Affordable Care Act turns 16, but Georgia still hasn’t expanded Medicaid
As we mark the 16th anniversary of the Affordable Care Act in March, Georgia is facing an unprecedented health care crisis.
Federal cuts to Medicaid and the expiration of premium tax credits will threaten access to health care for roughly 500,000 Georgians over the next decade.
Fortunately, there is a way for Georgia to help offset these changes: Expand Medicaid under the ACA, which will increase health care coverage for hundreds of thousands of Georgians and thereby bring in extra federal funding to the state’s health care system.
Sixteen years ago, the ACA gave states the new option to expand Medicaid access to people making up to 138% of the federal poverty level, with the federal government funding 90% of costs for these new enrollees.
Today, only 10 states have yet to expand Medicaid under the ACA. Georgia is one of them.
Instead, Georgia implemented a partial expansion program called Pathways to Coverage. Pathways was originally estimated to cover roughly 30,000 Georgians at the end of its first year in July 2024. Almost two years past that deadline, we are still at less than half that goal.
Meanwhile, the program has cost taxpayers more than $131 million. Moreover, a U.S. Government Accountability Office report showed the program spent twice as much on administrative costs than health care services for Georgians.
Peach State’s health care system is in danger
Georgians are also facing the issue of the expiration of premium tax credits, which were another key provision of the ACA. Until recently, these credits helped make marketplace coverage more affordable for families throughout the United States.
Congress expanded and extended these credits in 2021 and 2022. Unfortunately, Congress allowed these enhanced premium tax credits to expire at the end of last year.
We know from Kaiser Family Foundation data that 1.4 million Georgians relied on these tax credits before they expired to afford their health coverage. Upon expiration, these Georgians were forced to choose between medical care and other necessities.
Already, nearly 200,000 fewer Georgians enrolled in Georgia Access coverage in 2026 compared to 2025.
The expiration of enhanced premium tax credits in combination with the 2025 federal Medicaid cuts leave Georgia’s health care system in deep danger. The combined impact is expected to strip coverage from roughly 500,000 Georgians over the next decade. That is on top of the more than 1.3 million people in our state who are already uninsured and without affordable access to health care.
This crisis will negatively affect all Georgians.
When more uninsured Georgians seek the health care they need, our health care system absorbs more uncompensated care, which we know can drive up premiums for everyone. The hardest hit will be rural hospitals.
News reports from 2025 showed that 20 of our state’s 71 rural hospitals were in danger of closing their doors.
Data supports why Georgia should join other 40 states
As a fiscally conservative Republican, I was once skeptical about the benefits of expansion. But I quickly found the data compelling.
To that end, let’s look at those 40 states plus Washington, D.C., that have expanded Medicaid under the ACA.
We know that those states’ rural hospitals are performing better financially than nonexpansion states, like Georgia. We know that expansion is linked to overall better health outcomes, improved access to care for those living with chronic diseases, earlier detection of medical conditions and even reduced debt and more economic mobility.
I firmly believe Georgia must join those 40 states plus D.C. in expanding Medicaid. Medicaid expansion would increase the number of eligible Georgians and get us the extra federal funding to cover them.
Under expansion, the federal government pays 90% of costs for expansion enrollees compared with the 66% it currently pays for the Georgians who have Pathways coverage, according to the Georgia Budget & Policy Institute. This critical funding could help stabilize our struggling rural hospitals, cornerstones for our rural communities.
Expansion would also unlock a new Medicaid option for hundreds of thousands of our friends, family members and neighbors.
These include Georgians who earn too much for Pathways but not enough to afford coverage through Georgia Access; Georgians who Pathways has failed to cover for years; and Georgians we know won’t be able to — and already can’t — afford Georgia Access without enhanced premium tax credits.
Fewer insured Georgians means folks missing out on the care they need, which contributes to worsening conditions for those with chronic diseases and ultimately leads to unemployment. To keep our thriving economy healthy, we must ensure hardworking Georgians have access to care.
On this 16th anniversary of the ACA, it’s clear: Medicaid expansion is a win-win for the health of Georgians and our economy. But progress takes participation; I urge you to call your state lawmakers and tell them why you’d like them to prioritize closing the coverage gap by expanding Medicaid.
Natalie Crawford, a Republican, is a former two-term Habersham County Commissioner and founder and executive director of Georgia First, executive director of the Mended Hearts Inc. and chair of the Bridge Georgia health care coalition.
