Brian Kemp on Georgia Medicaid expansion in 2025: ‘I’m in the no camp’

In forceful remarks, the Republican governor says joining 40 other states with expanded Medicaid coverage is ‘not good policy’ for Georgia

ATHENS — Gov. Brian Kemp said he opposes an effort to expand Medicaid next year, even as a growing number of Republicans say they’re open to a debate on allowing Georgia to join the 40 other states that have boosted their programs for low-income residents.

The governor told “Politically Georgia” during a live event Thursday that he’s concerned that expansion will “increase your short-term costs and your long-term costs” by shifting hundreds of thousands of people from private-sector insurance to Medicaid.

“That’s just not good policy,” Kemp said. “It doesn’t matter if you’re a Republican or a Democrat. I’m in the no camp. I am supportive of what we did. We need some more time to continue to implement and get people to sign up on Pathways.”

It was a reference to Kemp’s Georgia Pathways to Coverage Program, which expanded Medicaid eligibility for poor people who work at least 80 hours per month or meet academic or other requirements.

“My position is to continue on the policies that the General Assembly voted on, in a bipartisan way, early in my administration and the Biden administration has tried to block,” Kemp said.

The Pathways program has drawn tepid interest since its launch in July, with about 3,800 uninsured applicants through March out of an estimated 370,000 who are eligible. It has cost taxpayers at least $26 million, with more than 90% going toward administrative and consulting costs.

The governor has blamed President Joe Biden for the program’s problems, and he recently filed a federal lawsuit seeking a three-year extension of a federal waiver that authorizes Pathways before it expires next year.

Kemp’s remarks were the strongest yet against a Medicaid expansion push backed by senior Republicans in the Legislature who want the state to consider a “private option” modeled after a program adopted by GOP-controlled Arkansas.

They’ll need Kemp’s support. Although the Georgia Legislature voted in 2014 to give itself authority to expand Medicaid’s rolls, the governor would still have the final say on whether to sign the measure into law or veto it.

For the first time, Kemp unveiled a set of statistics he said showed that his programs have increased health care coverage to about 713,000 additional Georgians, including the 3,800 or so on his Pathways plan. However, he appears to be referring to huge increases in signups for Affordable Care Act private plans driven mostly by federal subsidies under Biden. The subsidies made the plans nearly free to low-income people.

Advertising under the Kemp administration also helped a lot, said Laura Colbert, director of Georgians for a Healthy Future, which favors covering low-income people.

Pressed for details, the Department of Insurance said Friday that about 850,000 more Georgians have signed up for a state-based health care exchange called Georgia Access created by Kemp-backed legislation for those who don’t qualify for Medicaid. Kemp also helped subsidize ACA plans, helping make them more affordable, especially for upper- and middle-income people. Georgians sign up for the program through or other sites.

Insurance Commissioner John King’s office said it spent $14 million promoting the program with a campaign that included more than 70 events across the state.

Of those who signed up for Georgia Access, state insurance officials said about 710,000 are adults with annual incomes up to 138% of the federal poverty level, meaning they’d otherwise qualify for Medicaid coverage under a full expansion through the Affordable Care Act.

These are Georgians who signed up for private plans on the Affordable Care Act marketplace exchange who wouldn’t be covered under traditional Medicaid expansion.

Kemp said Republicans who back expanding Medicaid should think of it this way: “Are you going to be voting for something that’s going to take 713,000 people off private-sector insurance and put them on Medicaid.”

State Rep. Michelle Au, a Johns Creek physician, is among Democrats who have long called for Kemp to fully expand Medicaid to add hundreds of thousands of Georgians to the rolls.

She said the figures the governor cited show the federal law that President Barack Obama signed in 2010 is working, and that Kemp is “trying to take credit for a state-based website that simply allows patients to sign up for that coverage.”

Kemp also acknowledged for the first time that he helped squelch legislation this year that would have allowed the state to purchase private health insurance plans for some low-income Georgians.

It failed to pass a committee in March after a suspenseful debate, though two Republicans joined Democrats to vote for the bill. Kemp said lawmakers didn’t account for the fallout of the expansion, including an estimated $580 million price tag.

“Look, we were fine with the Legislature having a conversation about that. That’s certainly up to them. I was respectful of that,” Kemp said. But he said they crossed a line when “they start talking about going to the floor and into a vote.”

Democrats seethed over Kemp’s statements, which appeared to dash their hopes of a broader debate in 2025 over the issue. State Rep. Scott Holcomb, D-Atlanta, said Kemp proved he is “wrong on Medicaid expansion.”

”Georgia Pathways is not working and is more expensive than full expansion,” he said. “More delay leaves hundreds of thousands uninsured and more hospitals vulnerable to closure.”

This story has been updated to add specifics and context about the Georgia Access program.