For Georgians seeking affordable health care, it’s one battle after another
“I didn’t ask for this. That’s just how the cards were rolled out for me.” - Willa Ferguson, Oscar-nominated movie “One Battle After Another”
If you haven’t yet watched “One Battle After Another” don’t worry, there will be no spoilers here.
But in its title is a perfect reflection of Georgians’ relentless fight for affordable health care access, in a state rendered uniquely vulnerable as that access evaporates for tens of millions across the country.
So, what makes this moment particularly dangerous in Georgia? Because Georgia is one of the few states where the expiring enhanced Affordable Care Act (ACA) premium subsidies collide catastrophically with our state’s refusal to fully expand Medicaid.
And ironically, even as our Republican leadership performatively welcomes these changes, it is in fact these very enhanced subsidies that have padded their floundering health coverage numbers and insulated them from the consequences of their own bad choices.
Congress has failed to extend ACA subsidies
Georgia is among the states with the highest uninsured rates in the nation, a dubious distinction shared among most of the other states who, like us, continue to block full Medicaid expansion. Our tepid solution has instead been the state’s “Pathways to Coverage” program, which implemented a qualifying work requirement.
To say that “Pathways” has underperformed is … diplomatic. In its first two years less than 7% of those eligible for coverage under Pathways are enrolled, while costing Georgia taxpayers $110 million and failing to deliver on improved health outcomes or enhanced employment numbers.
You’d think these results would steer rational leaders away from following Georgia’s lead. Unfortunately, we’ve seen the opposite.
2025’s H.R. 1, the Trump Administration’s so-called “One Big Beautiful Bill,” modeled its own federal work requirement on Georgia’s, taking our state’s expensive folly and amplifying it nationwide. The nonpartisan Congressional Budget Office estimates this, along with the other policies proposed in H.R. 1, will result in 16 million Americans losing their health insurance.
That’s up to 750,000 Georgians losing coverage.
There are a few demonstrated solutions that could help mitigate this harm. Unfortunately, our majority seem disinclined to consider any of them.
On the federal level, Congress could extend the enhanced ACA premium subsidies which enabled many of the 1.5 million Georgians who enrolled via Georgia Access in 2025 to find coverage.
This solution seems unlikely. A bill offering a three year extension on these subsidies passed out of the U.S. House on Jan. 8 but has run into the buzzsaw of the U.S. Senate where negotiations have stalled. Even if a workable solution emerges, President Trump has indicated he may veto it.
If Ga. won’t expand Medicaid, do something better
Rather than waiting on federal lawmakers to act, the Georgia state legislature could also finally fully expand Medicaid, making the fiscally prudent decision to grow eligibility for hundreds of thousands of Georgians while welcoming back our own federal tax dollars to pay for it.
Tragically, this too seems unlikely. After skirting heartbreakingly close to fully expanding Medicaid in 2024 Republicans have only moved further away from this option, particularly in the second Trump administration where many seem more concerned with avoiding political retribution than rationally considering sound policy.
The 2026 session of the Georgia General Assembly has resumed. State lawmakers ran for office presumably to fix complex problems and make life better for the people in this state. What might that look like?
Well, if we’re determined to stick with Pathways to Coverage, we could at least invest in improving it.
Many of the barriers that have prevented Pathways from executing on its promises are administrative. Capricious eligibility requirements, onerous paperwork, buggy reporting interfaces and bureaucratic bloat — ironically, precisely the type of “big government” conservatives decry. While work requirements have consistently been shown to gut access even for those who qualify, Pathways is what we’re working with now, and so we deserve to have it work better for us.
Further, if the federal government refuses to extend enhanced ACA premium tax credits, we could craft, in the words of Gov Brian Kemp, an “innovative, Georgia-centric approach to providing health care coverage to thousands of hardworking Georgians.”
As a state, let’s step in and lead where the federal government has failed us. Let’s pass a targeted state affordability program providing enhanced premium and cost sharing assistance to those who otherwise would no longer be able to afford coverage.
Remember that failing to provide this coverage does not cost the state less, nor is the care we cover “free.” Uncompensated care is often more costly, if not catastrophic, and comes and takes a huge toll on the state and struggling hospital systems, particularly in underserved and rural areas. Early investment in patients saves money and lives.
It should not feel like those in power are making it harder for our patients to stay healthy.
Regardless of their political party, voters didn’t ask for this. But neither should they feel that the cards rolled out for them are all we have to play.
How many more battles will we have to fight?
To secure health coverage for Georgians, as many as it takes.
Nathan Holterman, M.D., is a preventive medicine physician based in Atlanta and the senior health policy advisor for State Rep. Michelle Au.
State Rep. Michelle Au, M.D., M.P.H., D-Johns Creek, represents the 50th House District.
