The already slim chance that Georgia may someday expand its massive Medicaid program under the Affordable Care Act dwindled even further Monday.
House lawmakers approved proposed legislation that would strip Gov. Nathan Deal of the power to expand Medicaid — a critical element of Obamacare's mission of insuring millions of low-income Americans. Instead, House Bill 990 would place that decision in the hands of the General Assembly.
The legislation is one of two controversial bills targeting the Affordable Care Act that cleared the House. The other, House Bill 707, would, among other things, force Georgians who run into problems with the health care law to seek help from the IRS or another federal agency instead of turning to their state leaders.
"(The Affordable Care Act) is one of the most egregious federal laws of our time," said Rep. Jason Spencer, R-Woodbine, who sponsored HB 707. "The prohibitions I am offering in this bill protects state resources."
A crucial juncture for both bills, Monday marked Crossover Day at the Georgia Legislature, when most legislation must clear one chamber or the other to have a chance at becoming law this year.
HB 707, which passed by a vote of 115 to 59, would bar any state or local government or agency from creating a health insurance exchange, or navigator program to help Georgians sign up for insurance through the federal Health Insurance Marketplace. It would also prevent Georgia’s insurance commissioner from investigating any health insurance complaints tied directly to the federal law, which Spencer admitted would mean people would instead have to turn to federal instead of state officials for help.
Obamacare supporters decried both bills, which will now go to the Senate for debate.
"It forgoes what is good public policy in the name of good politics," said Rep. Pat Gardner, D-Atlanta, of HB 990, which passed 118 to 57. "It is our responsibility to try to make the Affordable Care Act better and implement it well."
Deal, a staunch Obamacare opponent, has steadfastly rejected Medicaid expansion, saying the state can’t afford to broaden a program that is already overwhelmed and inefficient.
Medicaid expansion would extend coverage to an estimated 650,000 low-income Georgians, many of them adults under the age of 65 who don’t have children. The program currently covers about 1.7 million children, pregnant women, the elderly and disabled.
Expanding the government health program for the poor would have major implications for the state's budget and economy and needs to be carefully debated, said Rep. Jan Jones, R-Milton, who sponsored the bill.
“Gov. Deal wisely rejected Medicaid expansion,” Jones said. “Georgia cannot afford to expand Medicaid on many levels, but cost is the most obvious.”
Broadening Medicaid would cost Georgia about $2.8 billion, Jones said. Supporters argue the true cost of expansion would be lower and the state can’t afford to turn down the more than $30 billion in new federal funding it would bring over a decade.
While Medicaid expansion is a pillar of the health care law, the Supreme Court in 2012 ruled that the federal government couldn’t force states to move forward with it. Georgia is among 19 states that have rejected the expansion. Half of states are expanding, while six others are still debating the move, according to the nonprofit Kaiser Family Foundation.
For those moving forward, the federal government will pay 100 percent of the costs for the first three years with its share declining to no less than 90 percent thereafter.
Obamacare opponents, however, warn the federal government is already beleaguered with mountains of debt and can’t be depended on to uphold its part of the bargain. They also say the state shouldn’t expand a program that already costs too much and is inefficient.
Expanding Medicaid without getting to the root of its problems is "fiscally and morally irresponsible," said Rep. Edward Lindsey, R-Atlanta, who supported both bills.
If Georgia doesn’t expand Medicaid, its tax dollars are going to go to pay for expansion in Kentucky, Arizona and other states that are moving forward, Gardner said Monday.
Expansion would cost Georgia $350 million over 10 years, once new revenues fueled by the expansion are factored in, said Tim Sweeney, a health policy expert with the left-leaning Georgia Budget and Policy Institute. HB 990 is just another barrier to expansion, Sweeney said.
At the end of the day, the debate needs to be about whether and how to ensure poor Georgians get the health care that they need, not just about who makes the ultimate decision whether to expand, Sweeney said.
“If Georgia is not going to expand,” he said, “there should be some solutions put forward as to what the alternative is to address these issues.”
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