Georgia can lead by moving beyond Medicaid expansion vs. Pathways debate

For years, Georgia’s healthcare debate has been trapped between two choices: expand traditional Medicaid or defend Georgia Pathways.

We should not be forced to choose. We should build something better.

Gov. Brian Kemp and the Legislature deserve significant credit for challenging the assumption that federally mandated Medicaid expansion was the only answer for uninsured Georgians.

Pathways emphasized work, personal responsibility and private coverage rather than simply expanding another government entitlement.

But good policy also requires us to examine results and adapt when circumstances change.

Pathways is set to expire at the end of this year. At the same time, the federal landscape is changing. Beginning in 2027, federal Medicaid policy will increasingly incorporate work and community-engagement requirements, one of the fundamental principles Georgia pioneered through Pathways.

The question is no longer whether work requirements belong in Medicaid. The question is how Georgia leads next.

Focus on these five P’s, starting with patients

Dr. John Cowan is a neurosurgeon and the 2026 Republican nominee for Georgia’s 11th Congressional District. (Courtesy)

That creates an opportunity.

After almost three decades in medicine, I have watched American healthcare become increasingly complicated while becoming increasingly expensive. We spend enormous amounts treating disease, processing claims and administering programs, yet are failing to ask whether people are actually becoming healthier.

Imagine a system in which coverage follows the patient, prices are visible, prevention is rewarded, providers compete, catastrophic illness cannot bankrupt a family and public dollars are concentrated where markets cannot reasonably bear the risk.

That is neither Obamacare nor traditional Medicaid. And it need not abandon the principles behind Pathways.

That creates an opportunity.

After almost three decades in medicine, I have watched American healthcare become increasingly complicated while becoming increasingly expensive. We spend enormous amounts treating disease, processing claims and administering programs, yet are failing to ask whether people are actually becoming healthier.

Imagine a system in which coverage follows the patient, prices are visible, prevention is rewarded, providers compete, catastrophic illness cannot bankrupt a family and public dollars are concentrated where markets cannot reasonably bear the risk.

That is neither Obamacare nor traditional Medicaid. And it need not abandon the principles behind Pathways.

• Patients should have affordable, portable coverage they can understand and control. We should encourage universal savings accounts, prevention and greater individual ownership of healthcare decisions. We need to acknowledge that in many conditions, a person’s personal choices directly affect health outcomes no matter the level of medical sophistication applied.
• Providers should be free to care for patients rather than spending countless hours navigating prior authorizations, billing rules and administrative bureaucracy. Physicians and hospitals should be free to compete on quality, outcomes and price. We need to expand healthcare training programs and carefully integrate burgeoning technologies.
• Payers, whether employers, insurers or individuals, should benefit from genuine competition and transparent prices. Insurance should protect against risk and incentivize prevention rather than obscure the price of routine healthcare. Payers should be joined with providers in creating meaningful “savings” by limiting disease, not healthcare. Commercial plans should be governed by general playing field, but we need true free market forces shaping the best products.
• Public resources have an essential role, but government should function primarily as the safety “trampoline” and catastrophic backstop. A public reinsurance layer could protect Americans facing cancer, trauma or other extraordinarily expensive illnesses while allowing private plans to compete beneath that protection. This is where our government can function best; at high levels investing in the playfield that sets the global conditions for health, not in claims adjudication or procedural outcomes monitoring.
• Finally, healthcare needs purpose. Our goal cannot simply be more coverage, more spending or more services. The goal must be healthier Americans. We should establish understandable, uniform measures of outcomes and reward the patients, providers and payers that improve them.