A surprise bill to expand Medicaid in Georgia narrowly fails

Two Republican state senators voted with Democrats in the Regulated Industries Committee in favor of a bill to fully expand Medicaid in Georgia. The bill failed to advance on a 7-7 vote, but it indicates some Republicans are wavering in their opposition to full expansion of the state-federal health care program for the poor and disabled. AJC/Michelle Baruchman

Two Republican state senators voted with Democrats in the Regulated Industries Committee in favor of a bill to fully expand Medicaid in Georgia. The bill failed to advance on a 7-7 vote, but it indicates some Republicans are wavering in their opposition to full expansion of the state-federal health care program for the poor and disabled. AJC/Michelle Baruchman

A Republican-led Georgia Senate committee narrowly voted Thursday to kill a last-minute measure brought by Democrats to significantly expand Georgia’s Medicaid program.

The surprise measure, House Bill 1077, was defeated by a coalition of Republicans who said they wanted to give Gov. Brian Kemp’s more limited expansion more time to generate support. After a suspenseful debate, the Senate Regulated Industries Committee deadlocked 7-7 over the proposal, with Republican Sens. Matt Brass and Carden Summers joining the Democrats to vote in favor.

The proposal would have empowered the state to seek a federal waiver so Georgia could purchase private health insurance plans for people in the state who are above the poverty line but still can’t afford to buy their own insurance plans through the Affordable Care Act. It was modeled after the “private option” plan adopted in Arkansas.

Republican lawmakers stood behind Kemp, who last year year launched an alternative to fully expanding Medicaid — the state-federal health care program for the poor and disabled —known as Georgia Pathways. His aides said the governor privately lobbied lawmakers to oppose the measure, which had a roughly $580 million price tag.

“Why shouldn’t we give him a chance to see if Pathways can work before you cut his legs out from under him?” asked Republican state Sen. Bill Cowsert, who chairs the committee that took up the measure.

It was a setback for Democrats, along with a growing number of Republicans, who have said a full expansion is long overdue.

“We can’t kick the can down the road anymore,” said Democratic state Sen. David Lucas, who reminded lawmakers that U.S. Sens. Jon Ossoff and Raphael Warnock secured incentives in the coronavirus relief package to speed an expansion.

“That $1.2 billion is in D.C. waiting for Georgia to expand,” Lucus said, “but how long will it be there?”

Boycotts and betrayal?

The vote came days after Senate Democrats threatened to vote en masse against a prized health priority of Lt. Gov. Burt Jones — a pending rollback of hospital regulations — if they can’t win promises to broaden health care access to hundreds of thousands of Georgians.

Senate Minority Leader Gloria Butler said she thought she had struck a deal with Senate Republicans to vote the expansion bill out of the Senate in exchange for Democratic support to scale back hospital regulations.

Cowsert, however, said he had only promised to hold a vote in his committee — and made no apologies for the arrival of GOP state Sen. Ben Watson, who isn’t normally a member of the committee and cast a key “no” vote against the bill, saying it needed more time to “mature.”

Sen. Bill Cowsert, R- Athens, speaks in favor of House Bill 1339 at the Georgia State Capitol on Thursday, March 14, 2024. The bill would would roll back regulations to build new hospitals in counties with fewer than 50,000 people.  (Natrice Miller/ Natrice.miller@ajc.com)

Credit: Natrice Miller/AJC

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Credit: Natrice Miller/AJC

Democrats have said that opening new hospitals without expanding Medicaid, especially in rural areas, would further weaken hospitals because it would force them to compete for health care workers and patients.

And it surfaced weeks after House Speaker Jon Burns effectively tabled the discussion of expansion in his chamber until next year by proposing a commission to study the issue. Burns and his deputies entered the session signaling they were receptive to expanding the program.

Republicans centered on their support for Kemp’s Pathways to Coverage, which expanded Medicaid eligibility for low-income people who work at least 80 hours per month or meet academic or other requirements.

It has drawn muted interest, with about 3,500 uninsured applicants enrolled in it through March out of an estimated 370,000 who could apply. And it has cost taxpayers at least $26 million, with more than 90% of that money going toward administrative and consulting costs.

Kemp, meanwhile, hasn’t veered from his long-held opposition to full expansion of Medicaid, which he has said is too costly and inflexible. He instead favors the more limited Pathways program that ties work and academic requirements to eligibility.

Even so, Kemp notably hasn’t publicly threatened to block or veto legislation to fully expand Medicaid if GOP lawmakers embrace the idea, though he made clear in a recent interview that “I was never in favor of doing that last year or this year.”

Even with broader support, HB 1077 would have faced long odds of passing in 2024. The 40-day session ends next week, and rank-and-file Republicans who have long campaigned against Medicaid expansion would need to swiftly recalibrate their positions.

Still, some conservatives signaled a strategic shift. Brass, one of the chamber’s most influential Republicans, said that “massive inflation” has made it more difficult for struggling Georgians to qualify for Kemp’s program. Before voting for the expansion, he said he worries about employees at his business who need more health care access.

“Sometimes, roofs leak,” Brass said of the sort of unexpected costs that can strain a household’s finances.

A strategic shift?

Even though HB 1077 failed, the tight committee vote was the latest sign that some GOP leaders were departing from entrenched opposition toward expanding Medicaid.

That hostility has largely persisted since then-President Barack Obama muscled it through Congress more than a decade ago as part of the Affordable Care Act.

That seemed to change this year, when for the first time since the Georgia Legislature voted in 2014 to give itself authority to expand Medicaid’s rolls, senior Republican leaders entered the session indicating they were open to a serious discussion about expanding the program.

With the 2024 election looming — and wide-open races for governor and other top offices in 2026 — some Republicans hoped to neuter Democratic criticism of Georgia’s health policy by joining the 40 other states that have already expanded Medicaid.

Others harbor concerns over Kemp’s plan to extend Medicaid coverage to Georgians who meet work or activity requirements.

Pathways operates under a federal waiver granted in the final days of the Trump administration that’s set to expire in 2025. Some Republicans say it’s unlikely to get an extension if President Joe Biden is reelected, since he and other Democrats have pressed states to adopt a broader expansion.

Many Republicans favor a program adopted in GOP-led Arkansas, where 250,000 additional residents are eligible for Medicaid coverage under a policy that health care analysts have dubbed the “private option.

Under the Arkansas plan — which also operates under a federal waiver — the state used expansion dollars to buy private insurance for uninsured residents. The idea has already drawn interest from some officials who see it as an easier sell to conservative voters.

Cowsert, who cast the deciding vote against the expansion proposal, said the Arkansas program was among the options that a commission will study after the session ends next week.

“My feeling was we need to support our governor and his approach, and let’s give it a chance to work,” said the Athens Republican. “If it fails, then we’ll be back in here next year talking about other alternatives.”