Georgia’s refusal to expand Medicaid will create the “worst of all worlds” for poor, working parents — leaving many ineligible for either the government health program or financial help to buy private insurance, the Obama administration’s top health official said Tuesday.
Georgia lawmakers and its governor need to take a hard look at what rejecting the expansion will mean for Atlanta, U.S. Health and Human Services Secretary Kathleen Sebelius said in an interview with The Atlanta-Journal Constitution.
“To just leave people without health coverage at all — who will continue to come through the doors of emergency rooms, continue to be unproductive workers, continue to be in jails or under bridges — is really a scenario that just makes no sense,” said Sebelius, who has been in Atlanta this week. She noted that the federal government initially would pay the full cost of expanded Medicaid eligibility.
Gov. Nathan Deal, who ardently opposes expanding Medicaid under the Affordable Care Act, fired back through spokesman Brian Robinson: “Unlike the Secretary’s boss, the governor of Georgia can’t and won’t print money or deficit spend,” he said. “We’ve said all along that we cannot afford expansion and the administration has refused to work with Republican governors on a workable path.”
Deal contends the Medicaid expansion move would cripple the state budget.
A key element of the health care act’s effort to extend coverage to all Americans, the expansion would have brought an estimated 650,000 more low-income Georgians into Medicaid.
Sebelius pointed out that the federal government would pay the full cost for the first three years and no less than 90 percent after that. In turning down the expansion, Georgia has turned down $40 billion in federal funding over a decade and left affordable coverage out of reach for its low-income residents, she said.
Deal has estimated the expansion still would cost the state $4 billion over 10 years.
Atlanta was Sebelius’ latest stop on a national campaign to strategize with local elected officials and community leaders about how to educate consumers about another key aspect of the health care law, insurance “exchanges” where the uninsured are supposed to be able to shop for affordable coverage.
In addition to refusing the Medicaid expansion, Georgia also has declined to set up its own exchange, leaving that task to the federal government.
The Medicaid expansion was supposed to extend coverage to Americans with incomes up to 138 percent of the poverty level, or about $26,300 for a family of three. But the U.S. Supreme Court’s ruling on the law last year made the expansion optional for states.
While some low-income Georgians may be able to qualify for federal subsidies to buy insurance on the new exchange — scheduled to be up and running Oct. 1 — those who make less than 100 percent of the poverty level won’t because the way the law was written assumed they would be covered by the Medicaid expansion.
Robinson, the Deal spokesman, said in a statement that the governor encourages Sebelius to allow Georgia to turn its Medicaid program into a so-called “block grant” program. A block grant would limit federal dollars for Medicaid to a lump sum but come with fewer restrictions on how it must be spent.
The Obama administration opposes that idea out of concern it would lead to fewer people covered.
Sebelius said she remains optimistic that Georgia and other states that have rejected the Medicaid expansion will eventually choose to do so. States are able to opt in or out of the program at any time, though the federal government will only pay the full tab in 2014, 2015 and 2016.
Meanwhile, federal officials face tight deadlines to launch insurance exchanges in the 34 states that chose not to build and run the websites themselves. The exchanges will cater to consumers who don’t get health insurance through work, including the unemployed, the self-employed and students.
Late last month, Georgia Insurance Commissioner Ralph Hudgens asked Sebelius for a 30-day delay in approving insurance rates for health plans that private insurance companies are proposing to sell on the exchange. Hudgens said that the plans could increase insurance rates by up to 198 percent for some Georgians. Hudgens eventually approved the rates after failing to receive a response.
Asked about the issue Tuesday, Sebelius said that in many states competition among insurance companies is leading to lower rates than originally expected and that federal subsidies many consumers will qualify for will help make coverage affordable.
“It is a wildly erroneous calculation to say people are going to see rate increases that are that high,” she said. “I have no idea how he got those numbers.”
Hudgens’ responded: “I hoped Secretary Sebelius would respond to our request and delay the implementation of the exorbitant rates that were forced on our citizens. Instead she is ignoring credible reports from Georgia and other states — showing that she has succumbed to Obama’s Washington D.C. wishful thinking.”
“Day by day we are witnessing delays and failures in the rollout of Obamacare,” he added in a statement.
There is no question that getting the exchanges open is a huge undertaking and that the deadlines are tight, but the Obama administration is on track to meet the October deadline, Sebelius told the AJC. Plans bought through the exchanges will take effect Jan. 1.
Sebelius added that some elected officials and other leaders are helping to get the word out about the exchanges.
Kenneth Prince, head of at grants and contracts at Saint Joseph’s Mercy Care in Atlanta, said he is focused on educating people about the exchanges but hopes the state may opt to expand Medicaid in the future. Mercy Care recently received nearly $200,000 to hire workers who will help consumers learn about the exchange.
“Other states have changed their positions based on what they have learned,” he said. “We’re not giving up on Georgia.”
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