ATLANTA — Medicaid growth was lengthy politically not possible in Georgia.
Now it’s simply unlikely.
Georgia Home Speaker Jon Burns says he desires lawmakers to contemplate extra well being protection in Georgia as their session begins Monday. However he’s cautious to not label it Medicaid growth, and definitely not “Obamacare.”
“The speaker is committed to lowering costs and increasing access to healthcare across the state, and will be working closely with members over the coming weeks to develop sound policy to do just that,” Stephen Lawson, a spokesperson for the Newington Republican, stated Thursday.
After North Carolina started providing Medicaid to uninsured adults on Dec. 1, there are 10 remaining states that don’t cowl folks with incomes as much as 138% of the federal poverty line. That’s what was envisioned in President Barack Obama’s 2010 well being care overhaul.
Like in Georgia, there’s a thaw in Mississippi, the place GOP legislative leaders say they’re open to extending protection, even when newly reelected Republican Gov. Tate Reeves stays vocally opposed.
“We’re fixing to look at every facet of Medicaid expansion, and if it makes sense, we’re going to do it,” Rep. Jason White, newly elected as Mississippi’s Home speaker, stated final week.
However Robin Rudowitz, a KFF vice chairman who directs the inspiration’s program on Medicaid and the uninsured, stated there’s little motion in different states. In Kansas for instance, Republican lawmakers are spurning Democratic Gov. Laura Kelly’s pro-expansion marketing campaign of occasions with enterprise leaders, hospital directors and well being advocates.
Kelly argued in a latest interview that she’s addressed each Republican argument opposing growth and “there really, truly is no good reason” to not act.
Like different holdouts, Georgia Republicans lengthy resisted taking part. Lawmakers in 2014 even handed a legislation saying the governor couldn’t increase Medicaid with out their approval.
In July, Republican Gov. Brian Kemp launched a limited expansion providing protection to able-bodied adults incomes as much as the poverty line — $14,580 for a person or $24,860 for a household of three. However folks should doc 80 month-to-month hours of labor, examine, rehabilitation or volunteering to be eligible for Georgia’s Pathways program, and enrollment has plodded, with fewer than 1,100 folks signed up by October.
Opposition to broader growth in Georgia started publicly wavering in November, when state Home members held a listening to on how Arkansas makes use of Medicaid cash to buy private coverage for residents. Like conventional Medicaid, the plan requires copayments of $5 or much less for many providers whereas paying medical suppliers greater than Arkansas’ conventional Medicaid program.
Republican Arkansas State Sen. Missy Irvin instructed Georgia lawmakers that Arkansas lower uninsured visits to hospitals and clinics by half, calling it “the best outcome for Arkansas.”
Advocates of extending well being protection really feel hopeful.
“In the past it has been the Republicans that have said ‘no’ to Medicaid expansion. Now we see more coming around,” stated Monte Veazey, CEO of the Georgia Alliance of Neighborhood Hospitals.
KFF initiatives greater than 430,000 uninsured Georgia adults may achieve protection if Medicaid is broadened. Of these, 250,000 don’t qualify for subsidies to purchase particular person insurance policies, leaving them ineligible for each Medicaid and backed market insurance policies. Others are eligible for market insurance policies, however haven’t enrolled.
Nationwide, KFF estimates 3.5 million uninsured adults would grow to be eligible if all states expanded Medicaid.
Any growth would come as Georgia and different states are purging millions off the Medicaid rolls who had been retained throughout the pandemic with out proving persevering with eligibility. Georgia to date has eliminated virtually 450,000 folks.
Democratic state Sen. Nan Orrock of Atlanta calls Kemp’s refusal to increase whereas so many are being purged a “failure of governance.”
Any Georgia deal may additionally scale back or eradicate allowing necessities for hospitals and well being providers. That’s been a top priority for Lt. Gov. Burt Jones, the Republican who presides over Georgia’s Senate, whereas the Home has balked at loosening certificates of want guidelines. The same deal to scale back allowing necessities helped clinch expansion votes final yr in North Carolina.
Georgia Senate Majority Chief Steve Gooch says his extra ideologically conservative chamber isn’t taken with “full-blown expansion of Medicaid.” However he suggests an Arkansas-style plan may succeed.
“I believe there’s an appetite there to make some changes to our certificate of need requirements that could include better access for all Georgians to health care facilities and services,” the Dahlonega Republican stated.
Even then, Kemp may veto any plan. He invested years to win a authorized combat with President Joe Biden’s administration over the Pathways work requirement. In a 2022 letter to Georgia’s Democratic members of Congress, Kemp referred to as full Medicaid growth a “failed one-size-fit-none” coverage.
However Kemp may face a tough renegotiation on Pathways if Biden wins reelection. Georgia sought to increase this system previous its September 2025 expiration, saying the authorized combat delayed its begin. Last month, the federal Facilities for Medicare and Medicaid Companies stated it couldn’t think about Georgia’s request as a result of the state hadn’t met extension necessities, together with a public discover and remark interval.
Kemp, who didn’t reply to a request for remark Thursday, wouldn’t essentially must signal a legislation. In Georgia, payments not signed or vetoed by the governor can robotically grow to be legislation.
However with out vocal help, Veazey stated the inertia of entrenched opposition may defeat growth. That’s very true as a result of all of Georgia’s 236 legislators face 2024 elections.
“We’ve got to have the leadership to come out with a plan,” Veazey stated. “They have to have buy-in.”
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Related Press writers Sudhin Thanawala in Atlanta, John Hanna in Topeka, Kansas, and Emily Wagster Pettus in Jackson, Mississippi, contributed.
