Democrats and patient advocates are increasing pressure on Republicans in the state Legislature to take action, as prospects for Georgia's ability to fully expand Medicaid remain bleak — although they remain bleak.
But political experts, advocates and policy analysts say they face significant headwinds in approving the plan, which Republican lawmakers have long derided as wasteful, and could ultimately doom the effort. It says that there is a sex.
“There's reason to be a little more optimistic than we were a year or two ago, but we don't see much support from Republicans or an appetite to change the status quo,” said Harry Heyman, a health policy official. said. Professor at Georgia State University.
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The biggest hurdle is Georgia Pathways, a limited Medicaid expansion that includes the only work requirement in the country for Medicaid recipients, said an executive with the advocacy group Georgians for a Healthy Future. Director Laura Colbert said:
Georgia Gov. Brian Kemp, a Republican, supports the program, which began in July. It got off to a rocky start, with just under 2,350 people registered as of mid-December, but the Kemp administration is seeking to extend it past its September 2025 expiration date.
“Governor Kemp has invested significant political capital into Pathways,” Colbert said.
Colbert said he's optimistic that the Georgia Legislature will eventually approve full coverage expansion for low-income adults, but not necessarily this year.
Georgia Governor Kemp is pictured here leaving the House of Representatives after delivering the State of the Union address in Atlanta on January 11, 2024. (AP Photo/Bryn Anderson)
Kyle Wingfield, president of the conservative Georgia Public Policy Foundation, also said he was skeptical that Kemp would withdraw from Pathways.
He also warned that Republican lawmakers could face pushback from Republican primary voters on the Medicaid deal.
Expanding Medicaid to low-income adults who make up to 138% of the federal poverty level, with the federal government paying 90% of the cost, was a key part of the Affordable Care Act. Georgia is one of 10 states that hasn't done so.
Wingfield said Republicans in Washington state and, to a lesser extent, Georgia Republicans have accepted that the Affordable Care Act will remain, but that acceptance is not common among ordinary Republican primary voters. He said it may not have been shared.
“When it comes to Republican primary voters, I don't think I want to be the one to know that,” he said.
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But Republican political consultant Brian Robinson, who counts the Georgia Community Hospital Alliance and the House Republican Caucus among his clients, believes there is little risk from key opponents if Republicans vote for Medicaid. He says there is.
“The politics of risk have faded over time,” Robinson said. “We've had some small expansions in Georgia, and there's been no pushback against Republicans. In fact, Republicans have been proudly promoting it to groups like new moms.”
Georgia Republicans also risk alienating the conservative group Americans for Prosperity by voting to expand Medicaid.
Tony West, the group's Georgia state director, said the group opposes the expansion, even as part of a deal that would eliminate licensing requirements for hospitals and medical services. This type of agreement has emerged as a compromise between Republicans and Democrats.
West wants lawmakers to focus solely on eliminating licensing requirements and leave Medicaid expansion aside.
“I think we're taking our eye off the ball,” he said.
Conversely, Wingfield noted that Medicaid expansion has become a key political issue for the party in Georgia, raising the possibility that some Democrats may be reluctant to pursue a deal.
“What do they gain by taking one of their signature issues off the table and letting Republicans claim most of the credit?” he asked.
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At least for now, Democrats in the General Assembly don't seem worried about losing their ability to hurt Republicans on Medicaid. The Democratic caucus held a lengthy hearing Wednesday featuring health care providers, advocates and policy experts that focused on the economic and health benefits of expanding operations.
Democratic state Rep. Michelle Orr, a physician, noted in her opening remarks that Georgia has one of the highest rates of uninsured residents in the country and one of the worst health conditions.
“I hope all options will be on the table as we begin the 2024 legislative session,” she said.
