Medicaid expansion debate under way in Georgia General Assembly

Georgia Democrats and Republicans agree that lack of access to quality health care is one of the biggest challenges facing the Peach State.

But they differ over how to fix the problem. Democrats, encouraged by a more competitive showing at the polls last fall in what remains a predominantly Republican state, are pushing to expand Georgia’s Medicaid program through the Affordable Care Act a Democratic Congress enacted in 2010.

Newly elected GOP Gov. Brian Kemp and legislative Republican leaders support a more conservative approach that calls for obtaining a federal waiver aimed at extending health coverage to more Georgians with exemptions from some restrictions imposed by “Obamacare.”

The debate began during the first week of this year’s General Assembly session when Georgia House Minority Leader Bob Trammell introduced a one-page bill that would extend Medicaid coverage to Georgians with annual incomes up to 138 percent of the federal poverty level, the bar set by the Affordable Care Act. Three dozen states have preceded Georgia in taking that step, although several have done so through a waiver.

A “full-blown” Medicaid expansion through the Affordable Care Act would carry a net cost to Georgia taxpayers of up to $147.6 million during the next fiscal year, a cost that would rise to as high as $213.2 million by fiscal 2022 as more enrollees sign up, according to a fiscal note on Trammell’s bill from the state Department of Audits and Accounts.

The legislation would add a projected 526,968 Georgians to the Medicaid rolls in fiscal 2020, a figure that would increase to 598,329 by fiscal 2022, according to the fiscal note, a significant number in a state of 10.4 million people.

“Thirty-six states have figured this out,” said Trammell, D-Luthersville. “What’s so different about Georgia? How can we afford not to do this?”

The same day Trammell introduced his bill, Kemp asked the legislature for $1 million to explore what it would take for Georgia to obtain a waiver.

“We will expand access without expanding a broken system that fails patients,” the governor said during his first State of the State address. “We will drive competition and improve quality while encouraging innovation.”

Kyle Wingfield, president and CEO of the Georgia Public Policy Foundation, an Atlanta-based free-market think tank, said the major drawback to the Democrats’ approach is that it emphasizes getting more people covered by health insurance rather than improving access to a doctor. Many physicians won’t treat Medicaid patients because the program fails to provide adequate reimbursement, he said.

“It is harder to find a doctor who will serve you if you’re on Medicaid rather than private insurance,” he said.

A waiver essentially would let Georgia replicate the successes of employment-based health coverage and the individual insurance market with the Medicaid population, Wingfield said.

Monty Veazey, president and CEO of the Georgia Alliance of Community Hospitals, agreed low physician reimbursements are a problem. But he said that’s not a reason to avoid a full-blown expansion of Medicaid, to provide cash flow particularly vital to financially struggling hospitals serving rural communities.

“We’re leaving millions and millions of dollars of dollars on the table that are going to other states that have expanded Medicaid,” he said. “It’s the only thing that’s going to throw out a lifeline to rural hospitals.”

But Wingfield said those federal dollars could dry up at any time, which would leave states holding the bag for a massively expensive program. While the federal government has covered two-thirds of Medicaid funding since the program’s inception in 1965, the 90 percent support the feds provide to states expanding Medicaid coverage exists only through the Affordable Care Act.

“There’s no guarantee Congress is going to continue to finance the expansion population at 90 percent,” Wingfield said.

Bill Custer, director of the Center for Health Services Research at Georgia State University, said Arkansas addressed that uncertainty by obtaining a waiver that stipulates the state would repeal Medicaid expansion if the level of federal funding drops below 90 percent.

Georgia Senate Minority Leader Steve Henson, D-Tucker, introduced a measure Jan. 28 that would put the same condition on Medicaid expansion.

While legislative Democrats prefer a full-blown expansion of Medicaid in Georgia, they concede majority Republicans are more likely to go with a waiver. They welcome even that approach because it means Kemp and legislative leaders are serious about reducing the number of uninsured Georgians.

“The mere presence of [$1 million] in the budget is a signal there’s momentum on this issue,” Trammell said. “This feels like a year where major health-care policy coming out of the General Assembly is possible.”

Medicaid expansion

Expanding Medicaid through the Affordable Care Act in Georgia would cost the state up to $213.2 million in fiscal 2022 while adding nearly 600,000 enrollees:

Fiscal | Net cost | Projected enrollment

2020: $147.6 million; 526,968

2021: $203.5 million; 595,116

2022: $213.2 million; 598,329

Source: Georgia Department of Audits and Accounts

  By Dave Williams – Staff Writer, Atlanta Business Chronicle Feb 1, 2019

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