Georgia business leaders revealed on Wednesday three Republican-friendly alternatives to expanding the state’s Medicaid program — a move that would extend health coverage to hundreds of thousands of poor Georgians and bring billions of dollars in new federal funding to the state.
The proposal by a Georgia Chamber of Commerce task force comes as some conservative state legislators have begun to reconsider their once-staunch refusal to expand Medicaid under the Affordable Care Act. That softening of opposition is fueled in part by the ongoing crisis facing Georgia’s rural health care system. Five rural hospitals have shuttered since the beginning of 2013.
Meanwhile, Georgia’s uninsured rate has remained one of the highest in the nation in the post-Obamacare era at 16 percent, while other states that embraced Medicaid expansion have seen dramatic drops.
The three expansion options proposed by the task force would cover people — most of them adults without children — who make less than the federal poverty level. They also include features aimed at increasing consumer responsibility, such as requiring premiums and co-pays, that may please many Republican legislators, who are clearly the target of the effort.
The options present a playbook for lawmakers looking for a fiscally responsible and sustainable path to covering Georgia’s uninsured, addressing the rural health care crisis and bolstering the state’s safety net hospitals, Chamber CEO Chris Clark said in a statement.
“That’s important not just to the health of our families but also to the health of our economy, because no good jobs are going to come to a region that lacks access to quality health care,” Clark said.
Currently, the state’s Medicaid and PeachCare for Kids programs provide health coverage to more than 2 million low-income Georgians, most of them children, pregnant women, the elderly and the disabled, at a cost to the state of roughly $2.8 billion.
Expansion would add at least 500,000 or more enrollees to Medicaid, though the federal government would cover 90 percent of the cost.
The Chamber task force did not release an enrollment estimate, a price tag or projected savings for its three expansion proposals. Those figures will come later in the year, the group’s leaders said.
The Chamber’s proposals reflect Georgia’s conservative values and its desire to care for the needs of its citizens who don’t have health insurance, state Sen. Renee Unterman, R-Buford, said in a statement Wednesday. Unterman, who chairs the senate health committee, is working with a small group of Republicans to push for expansion.
“We can no longer close our eyes and hope this problem of accessibility goes away,” she said. “We can no longer prop up our current budget with only state medical care dollars.”
The ‘Georgia Way’
Medicaid expansion under the Affordable Care Act has been adopted by 31 states, the latest being Louisiana. While most have expanded the program as is, some Red states, such as Arkansas, have received special approval from federal health officials to try other approaches.
In Georgia, Republican Gov. Nathan Deal and leaders in the GOP-dominated General Assembly have so far opposed expansion, citing the costs to the state.
But the alternatives laid out by the task force may make expansion more palatable to Republicans.
The first option presented by the group would cover the fewest people.
It would extend Medicaid coverage to adults without kids who make less than than the federal poverty level ($11,880 for an individual).
The other two options presented would increase eligibility to adults earning up to 138 percent of the federal poverty level ($16,394 for an individual), as originally envisioned by the Affordable Care Act.
One would enroll all beneficiaries up to that income level in Medicaid, while the other would place those who earn above the 100 percent threshold in a private insurance plan (paid for by Medicaid). Even the plan with the strictest eligibility would still cover up to 565,000 people, task force spokesman Brian Robinson said in June.
“The ‘Georgia Way’ should present the most conservative, most sustainable pathway under U.S. law to close the coverage gap and to save or improve our health care provider network,” according to the task force blueprint.
Features of all three Georgia options include cost-sharing by patients; health savings accounts; the “skinniest’’ Medicaid benefit plan possible; and intensive behavioral health care for former inmates leaving prison.
It also would extend statewide a work requirement for Georgians to get food stamp benefits. Currently, Georgia plans to extend that requirement from three counties to 24.
Debate ahead
The task force, which included hospital industry leaders, physicians and insurance company officials, aims to ignite debate in the General Assembly during the legislative session starting in January.
“All Georgians and Georgia businesses are affected by this uninsured burden through higher health insurance premiums and the corresponding cost shift on employer-sponsored health insurance,’’ said Earl Rogers, president of the Georgia Hospital Association.
Robinson said the next phase of the group’s effort is to discuss the plan with the governor’s office and key lawmakers.
“There’s a growing acknowledgment that we have to do something,’’ Robinson said.
“We’re going to keep a close eye on every penny and emphasize personal responsibility,’’ he added.“No plan that doesn’t pass Republican muster is going to get consideration.”
House Minority Leader Stacey Abrams, long an outspoken expansion supporter, said the report shows the need for more healthcare coverage for needy Georgians.
“(Democrats) look forward to a robust debate about how and when we move forward to accept the billions in investment available to our state,” she said.
Despite increased interest from lawmakers, expansion advocates still face an uphill battle.
State Rep. Jason Spencer (R-Woodbine), a strong opponent of the Affordable Care Act, said that adopting any of the Chamber plans “will do lasting damage to our state — not only to our taxpayers but also to the enrollees themselves by trapping them in a new welfare program.”
A spokeswoman for Gov. Deal, Jen Talaber Ryan, told the AJC that the governor “is always open to financially sustainable solutions or ideas to provide health care coverage to Georgians. However, any action in regards to this report will have to come from the General Assembly.”
In 2014, the legislature passed a law transferring power over the expansion decision from the governor to the General Assembly. Any plan approved by state lawmakers would also have to get approval from the federal government.
House Speaker David Ralston on Wednesday hinted at the difficult conversations to come.
“While we are committed to maintaining access to quality, affordable healthcare in Georgia, we must recognize that there is no easy — or cheap — solution available,” Ralston said.
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