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THERE’S A GLIMMER OF HOPE FOR BROADER HEALTH COVERAGE IN GEORGIA, BUT ALSO A
GOOD CHANCE OF A FIZZLE

By JEFF AMY The Associated Press
Updated: January 4, 2024 - 12:35 PM
Published: January 4, 2024 - 10:40 AM

FILE - DR. REED PITRE, DIRECTOR OF PSYCHIATRY AND INTERIM CHIEF MEDICAL OFFICER
AT MERCY CARE CLINIC, LEFT, SPEAKS WITH A PATIENT AFTER HER APPOINTMENT, JUNE
27, 2023, IN ATLANTA. SOME REPUBLICAN LEGISLATIVE LEADERS SAY THEY WANT TO
EXAMINE BROADER HEALTH CARE COVERAGE THROUGH GEORGIA'S MEDICAID PROGRAM IN 2024.
(AP PHOTO/ALEX SLITZ, FILE)[ASSOCIATED PRESS/ALEX SLITZ]

ATLANTA (AP) — Medicaid expansion was long politically impossible in Georgia.

Now it’s just unlikely.

Georgia House Speaker Jon Burns says he wants lawmakers to consider more health
coverage in the state as their session begins Monday. But he’s careful not to
label it Medicaid expansion, and certainly 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, said Thursday.

After North Carolina began offering Medicaid to uninsured adults on Dec. 1,
there are 10 remaining states that don’t cover people with incomes up to 138% of
the federal poverty line. That’s what was envisioned in President Barack Obama’s
2010 health care overhaul.

 1. 

FILE - SOUTHWEST GEORGIA REGIONAL MEDICAL CENTER IN CUTHBERT, GA., SEEN HERE ON
OCT. 7, 2022, CLOSED IN 2020. SOME REPUBLICAN LEGISLATIVE LEADERS SAY THEY WANT
TO EXAMINE BROADER HEALTH CARE COVERAGE THROUGH GEORGIA'S MEDICAID PROGRAM IN
2024, WHICH COULD AID THE FINANCES OF RURAL HOSPITALS. (AP PHOTO/JEFF AMY, FILE)

Photo: ASSOCIATED PRESS/Jeff Amy

Like in Georgia, there’s a thaw in Mississippi, where GOP legislative leaders
say they’re open to extending coverage, even if newly reelected Republican Gov.
Tate Reeves remains 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
House speaker, said last week.

But Robin Rudowitz, a KFF vice president who directs the nonprofit group’s
program on Medicaid and the uninsured, said there’s little movement in other
states. In Kansas for example, Republican lawmakers are spurning Democratic Gov.
Laura Kelly’s pro-expansion campaign of events with business leaders, hospital
administrators and health advocates.

Kelly argued in a recent interview that she’s addressed every Republican
argument opposing expansion and “there really, truly is no good reason” not to
act.

Like other holdouts, Georgia Republicans long resisted participating. Lawmakers
in 2014 even passed a law saying the governor couldn’t expand Medicaid without
their approval.

In July, Republican Gov. Brian Kemp launched a limited expansion offering
coverage to able-bodied adults earning up to the poverty line — $14,580 for an
individual or $24,860 for a family of three. But people must document 80 monthly
hours of work, study, rehabilitation or volunteering to be eligible for
Georgia’s Pathways program, and enrollment has plodded, with fewer than 1,100
people signed up through October.

Opposition to broader expansion in Georgia began publicly wavering in November,
when state House members held a hearing on how Arkansas uses Medicaid money to
buy private coverage for residents. Like traditional Medicaid, the plan requires
copayments of $5 or less for most services while paying medical providers more
than Arkansas’ traditional Medicaid program.

Republican Arkansas State Sen. Missy Irvin told Georgia lawmakers that Arkansas
cut uninsured visits to hospitals and clinics by half, calling it “the best
outcome for Arkansas.”

Advocates of extending health coverage feel hopeful.

“In the past it has been the Republicans that have said ‘no’ to Medicaid
expansion. Now we see more coming around,” said Monte Veazey, CEO of the Georgia
Alliance of Community Hospitals.

KFF projects more than 430,000 uninsured Georgia adults could gain coverage if
Medicaid is broadened. Of those, 250,000 don’t qualify for subsidies to buy
individual policies, leaving them ineligible for both Medicaid and subsidized
marketplace policies. Others are eligible for marketplace policies, but haven’t
enrolled.

Nationwide, KFF estimates 3.5 million uninsured adults would become eligible if
all states expanded Medicaid.

Any expansion would come as Georgia and other states are purging millions off
the Medicaid rolls who had been retained during the pandemic without proving
continuing eligibility. Georgia thus far has removed almost 450,000 people.



Democratic state Sen. Nan Orrock of Atlanta calls Kemp’s refusal to expand while
so many are being purged a “failure of governance.”

Any Georgia deal could also reduce or eliminate permitting requirements for
hospitals and health services. That’s been a top priority for Lt. Gov. Burt
Jones, the Republican who presides over Georgia’s Senate, while the House has
balked at loosening certificate of need rules. A similar deal to reduce
permitting requirements helped clinch expansion votes last year in North
Carolina.

Georgia Senate Majority Leader Steve Gooch says his more ideologically
conservative chamber isn’t interested in “full-blown expansion of Medicaid.” But
he suggests an Arkansas-style plan could 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 said.

Even then, Kemp could veto any plan. He invested years to win a legal fight with
President Joe Biden’s administration over the Pathways work requirement. In a
2022 letter to Georgia’s Democratic members of Congress, Kemp called full
Medicaid expansion a “failed one-size-fit-none” policy.

But Kemp could face a difficult renegotiation on Pathways if Biden wins
reelection. Georgia sought to extend the program past its September 2025
expiration, saying the legal fight delayed its start. Last month, the federal
Centers for Medicare and Medicaid Services said it couldn’t consider Georgia’s
request because the state hadn’t met extension requirements, including a public
notice and comment period.

Kemp spokesperson Garrison Douglas said Thursday that the governor “has
championed and continues to support” Pathways and a linked program that has
subsidized private health insurance premiums. He declined to comment on the
prospect of a broader expansion.

Kemp wouldn’t necessarily have to sign any proposal. In Georgia, bills not
signed or vetoed by the governor can automatically become law.

But without vocal support, Veazey said the inertia of entrenched opposition
could defeat expansion. That’s especially true because all of Georgia’s 236
legislators face 2024 elections.

“We’ve got to have the leadership to come out with a plan,” Veazey said. “They
have to have buy-in.”

___

Associated Press writers Sudhin Thanawala in Atlanta, John Hanna in Topeka,
Kansas, and Emily Wagster Pettus in Jackson, Mississippi, contributed.





Copyright 2024 The Associated Press. All rights reserved. This material may not
be published, broadcast, rewritten or redistributed without permission.

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