Opinion: Medicaid expansion would still benefit Ga.

Georgia’s State Capitol.
Georgia’s State Capitol.

“Georgia’s leaders continue to ignore the most cost-effective, evidence-based, equitable, and practical steps to addressing our health care problems.”

Laura Colbert, executive director, Georgians for a Healthy Future.

A total of 38 states, red and blue, have already expanded their Medicaid programs, bringing the U.S. rate of uninsured down to 9.2%. But not Georgia.

As of 2019, there were 10.6 million Georgians and 13.4% of them were medically uninsured (the percentage of adults is even higher). Only Oklahoma and Texas have a higher percentage of uninsured.

We have over 1.4 million Georgians without medical insurance. Why are we so high compared to other states? Because our Governor and Legislature have refused to accept federal dollars to expand our Medicaid program (which would have been 100% paid by the feds for the first three years had we done so a decade ago). Estimates are that an additional 567,000 low-income Georgians would get Medicaid coverage if the program were simply expanded now.

Instead, Georgia’s Governor and Legislature have hemmed and hawed for a decade, with Kemp finally submitting Section 1115 and 1332 “waivers” to CMS (the federal government) last year. These waivers are submitted to obtain approval for a state to administer Medicaid differently than other states. Both plans were approved by CMS in recent weeks.

Jack Bernard, the first director of Health Planning for the state of Georgia, has been a senior level executive with several national health care firms. A Republican, he's a former chairman of the Jasper County Board of Commissioners.
Jack Bernard, the first director of Health Planning for the state of Georgia, has been a senior level executive with several national health care firms. A Republican, he's a former chairman of the Jasper County Board of Commissioners.

Credit: contributed

Credit: contributed

Most Americans believe that there is a right to healthcare and that the government should ensure that we get it. However, the ideological basis for the Georgia 1115 waiver is that to obtain Medicaid coverage a person must be employed. Therefore, there is a waiver requirement that an applicant must work at least 80 hours a month. Even during the current depressed economy, with the unemployment rate at high levels not seen in over a decade.

The ideologically based waiver also severely limits the income level needed to qualify ($12,700 for a single person up to $26,000 for a family of four). The ACA guidelines are 38% higher.

Therefore, only 50,000 Georgians qualify, versus over half a million who would be covered if Medicaid were simply expanded. Plus, the waiver calls for co-pays and premiums, not normally charged to Medicaid recipients due to their low income levels.

Plus, by asking for the waiver rather than just expanding Medicaid as other states have done, the state will not receive the 90% federal reimbursement level. Instead, it will get only 67%, costing the state over 3 times as much per enrollee versus full Medicaid expansion (33%, versus 10% with full expansion).

Georgia’s 1332 waiver, which restructures our state’s health insurance market, has pros and cons. On the positive side, it permits implementation of a reinsurance program. Reinsurance cuts risk factors, helping to reduce premiums.

However, on the negative end, it erases the health insurance marketplace to obtain coverage, which will inevitably lead to consumer confusion and is predicted to substantially reduce the number of Georgians covered . Specifically, to get full ACA coverage now, people simply need to go to healthcare.gov. Kemp’s plan sets up a confusing Georgia-specific system which would be driven by for-profit insurance companies and brokers, containing non-compliant substandard plans. Such plans do not contain the ACA’s legally mandated “Essential Health Benefits”, failing to fully cover prescription drugs, mental health services, maternity care and other key healthcare services.

So, in summary, where does this leave us? We have a political decision to apply for waivers, based on ideology versus fiscal sense. A decision that still leaves over 1 million Georgians without coverage. A decision that is illogical and lacks rationality, covering only one-tenth of the people who would be covered had we simply expanded Medicaid.

There are good reasons why Georgians who commented on Kemp’s Medicaid waiver plan opposed it by a 9-to-1 margin. Here’s what we as concerned citizens can do: a). let your state legislators know how you feel, b.) contact the Governor’s office and express your concerns; and c.) in the future, support elected officials of either party who support full Medicaid expansion.

Jack Bernard, the first director of health planning for Georgia, has been an executive with several national health care firms. A Republican, he’s a former county commission chairman.

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