The federal coronavirus relief plan that passed the U.S. House on Wednesday tries to plug one of the biggest loopholes in the Affordable Care Act by dangling sweeteners in front of Georgia and other states that have refused to expand Medicaid.
Republican leaders in Georgia have adamantly opposed expanding the program to cover more low-income adults, saying it would be too costly in the long run and deny state health officials flexibility. But the $1.9 trillion stimulus aims to make resistance harder by including an infusion of about $2 billion to the state to cover the full tab of Medicaid expansion for two years.
Gov. Brian Kemp is unlikely to drop his long-standing opposition and accept the offer, though he didn’t immediately dismiss it.
Still, with the fate of his unconventional plan to reshape the health care system in limbo, along with increased pressure to insure more low-income residents during a global health crisis, Democrats and other advocates of the idea say Georgia is ready to join the 38 states that have already expanded their Medicaid programs.
“It’s now up to our state leaders to take those resources, expand Medicaid and make sure no one in this state lacks access to health care because they can’t afford it,” U.S. Sen. Jon Ossoff said this week at a virtual town hall meeting. “Because health care is a human right. If that hasn’t been clear before now, this COVID-19 pandemic has made it incredibly clear.”
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The governor and other GOP leaders have since 2012 resisted expanding the Medicaid program as too costly and too dependent on the whims of the federal government. During his 2018 campaign, Kemp promised instead to back what he called an innovative conservative approach to cover more of Georgia’s poor.
Months after he took office, the Republican unveiled a narrowly tailored initiative to add an estimated 50,000 poor Georgians to the rolls over the course of two years. He framed it as a way to help “hardworking Georgians climb the ladder” by adding a work or activity requirement, such as working for a registered employer for 80 hours a month or attending college full time.
Democrats and health care advocates dismissed the waiver plan, known as Georgia Pathways, as a confounding half-measure that, even if fully implemented, would still leave more than 350,000 Georgia adults uninsured, according to estimates by Kemp’s office.
It won approval by President Donald Trump’s health officials in October and was trumpeted at a Capitol press conference. But President Joe Biden’s administration put the initiative on hold in February, saying it’s “unreasonably difficult or impossible” to meet the eligibility requirements during a pandemic.
The governor’s options include renegotiating the waiver, abandoning it altogether or, less likely, embracing a full-scale expansion of Medicaid. His office has said it would “do everything we can — both legally and administratively — to not allow them to block implementation.” A formal response to federal Medicaid administrators is expected this week.
The waiver’s supporters say the governor should be given more time to prove his “Georgia-centric” plan can work. State Rep. Mark Newton, a physician and Augusta Republican, said Kemp’s plan has a chance to be a national model.
“This deserves a chance to be put into practice,” said Newton, who chairs a House health committee that vetted the program. “These job-training and education requirements could really be a leg up. Let’s implement what Georgia lawmakers and the last administration approved.”
Health care advocates and other supporters say a full-scale expansion is long overdue to prop up the state’s ailing rural hospitals and insure more Georgians than Kemp’s proposal would.
Under the stimulus measure, states that expand would receive a 5% boost in their regular federal Medicaid matching rate for two years. The Kaiser Family Foundation estimates Georgia would net $700 million even after factoring in the costs of financing the expansion.
Laura Harker of the left-leaning Georgia Budget and Policy Institute said the federal incentives make it an “even more obvious choice than before.”
“Changes at the federal level may make the state’s current Medicaid plan, which covers fewer people, cost far more than expected,” she said. “Georgia lawmakers should expand Medicaid and help cover more Georgians while drawing down federal dollars to help fund the state’s budget.”
The debate is also sure to factor into Kemp’s reelection campaign next year, when he’s set to run for a second term. Ossoff and fellow Democratic U.S. Sen. Raphael Warnock both campaigned on a promise of extending insurance coverage to hundreds of thousands of Georgians who don’t now receive it, and both have highlighted their work securing the Medicaid funding.
Warnock, who is up for reelection next year, also made clear the issue would factor into his 2022 campaign. At a stop this week at the Morehouse School of Medicine, he said Medicaid expansion would better arm hospitals and medical officials with the tools they need to contain the pandemic.
“If Georgia does not expand Medicaid,” he said, “then we are literally leaving money on the table that could save the lives of Georgians.”
Staff writer Eric Stirgus contributed to this article.