Rick Jackson proposes ‘intelligent Medicaid expansion’ in Georgia

Republican Rick Jackson is pledging to close Georgia’s health insurance coverage gap by embracing what he calls an “intelligent Medicaid expansion” to address one of the state’s most politically contentious fights.

The GOP nominee for governor said Tuesday his approach would broaden coverage while preserving work requirements for some Medicaid recipients and protecting hundreds of thousands of Georgians who receive subsidies for private insurance plans.

“We will cover those who need it the most and keep work requirements in place for those who are able,” said Jackson, a billionaire healthcare executive. “And we will not force the 500,000 people who have subsidized private plans onto a government plan.”

The pledge is the centerpiece of a broader blueprint that also calls for a tougher state approach toward insurers, strengthening rural healthcare and expanding the state’s medical workforce.

It is Jackson’s most direct effort yet to tackle a debate that has divided Georgia politics since the Affordable Care Act gave states the option to make more people eligible for Medicaid, the government-funded health insurance program.

And it puts him on a collision course with Democrats, and a smaller number of Republicans, who say a full-scale Medicaid expansion is the better route.

Democrat nominee for governor Keisha Lance Bottoms — pictured during a news conference in Lawrenceville last week — said Georgia’s refusal to expand Medicaid has resulted in shuttered hospitals and has left more Georgians vulnerable. (Hyosub Shin/AJC)

Democratic nominee Keisha Lance Bottoms said earlier Tuesday that Georgia’s refusal to join the 40 states that have expanded Medicaid has been an “epic failure” that’s resulted in shuttered hospitals and left more Georgians vulnerable.

“It’s costing people access to healthcare, and it’s the difference between life and death,” she said.

A new GOP approach

Though some influential Republicans have endorsed traditional Medicaid expansion, Georgia GOP leaders have repeatedly rejected the proposal and instead supported a narrower program that Kemp developed during his first term.

Kemp’s Pathways to Coverage program provides Medicaid to adults earning up to the federal poverty level who meet work, education or other requirements. The program has struggled for years with enrollment far below the 90,000 recipients Kemp’s office once projected.

Jackson wants to go further. His plan says Georgia should “close the coverage gap for low-income working adults and families” who earn too much for traditional Medicaid but too little to afford reliable coverage on their own.

The proposal would retain work-related requirements under Kemp’s program while also using Medicaid funding to help some Georgians stay on private or employer-sponsored insurance plans if they choose.

But important details of Jackson’s plan remain unresolved, including exactly who would qualify, how the state would structure the program and how much it would cost.

Jackson would also need federal approval to make any changes to Georgia’s Medicaid program, no easy task even with a friendly White House. The Republican — who vowed to be President Donald Trump’s “favorite governor” — sounded confident he can strike a deal.

Republican nominee for governor Rick Jackson (right) — pictured sharing hands with President Donald Trump during a July event in Cobb County — has vowed to be Trump’s “favorite governor.” (Arvin Temkar/AJC)

Still, that confidence comes at a precarious moment.

Medicaid is jointly funded by the state and federal governments. The federal government pays for roughly two-thirds of the cost for Kemp’s Pathways program. But the federal government would cover 90% of a traditional Medicaid expansion allowed under the ACA.

Kemp sought a 90% federal contribution for Pathways during Trump’s first term, but Georgia ultimately launched the program without receiving the extra federal help. Kemp’s administration warned last month that Pathways could become financially unsustainable without a larger federal contribution.

A broader healthcare agenda

Jackson’s proposal also calls for directing new resources toward rural hospitals, primary care, mental health and substance-abuse treatment, maternal health and the healthcare workforce.

Beyond Medicaid, Jackson would strengthen protections against insurance company delays and denials of medically necessary treatment, require greater price transparency and make medical records easier to share between providers.

He also wants to add more rural residency slots for doctors, expand nursing and specialty programs at Georgia schools and add inpatient psychiatric beds.