Gov. Nathan Deal has expressed concern that because Georgia did not expand its Medicaid program under Obamacare that the state could receive less money under the GOP health care proposal now working its way through the U.S. House than states that did add more people to the state and federal health care program for the poor and disabled. “As a governor, and a Republican governor, my concern is that states like ours that did not expand Medicaid coverage is that we not be punished, that we be treated fairly in the process of the reform,” Deal said Wednesday. (DAVID BARNES / DAVID.BARNES@AJC.COM)

Georgia leaders worry state may be ‘punished’ under GOP health care plan

As Gov. Nathan Deal raised concerns again this week that the U.S. House GOP health care plan could “punish” Georgia and other states that didn’t expand the Medicaid program, one of the state’s leading supporters of the plan urged patience.

U.S. Rep. Buddy Carter is Georgia’s sole member on the Energy and Commerce Committee, one of three House panels with jurisdiction over the plan known as the American Health Care Act, and he’s voted to approve the Obamacare replacement plan. Pressed on Deal’s concerns at the statehouse Wednesday, he said the measure is a work in progress.

“Certainly those concerns are legitimate. And that is one of the biggest hurdles we have to get over before we can get this bill finalized. Keep in mind, we’re only in the first phase,” the Pooler Republican said. “We want to make those states that didn’t expand Medicaid whole.”

What You Need To Know: American Health Care Act

The governor on Wednesday renewed his call to allow Georgia and other states to craft their own health care policies.

“What we’re finding out is what I knew all along: When you give somebody something for nothing, it’s going to be very difficult to take that away,” Deal said. “And those states that expanded their Medicaid rolls are finding it’s very difficult to take them off the rolls, they’re going to have to find some alternative. And that’s perfectly fine with me — as long as they don’t punish Georgia in the process.”

The imperiled measure is under attack on multiple fronts.

Democrats won’t play ball on crafting any bill that repeals the 7-year-old Affordable Care Act. Conservatives oppose the plan because it doesn’t go far enough in stripping away Obamacare’s framework. More moderate Republicans from states that expanded Medicaid are concerned about constituents losing health care coverage after the nonpartisan Congressional Budget Office estimated that up to 24 million fewer Americans would be covered under the GOP plan by 2026. Carter and other supporters, including Health and Human Services Secretary Tom Price, have cast doubt on the analysis. 

The House GOP plan, which has the backing of the White House, would allow the more than two dozen states that have expanded the Medicaid program to continue receiving the generous federal funding until 2020. But the enrollment under the expansion would freeze in 2020, meaning that states adding new residents to the rolls after that would do so without the federal government covering nearly all their costs.

Georgia and the 18 other states that have not expanded their Medicaid programs would split $10 billion over five years in “safety-net funding” under the GOP plan, according to the Kaiser Family Foundation. Critics say the states that did choose to expand the program under Obamacare would generally get far more from the federal government each year under the same legislation, which would provide an incentive to states that didn’t expand Medicaid previously to do so before the cutoff date in 2020.

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That puts Georgia in the tricky position of deciding whether to expand the program — despite repeated vows from Deal that he won’t — or accepting the likely smaller payout.

The way the Republican bill treats non-expansion states such as Georgia is one of the reasons why Carter’s Republican colleague, U.S. Rep. Barry Loudermilk of Cassville, says he cannot support the legislation in its current form.

“In Georgia we took a stand and said we weren’t going to expand the Medicaid rolls,” Loudermilk said. “We took the lumps, and yet (the GOP bill) is going to reward the states that didn’t by allowing them to continue to expand Medicaid, which further increases the rolls and the costs of this.”

At the suggestion of President Donald Trump, House Republican leaders have indicated their openness to tweaking the measure in order to make it more palatable to conservatives. Among the potential changes being floated is an earlier phase-out date for Obamacare’s Medicaid expansion.

Deal has said he’s still glad that Georgia refused to expand Medicaid because it would be too expensive in the long run, repeating a mantra of his 2014 re-election bid against an opponent who vowed to accept the federal money to grow the program. He told Georgia Health News his message was simple: “We want to be treated fairly.”

“As a governor, and a Republican governor, my concern is that states like ours that did not expand Medicaid coverage is that we not be punished, that we be treated fairly in the process of the reform,” Deal said Wednesday.

Carter said he had his own message for Deal and others concerned with the proposal.

“We will certainly respect the governor and whatever he and his staff and the Legislature decide to do,” he said. “But we are doing our best to bring about parity, to make those states whole and make it as even as we can between the expansion states and the non-expansion states.

Meanwhile, GOP dissent over the plan is mounting. State Sen. Chuck Hufstetler, a member of Lt. Gov. Casey Cagle’s health panel, said Georgia would be receiving “significantly less money” under the House plan than other states that expanded the program.

“It doesn’t seem that a state that has had a fiscally conservative plan should be punished while a state that has a more generous plan should be rewarded,” the Rome Republican said Wednesday. “But that’s how this plan seems to work.”

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