GA House Speaker considers expanding health coverage in the state

Expanding Medicaid has long been politically impossible in Georgia.

Now that's unthinkable.

Georgia House Speaker John Burns said he wants lawmakers to consider expanding health insurance in the state as the legislative session begins Monday. But he is careful not to call it Medicaid expansion or, of course, “Obamacare.”

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“The Speaker is committed to lowering costs and increasing access to health care across the state and will work closely with legislators over the coming weeks,” Newington Republican spokesman Stephen Lawson said Thursday. We will formulate sound policies to achieve this goal.” .

After North Carolina began offering Medicaid to uninsured adults on Dec. 1, 10 states remain without coverage for people with incomes up to 138% of the federal poverty line. That's what President Barack Obama's 2010 health care reform envisioned.

Like Georgia, the thaw is underway in Mississippi, where Republican legislative leaders are reluctant to expand coverage even though re-elected Republican Gov. Tate Reeves remains vocally opposed. He says he is positive.

Rep. Jason White, the newly elected speaker of the Mississippi House of Representatives, said last week: “We are gearing up to look at all aspects of Medicaid expansion, and if it makes sense, we will do it.” said.

But Robin Ludowitz, KFF vice president who directs the nonprofit's programs on Medicaid and the uninsured, said there has been little movement in other states. In Kansas, for example, Republican lawmakers are pushing back against Democratic Gov. Laura Kelly's campaign to expand events with business leaders, hospital administrators and health advocates.

In a recent interview, Mr. Kelly cited all of the Republican arguments against expansion, insisting there was “no really, really good reason” for not taking action.

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Like other resistance groups, Georgia Republican lawmakers had long resisted joining. In 2014, lawmakers even passed a law that says Medicaid cannot be expanded without the governor's approval.

In July, Republican Gov. Brian Kemp launched a limited expansion that provides coverage to able-bodied adults with incomes above the poverty line ($14,580 for an individual and $24,860 for a family of three). did. But to qualify for Georgia's Pathways program, which requires documenting 80 hours of work, study, rehabilitation or volunteer work per month, enrollment has been slow, with only 1,100 people enrolled by October. remains below.

Opposition to widespread expansion in Georgia began to sway in November, when the state held a public hearing on how the state of Arkansas would use Medicaid funds to buy private insurance for its residents. Like traditional Medicaid, the plan requires copays of $5 or less for most services, while paying providers more than Arkansas' traditional Medicaid program.

Sen. Missy Irvin, R-Arkansas, told the Georgia Legislature that the state has cut uninsured visits to hospitals and clinics in half, calling it “the best outcome for the state of Arkansas.” Ta.

Advocates for expanding health insurance are hopeful.

“It's been the Republicans who have said 'no' to Medicaid expansion in the past, and now we're looking at even more expansion,” said Monte Veasey, CEO of the Georgia Community Hospital Alliance.

KFF estimates that more than 430,000 uninsured adults in Georgia could gain coverage if Medicaid is expanded. Of those, 250,000 do not qualify for subsidies to purchase individual insurance and are ineligible for both Medicaid and subsidized marketplace insurance. Some people may be eligible for marketplace policies but are not enrolled.

KFF estimates that 3.5 million uninsured adults nationwide would become eligible if all states expanded Medicaid.

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Any expansion would come as Georgia and other states have disenfranchised millions of people from Medicaid who were held without proving continued eligibility during the pandemic. Georgia has so far evicted about 450,000 people.

Sen. Nan Orlock, D-Atlanta, called Kemp's refusal to expand while so many people are being purged a “failure of governance.”

The agreement with Georgia also could reduce or eliminate licensing requirements for hospitals and medical services. This has been a top priority for Republican Lt. Gov. Bert Jones, who leads the Georgia Senate, but the House has been reluctant to loosen the hardship certificate rules. A similar agreement relaxing permitting requirements helped win expansion votes in North Carolina last year.

Georgia Senate Majority Leader Steve Gooch said his ideologically conservative chamber is not interested in “a real expansion of Medicaid.” But he suggests an Arkansas-style plan could be successful.

“I think there is a willingness to make some changes to the certificate of need requirements, including making health care facilities and services more accessible to all Georgians,” the Dahlonega Republican said.

Still, Kemp could veto any plan. He spent years trying to win a legal battle with President Joe Biden's administration over Pathways' operating requirements. In a 2022 letter to Georgia Democratic lawmakers, Kemp said full Medicaid expansion is a “failed one-size-fits-all policy.”

But if Biden is re-elected, Kemp could face a difficult renegotiation of the pathway. Georgia had sought to extend the program past its September 2025 deadline, arguing that legal battles delayed its start. The federal Centers for Medicare and Medicaid Services said last month that it could not consider Georgia's request because the state did not meet extension requirements such as public notice and comment periods.

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Kemp spokesman Garrison Douglas said Thursday that the governor “continues to champion and support” Pathways and related programs that subsidize private health insurance premiums. He declined to comment on the prospects for broader expansion.

Mr. Kemp does not necessarily have to sign the proposal. In Georgia, bills that the governor does not sign or veto can automatically become law.

But without vocal support, the inertia of deep opposition could defeat expansion, Veasey said. This is especially true as all 236 Georgia members of Congress face elections in 2024.

“We need leadership to come up with a plan,” Veasey said. “They need buy-in.”