Gov. Brian Kemp unveiled legislation Wednesday that could remake health care for hundreds of thousands of Georgians. Or just a few.
The Patients First Act would give the governor wide latitude to approve a range of options in pursuit of federal “waivers” with the aim of improving government-funded health care access for the poor and middle class.
That could mean something close to expanding Medicaid to cover hundreds of thousands of poor Georgians who currently have no health insurance. Or it could mean small, tailored pilot projects that stabilize insurance premiums and offer more focused mental health services.
The legislation was accompanied by a show of Republican force: Lt. Gov. Geoff Duncan and House Speaker David Ralston both signaled their support for the plan, and Duncan stood by Kemp as he unveiled it. Most of the Republicans in the state Senate co-sponsored the legislation.
But no Democrats added their names to the bill, and there was little sign of bipartisan support for the idea. Several Democratic leaders said they would support nothing short of full-scale Medicaid expansion and worried that the measure gives Kemp too much power over the process.
The governor pushed back on those concerns, telling reporters he wants to find a way “that’s focused on Georgia.” He added that he’s mindful of the broad leeway the legislation gives him, including the final sign-off on any agreement proposed to the federal government.
“It is giving me the authority to do this, and I take great responsibility with that,” he said. “But I’m not trying to be the Lone Ranger on this — we’re all in this together, we’re all working to together to tackle all the issues we have.”
He also vowed the process wouldn’t lead to outright expansion of the Medicaid program, something he campaigned against during the governor’s race. He has said such an expansion, which analysts say would add more than 500,000 Georgians to the state’s rolls, could be too costly in the long run.
The process could lead to a more limited expansion of the program, but Kemp said it’s too early to determine what that would look like.
“Look, everybody keeps talking about Medicaid expansion. We are working on a couple of things here. We want to lower private-sector health care costs — that’s what’s killing hardworking Georgians out there,” he said. “And we want to innovate a health care system that’s not working.”
‘This is bigger’
Kemp’s administration wants the waivers, first reported by The Atlanta Journal-Constitution last week, to gain federal approval by next year. They would cover two groups of people.
The first category includes very poor people with incomes up to the poverty level, which in 2019 is about $12,000 for a single individual. The legislation forbids the waiver proposal from covering Georgians who make above that level, though some are already eligible for other forms of cheap or free coverage.
The other group involves those who use the Affordable Care Act’s exchange market to buy private health insurance. A separate waiver, if approved, could allow the state to set up some kind of fund to keep those ACA plans from undergoing such big price spikes.
The Kemp administration is already facing pressure over how to tailor the Medicaid waiver. The left-leaning Georgia Budget and Policy Institute outlined a range of recommendations that call for year-round enrollment and no work requirements, which analyst Laura Harker said could ultimately jeopardize access to care.
Some conservatives want work requirements embedded in the program, but with exemptions that cover people who are caring for children or the elderly. Others oppose any step toward growing the program, fearing it will help prop up the federal Affordable Care Act, or Obamacare, and put Georgia taxpayers on the hook for more long-term costs.
Those concerns were aired last week during a debate over the $1 million Kemp included in his budget proposal to finance the consultant to devise a waiver plan. House Speaker Pro Tem Jan Jones, R-Milton, cautioned against adding “an entirely new entitlement program” that could shift state dollars away from education and other priorities.
Both sides of the debate have fresh fiscal numbers to use: The cost of full Medicaid expansion would be about $200 million a year, according to an estimate state analysts prepared earlier this year.
That amount would be matched 9-to-1 by the federal government, pouring billions of federal dollars into the state’s health care industry. The audit projects as many as 535,000 newly eligible Georgians would join the program by 2022, along with 40,000 other people who are already eligible.
But if the bill passes with the limit of covering only those who make up to 100 percent of poverty level, that actually has the potential to cost the state more money than full expansion. Under full expansion, covering those who make up to 138 percent of the poverty level, states receive a special deal and only have to pay 10 percent of the cost while the feds pay the rest. If the program covers fewer people, the portion the state has to pay can go much higher.
“Any discussion on health care is a positive step,” said Senate Minority Leader Steve Henson, D-Stone Mountain. “But I have concerns about the governor’s bill since it only helps people at 100 percent of poverty. I’m disappointed he’s not looking at helping as many people as possible. It’s very limited and unimaginative in scope. But I’m looking forward to talking with the governor’s staff about what’s next.”
Pressure has built on Kemp since his narrow November election victory to take action. AJC polls have consistently shown that more than 70 percent of Georgians support expanding Medicaid coverage for the poor. And a growing number of Republican leaders, unnerved by a spate of election losses across Atlanta’s suburbs, are embracing the idea.
The figures behind the Senate measure reinforce that narrative. State Sen. Blake Tillery, a conservative from rural Vidalia, is the main sponsor of the bill. But one of his top allies is state Sen. Kay Kirkpatrick, a Marietta physician who is one of only two GOP women in the Senate — and among a small number of suburban Republicans in the chamber.
“This is bigger than just getting everyone covered. We have to work on making the whole system better,” said Kirkpatrick, who suggested the waiver process could partly focus on expanding mental health coverage. “This is a way to get the ball moving.”
Democrats, meanwhile, say nothing short of full-on Medicaid expansion will suffice. They pitch it as an economic boost — some studies have shown it will help spur tens of thousands of new jobs — as well as help bolster Georgia’s financially struggling rural hospitals.
“This doesn’t go far enough,” said House Minority Leader Bob Trammell, D-Luthersville. “They’ve contorted it so that it will be more expensive, cover fewer people and take longer than Medicaid expansion. That’s the trifecta.”
Other Democrats had a more guarded reaction. Stacey Abrams, who was narrowly defeated by Kemp in November, criticized Republicans for supporting a “pale facsimile” of Medicaid expansion but applauded the GOP for taking a step that could eventually add more people to the rolls.
“I think they listened to communities that are losing jobs, losing opportunities, and people who are losing their lives,” she said after a rally in Gwinnett County. “I don’t care why they came to the party. I’m glad they finally showed up, and I hope they finally do the right thing now that they’re here.”
It was also welcomed by the small group of Republicans who bucked party lines to call for an expansion. Among them is state Sen. Chuck Hufstetler, an anesthetist from Rome who said Georgia should look to Indiana, which included work requirements as part of a Medicaid expansion, as a model.
“It’s a positive step in the right direction,” he said. “We’ve seen what’s worked in other states, and we need to move toward a preventive health care system.”