Georgia lawmakers’ frigid response to Medicaid expansion may be thawing a bit, though legislative leaders and the governor remain staunchly opposed to the idea.
At least three state legislators have said publicly in recent weeks that fellow lawmakers should consider Medicaid expansion as they search for ways to address Georgia’s uninsured problem. Nearly one in five Georgians doesn’t have health coverage; expanding Medicaid, as called for by the Affordable Care Act, would extend coverage to hundreds of thousands of low-income residents.
It would also help struggling rural hospitals stay afloat, Sen. Chuck Hufstetler said. The Rome Republican said he believes there will be hearings on the issue during the current legislative session, but it’s too soon to tell whether any legislation will surface.
The willingness of some Republicans to take a second look at expansion is inspired by other red states that have found ways to take advantage of the billions flowing out of Washington for growing Medicaid.
Health and Human Services Secretary Sylvia Burwell, visiting Atlanta on Friday, said she is in continuing talks with governors who are exploring expansion plans. (She has not spoken with Georgia’s governor.)
“Each state has certain needs and different plans and different approaches,” Burwell said during a visit to a health center here. “We are willing to have that conversation about flexibility.”
Sen. Dean Burke, R-Bainbridge, said he thinks Georgia lawmakers are more open to discussing expansion this year. That’s due in large part to the crisis facing rural hospitals, Burke said. Eight rural hospitals in Georgia have shut down since 2001, dozens more are losing money at an alarming rate.
“People are realizing something has to give,” Burke said.
‘My greatest fear’
Opposition to Medicaid expansion remains unyielding, however, in Georgia’s Republican-dominated Legislature. And though some lawmakers may be talking about the idea, there is no sign of any serious expansion effort as of yet this year.
A pillar of the health care law, Medicaid expansion was supposed to extend health care coverage to 17 million Americans with incomes up to 138 percent of the federal poverty level, or about $27,300 for a family of three. But the U.S. Supreme Court ruled in 2012 that the federal government couldn’t force states to expand the program. So far, 27 states and the District of Columbia have opted to expand.
Gov. Nathan Deal has long said the state can’t afford to expand a program that’s already too expensive, bloated and dysfunctional. Obamacare opponents also argue that there’s no guarantee the debt-laden federal government will honor its pledge to pay 90 percent of expansion costs.
“That’s my greatest fear about Medicaid expansion,” said Sen. Renee Unterman, R-Buford, who opposes expansion. “How can you plan … not knowing you have stability coming down from the federal government?”
Unterman added that she believes the issue has already been debated plenty, and that the governor has made it clear that’s not the direction the state needs to go.
Instead of hearings on Medicaid, lawmakers should focus on alternative solutions for Georgia’s rural hospitals, she said, such as funneling more money into the state’s trauma care network.
Flexibility for states
Last month, Tennessee’s Republican Gov. Bill Haslam unveiled a Medicaid expansion plan he says won’t cost the taxpayers any extra money. Utah’s Gov. Gary Herbert, meanwhile, is pushing for his own twist on traditional Medicaid expansion, which would help low-income residents enroll in private health coverage. And most recently, Alaska Gov. Bill Walker, an independent, said in his state of the union speech that he plans to pursue expansion.
Many of the red states moving forward are getting special approval, called a “waiver,” from federal health officials to experiment with alternatives to traditional Medicaid, said Joan Alker, a health policy expert at Georgetown University. Arkansas, Iowa, Pennsylvania and Michigan have all received waivers. Indiana is awaiting federal approval of its waiver.
Each state’s approach is unique, though some share common themes, such as a requirement that policy holders pay something for their coverage. Another popular idea: using Medicaid dollars to buy private insurance, Alker said. Rep. Bruce Broadrick, R-Dalton, said he thinks the state should look at waiver possibilities but be very cautious. Georgians need to direct their own future, not become too dependent on federal dollars that could disappear down the road, he said.
‘Keep talking about this’
For now, Democrats and Obamacare supporters remain hopeful that a Georgia-based solution to the Medicaid dilemma will eventually take shape.
The fact that any legislators are talking about it at all is very encouraging, said Tim Sweeney, a health policy expert at the left-leaning Georgia Budget & Policy Institute. “It shows, if nothing else, a window to keep talking about this.”
People need to continue to put pressure on the leadership of this state, said Rep. Pat Gardner, D-Atlanta, who supports expansion.
“Will it be different this year?” she said. “I wish I could think so.”
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