Kemp’s health care waivers a matter of perspective

If Gov. Brian Kemp's plans to transform health care coverage in Georgia are approved, will they be a big help to thousands of Georgians who get new Medicaid coverage or lower premiums? Or will they leave thousands of Georgians without coverage and some vulnerable through skimpier plans?

It depends on who you ask. The cases for and against the waiver plans are diverse and strong, and they’ve rolled in to Kemp’s office in public comments over the past month, ending this week. After going through them and addressing them, his administration will forward the waiver proposals to Washington for review by the end of the year.

It remains to be seen how much the proposals will change as a result. Kemp has to take the comments into account, but he doesn’t have to agree with them.

To cap off the comment period, state Senate and House Democratic leaders gathered at the Capitol to once again say the waivers will waste money that should go instead toward full Medicaid expansion. Just as Kemp and his staff have laid out their cases for the waivers, the Democrats laid out their cases for opposition. Here are some of the top issues:


State House Minority Leader Bob Trammell of Luthersville pointed to the amount of state money Kemp wants to put toward the two waiver programs and noted it would only expand coverage to just over 80,000 people, most of them poor. After the program has ramped up to full force, Trammell said, estimates show its cost to the state at $215 million. For that amount of money, he said, the state could expand Medicaid to all the state’s poor, which some estimates put at up to 600,000 people. A state auditor’s report said the cost to the state of full Medicaid expansion to all Georgia’s poor would be about $188 million to $213 million. And to boot, full Medicaid expansion would pull in a huge Washington contribution of $9 in federal money for each $1 in state money, putting billions of new federal dollars into the state’s economy.

What Trammell didn’t point out was that the $215 million state cost in Kemp’s waivers would do something different than just pay for new Medicaid. That figure combines both of Kemp’s waiver proposals, and one isn’t much about the poor at all.

Instead, the second waiver proposal, by far the more expensive one, would help make premiums affordable to people who make too much money to qualify for a big enough subsidy on the Obamacare insurance market. Those people now must pay at or near the list price of insurance premiums, which have grown colossal. So the second set of proposals aims to lower premiums somewhat on the individual insurance market, which would both lure some people back into buying health insurance and lessen the burden on people who are keeping the insurance they already have.

The cost of work requirements

State Sen. Jen Jordan, D-Atlanta, pointed out that instituting a work requirement will cost money, and the state hasn’t disclosed how much. A new piece of bureaucracy will have to be created and funded to sort out what constitutes meeting the requirement and keep vetting people. She estimated that could cost $10 million to more than $80 million. In fact, a report by the U.S. Government Accountability Office said the five states that had attempted to implement work requirements so far had reported costs ranging from $6 million to $272 million just for the red tape.

Kemp’s aides say they have no estimate yet on what it will cost and any numbers thrown out at this point were speculation. Moreover, Kemp spokeswoman Candice Broce said, other states’ numbers can’t be used for Georgia. “Our waivers are unique to Georgia,” she said.

How many would receive access to Medicaid?

This is a matter of perspective. The numbers aren’t in serious dispute. But the language is.

From Kemp’s perspective, the plan offers access to health coverage to every poor Georgian.

From the Democrats’ viewpoint, it doesn’t.

What most riled the Democrats on Tuesday was the small number of poor people projected to enroll in Medicaid under the waivers: about 50,000, Kemp aides believe. Democrats say that’s a paltry slice of the half-million uninsured poor Georgians who would gain insurance under full Medicaid expansion under Obamacare. What plays a big part in whittling that number down under the Kemp plan is his requirement that enrollees show they’re working or engaged in specific types of community service. State Rep. Karen Bennett, D-Stone Mountain, called the requirement “unconscionable.”

She said the reporting requirement would be a roadblock for people without access to the internet and people unable to get themselves federally certified as disabled, such as many mentally ill homeless people. Many people also work in ways that don’t meet the requirement, for example as full-time caregivers for elderly family members.

Supporters of the plan have said there wasn’t enough money to be all things to all people. But they said some of those unenrolled might be motivated by the promise of Medicaid to rouse themselves to make it through the application process. State Senate Health Committee Chairman Ben Watson, R-Savannah, said that for caregivers, they can find someone else to take over caregiving for 20 hours a week so they can meet the working requirement at a qualifying job.

How much coverage is coverage?

Democrats also decried a portion of the Kemp waivers that isn’t getting much attention: It would help Georgians who want to get subsidized health insurance plans that don’t cover all the mandatory things that insurance has to cover these days, such as prescriptions, maternity care, mental health care and emergencies. For the Democrats who spoke Tuesday, that meant people might not get the coverage it turns out they need. And that would put that cost back on the hospitals that end up treating insufficiently insured patients.

For the supporters of the plan, it’s just allowing people to choose the product that they believe is right for them, and to save money in the process.