Pressed by questions on the campaign trail about economic equality, rural development or even infrastructure, Abrams regularly connects her answer to a promise to add hundreds of thousands of Georgians to the Medicaid rolls. She makes no excuses for the relentless message.

“I’m going to talk about Medicaid expansion every chance I get,” she said at a recent fundraiser.

As a result, Abrams has devoted less attention to promoting policies that were mainstays of her previous campaign.

She has yet to emphasize proposals on her platform to decriminalize marijuana or institute new gun restrictions, nor has she waded into many of the debates that have dominated the legislative session.

And during her first campaign stops, she only briefly touched on her other signature policy initiative — a voting rights expansion — while framing last year’s Republican-backed rewrite of Georgia’s election laws as a vindictive response to Democratic electoral successes.

“She certainly has earned her bona fides for liberals and progressives. But in order to get to the number she needs to win, what do moderates also need to hear from her?” said Democratic state Sen. Sonya Halpern, an Abrams ally from Atlanta.

“It seems that part of the strategy is to focus on the issues like Medicaid that impact the largest numbers of people,” Halpern said.

Credit: AJC

Credit: AJC

That approach holds risk. While Abrams’ allies believe expanding the program makes sense in terms of both policy and politics — and several public polls show a broad majority of Georgians support it — the idea remains deeply unpopular with many conservative GOP primary voters.

Faced with a Donald Trump-backed challenge from former U.S. Sen. David Perdue, the governor has staunchly opposed the expansion as too costly in the long run, since it requires the state to pick up 10% of the cost of expansion.

He’s instead backed a narrow alternative that critics view as a half-measure. Kemp’s “waiver” program would allow Georgia to impose a work and activity requirement for some lower-income Georgians to qualify for Medicaid insurance.

That plan, approved in the waning days of the Trump administration, is now in legal limbo after President Joe Biden’s top Medicaid official rejected the work and activity requirement. Kemp has since sued the federal government to reverse the decision.

The governor’s proposal would wind up covering about 50,000 of Georgia’s poor adults. A full Medicaid expansion could cover at least 400,000 additional Georgians in need of health insurance, according to estimates.

“It’s an easy thing to say, but it’s going to cost a lot of money,” Kemp said after a GOP gathering in east Georgia.

“How is she going to pay for it? How high are taxes going to go up?” Kemp said. “It’s a one-size-fits-all government program, and there aren’t enough doctors out there to take Medicaid patients to make it profitable.”

Not just a ‘tag line’

Abrams’ focus on Medicaid expansion is not novel in Georgia Democratic politics. Jason Carter made expanding the program a cornerstone of his bid for governor in 2014, and it was a mainstay of Abrams’ campaign in 2018.

But back then, Abrams also had to prove her liberal credentials to state Democrats and national figures as she fought off a primary challenger.

Now she has cemented herself as a hero in the minds of many liberals and has built a fundraising juggernaut to match her national profile. In the first two months of her campaign, she raised more campaign cash than Kemp did over a seven-month span.

Credit: TNS

Credit: TNS

Her newly updated website includes broad policy stances designed to excite the base. She endorsed universal pre-kindergarten, promised to repeal expansions of firearms laws, vouched for a new tax credit for working-class families and pledged to set a standard minimum salary for all law enforcement officers.

But on the campaign trail she’s focused almost exclusively on health care, underscoring her belief that the issue is more important than ever to voters living through a coronavirus pandemic that’s claimed the lives of tens of thousands of Georgians.

She began her first statewide tour in rural Randolph County, where she highlighted the plight of a tiny hospital in Cuthbert that shuttered in late 2020 amid crippling financial problems at a time when the community sorely needed it.

“Medicaid expansion isn’t just a tagline,” she said at one of her early stops. “It’s the biggest economic development project in Georgia history.”

She hopes that message will help her overcome the stiff headwinds Democrats face this election cycle, with inflation hitting 40-year highs in metro Atlanta, energy prices on the rise, global supply-chain problems and the war in Ukraine fueling more economic uncertainty.

And while Kemp also had to contend with an unpopular president — he won despite Trump’s favorability ratings in the mid-40s — Abrams might have an even greater challenge.

She’ll have to break the GOP’s 20-year grip on the governorship while her fellow Democrat, Biden, faces problems similar to Trump’s in terms of popularity while occupying the White House.

“She probably wishes Trump had gotten reelected,” said Jay Morgan, a former Georgia GOP executive director. “Expanding Medicaid is a ‘keep the base fired up’ issue. It will not determine the outcome in November. Gas prices and Biden’s performance will.”

Of course, Trump looms large over this race, too. He predicted at a March 26 rally in Commerce that his supporters in Georgia wouldn’t back Kemp in November if he’s the nominee. And he questioned whether Abrams has lost some of her appeal since 2018.

Abrams greeted Trump’s visit with silence. In fact, she has scarcely mentioned the former president at all, instead lacing her speeches with attacks against Kemp — and shared personal stories about her father, who was recently hospitalized with a severe illness while staying at Abrams’ Atlanta home.

“It makes no sense in the state of Georgia if he’d been a few miles away, or a few counties away, my father would not be with us here today,” she said. “That is a solvable problem, and by God’s love for Georgia, I’m going to fix it.”