State eyeing Medicaid expansion options


The Atlanta Journal-Constitution is closely following the effects of the Affordable Care Act in Georgia. Gov. Nathan Deal has said the Medicaid expansion called for in the law is too expensive longterm and that the state will exercise its right to opt out. Advocates for the expansion say that wastes the chance for significant federal funding and leaves hundreds of thousands of Georgians without health coverage.

Gov. Nathan Deal has for months argued that the state can’t afford to expand its already-strained Medicaid program to include at least 650,000 more Georgians. His administration, though, is quietly studying ways other states are expanding in case an alternative emerges.

Deal’s aides said budget analysts are just doing due diligence to ensure their decision makes financial sense, not to find the governor wiggle room. Advocates of the expansion, an element of President Obama’s health care overhaul, hope the review is a sign Deal may be rethinking his opposition.

The governor, in an interview Tuesday, didn’t rule out ever reconsidering Medicaid expansion, but he said the door remains shut “for now.”

“I don’t know what the future holds,” Deal said. “I do think that this is an issue that Congress is going to be required to revisit, because much of the Obamacare legislation is beginning to unravel.”

The issue came up earlier Tuesday when Deal’s health policy adviser, Katie Rogers, spoke at a Children’s Advocacy Network event. Asked about the Medicaid expansion, she said analysts run the numbers on a range of expansion models, including a novel approach embraced by Arkansas that has piqued the curiosity of conservative leaders. That plan would pay for new Medicaid enrollees to buy coverage from private insurers through a government-run marketplace expected to open in January.

“We are reworking the numbers, looking at different models like the Arkansas model. We’re never going to stop looking,” Rogers said. “Just saying ‘no’ is not an option.”

Medicaid now covers 1.7 million low-income Georgians, mostly women who are pregnant, children, the elderly and disabled. In Georgia, an expansion would mean extending coverage to include single adults.

Critics of Deal’s stance say refusing the expansion will leave insured Georgians footing the bills for the uninsured through higher hospital bills and premiums. About one in five Georgians is uninsured.

Expansion advocates also say refusal to join the expansion will mean the state turning its back on federal funding of as much as $40 billion over 10 years, including full funding of the expansion for the first three years.

But tea party groups and other conservatives see it as a line in the sand that no Republican candidate should cross. They cite official state projections that it will cost Georgia taxpayers $4.5 billion over a decade, though some experts put the pricetag at closer to half that.

Deal was reminded of that hard-line opposition on Tuesday when Debbie Dooley, a prominent tea party activist, praised his stance at an anti-tax rally at the statehouse. She expressed pride that “Georgia has a governor that said, ‘No, we’re not going to expand Medicaid’” as a crowd of about 100 sign-waving supporters cheered on Deal.

“We’ve got to oppose expansion,” said Jennifer Hulsey, a tea party activist with the Georgia Grassroots Coalition. “We just can’t afford to pay it.”

Deal spokesman Brian Robinson said the reviews mentioned by Rogers merely show that Deal’s aides have vetted their options and nothing changed their perspective.

“The administration does its due diligence to study the issue from every possible angle,” Robinson said. “Nothing changes the fact that as long as the state is on the hook for ballooning costs, the governor is going to say no.”

But Tim Sweeney, a health policy analyst at the left-leaning Georgia Budget & Policy Institute, said he hopes the reviews are a sign the governor is listening to people who want him to broaden the program.

“Any movement toward reconsidering the expansion is a good thing,” Sweeney said.

Obamacare originally required states to expand Medicaid in 2014 as part of its goal of insuring virtually all Americans, but last year’s Supreme Court ruling on the law allowed states to opt out.

Despite the full federal funding the first three years and 90 percent funding after that, many Republican governors worry that the debt-strained federal government won’t be able to uphold its part of the bargain. Only a handful of states with GOP governors plan to expand.

Holdout states can choose to expand later but may not get as much federal funding.

Medicaid now costs Georgia roughly $2.5 billion annually. Meanwhile, hospitals shell out hundreds of millions of dollars in free care to uninsured patients — hiking bills for paying patients to make up for the loss.

As key parts of Obama’s healthcare overhaul are set to kick in next year, a divided Congress will likely grapple with more changes to the controversial law. How that affects Georgia’s healthcare outlook is an open question, the governor said.

“As the costs associated with the implementation of the legislation kick in full-speed next year, I have a reason to believe that Congress is going to have to revisit the issue,’ said Deal. “And what their revisiting will bring to us is impossible to know.”