Georgia Gov. Nathan Deal's office had no immediate comment on the Senate health bill, but he had deep concerns about the House version. This story was published on March 28, 2017.
Gov. Nathan Deal's administration is exploring changes to Georgia's Medicaid program after a sweeping Republican overhaul of the Affordable Care Act was scuttled last week in a stunning rebuke to Donald Trump and Congressional leaders.
The collapse of the GOP health plan has reignited debate in Georgia and other red states over whether to expand Medicaid — the health program for millions of poor Americans — a move they’ve long rejected as too costly.
On Monday, Deal said the state would review health care options that could include changes to “mandated minimum coverage” provisions that require Medicaid to cover a range of health services to recipients.
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“Those are areas that some would like for us to explore,” Deal said, without going into specifics, “and I think we have the possibility of doing that within the context of our Medicaid program.”
Major changes aren’t expected this year, and conservative lawmakers who have been skeptical of any measure that would enlarge Georgia’s Medicaid rolls would likely need to sign off on any overhaul. But the governor’s remarks offer a glimpse of how the state could proceed after the collapse of the House GOP health care plan. The failure of the GOP to pass their own bill means that the Affordable Care Act - also known as Obamacare - will remain in place, at least for now.
‘The right option’
Since last summer, some conservatives have joined Democrats and consumer advocates in calling for the state to explore expansion options under Obamacare. Enlarging the Medicaid program would bring in billions of dollars in new federal funding that, they say, could help shore up the state’s ailing rural health care system.
One option other Republican-led states have embraced to expand their Medicaid programs on their own terms is known as a Section 1115 waiver. Arkansas, for one, used a waiver to let people on Medicaid buy private health insurance. In Vice President Mike Pence's home state of Indiana, a waiver allowed the state to require certain Medicaid recipients to pay modest premiums and contribute to health savings accounts.
“The health care challenge is real and needs attention,” said state Rep. Scott Holcomb, D-Atlanta. “All too many do nothing more than yell and complain. We should expand Medicaid and work to reduce our population of under-insured Georgians.”
Georgia’s Medicaid program provides health coverage to about 2 million poor children, pregnant women, the elderly and disabled. Expanding it would add roughly 600,000 people to the rolls, most of them men and women without kids. Under Obamacare, the federal government would pay 90 percent of the cost of people newly eligible under an expanded program.
Nationwide, more than two dozen states have expanded Medicaid under Obamacare, while Georgia and 18 others have not.
Expansion supporters say if Georgia wants to grow Medicaid, it needs to do it right. Some of the requirements other red states have woven into their expansions, such as requiring co-pays and premiums, could be a barrier to coverage, said Laura Harker, a health policy analyst with the left-leaning Georgia Budget & Policy Institute.
It has to be “the right option to make sure people stay enrolled and have coverage,” she said.
In 2015, Georgia flirted with a wide-ranging waiver under President Barack Obama's administration that would have sought more Medicaid money, but the state later quietly abandoned those discussions.
The demise of the GOP health care proposal appears to have revived those discussions. And this time, Georgia officials would be appealing to a familiar figure to sign off on the changes: Former Georgia Rep. Tom Price, now Trump's health secretary.
Although Price doesn’t have the power to transform Medicaid funding into the lump-sum block grants that state leaders have long sought, he has broad discretion to make other changes to health care funding that could be more politically acceptable for conservatives.
Price could, for instance, allow states to require that people newly enrolled under expansion be looking for work or undergoing job training – a conservative idea that the Obama administration rejected, said Bill Custer, a health care expert at Georgia State University who has argued that expanding Medicaid in Georgia makes fiscal sense.
With statewide elections looming in 2018, Deal’s administration signaled talks over Medicaid would likely wait until next year. His administration said it would seek legislative approval before making any major changes to the program, and lawmakers have no plans to tackle that debate in the final stretch of the legislative session that wraps up Thursday.
“We are exploring a variety of solutions that bring Georgians greater flexibility and access to care,” said Deal spokeswoman Jen Talaber Ryan. “No specific proposals have been decided upon, but he will continue working with members of the General Assembly to evaluate all options.”
Georgia lawmakers in 2014 passed legislation that gives the Legislature the final say over any expansion to the Medicaid program. Provisions were slipped into the last three budget plans allowing the state to pursue a specialized Medicaid waiver, but no such authorization was put in this year’s spending law.
“We will be looking at those possibilities,” Deal said, offering no particulars about the state’s review. “We have not formulated any proposal at this time, but the waivers will be primarily restricted to our Medicaid program.”
Deal said he has no regrets over not expanding the state’s Medicaid program, which he and other critics have said would be too costly in the long run. And he and other state leaders did not lament the failure of the GOP plan last week.
The governor had repeatedly urged Congress not to "punish" Georgia and other states that refused to expand Medicaid, as the proposal would have rewarded states with more generous Medicaid funding.
‘We need to reevaluate’
If Deal’s administration embraces Medicaid waivers, he would have backup from some legislative leaders.
State Sen. Renee Unterman, a Gwinnett Republican who chairs the Senate Health Committee, singled out the state’s practice of funding Medicaid reimbursements for dentists, pediatricians and other health care providers.
“We need to reevaluate where we are,” said Unterman. “The question becomes, do you continue to go down that road and ignore the other avenues? No. We’ll continue to look at these waivers.”
She’s one of the leaders of a panel formed by Lt. Gov. Casey Cagle that has also vetted several waiver options for Georgia. With the Affordable Care Act locked in as the law of the land for the foreseeable future, she said, it’s time for some tough fiscal decisions.
“I don’t think we can continue down the same path we’re on now,” she said.