, complex, contradictory, bureaucratic and, yes, often-wasteful assemblage of many moving parts. In truth, that was the status quo long before the ACA was signed into law. It would remain the case if Obamacare were somehow, miraculously, repealed tomorrow.
That reality won’t change anytime soon. What can, and should, change in Georgia is finding a way to cover more of the uninsured as effectively and cost-efficiently as possible. Doing so will provide benefits to all of us, and not just those who would gain insurance cards for the first time.
About the Author
