President Biden firmly stated on Wednesday that he would not accept any work requirements that would impact the medical health needs of Americans, rejecting a GOP Medicaid work requirement proposal. The issue of Medicaid expansion has long been politically contentious, particularly in Georgia, where it was previously deemed impossible but is now being considered as the state’s legislative session begins.
Georgia House Speaker Jon Burns has expressed his desire for lawmakers to explore options for expanding health coverage in the state. However, he is cautious about labeling it as Medicaid expansion or associating it with “Obamacare.” Burns emphasized that his goal is to lower healthcare costs and increase access to healthcare across the state. He plans to work closely with members in the coming weeks to develop sound policies to achieve these objectives.
Although North Carolina recently started offering Medicaid to uninsured adults, there are still 10 states that do not provide coverage to individuals with incomes up to 138% of the federal poverty line, as envisioned in President Obama’s 2010 healthcare overhaul. Mississippi, despite the opposition from Republican Governor Tate Reeves, has shown signs of considering extending coverage. Republican lawmakers in the state are open to exploring Medicaid expansion and its potential benefits.
However, Robin Rudowitz, a vice president at KFF who directs the organization’s program on Medicaid and the uninsured, notes that there is little movement in other states. For instance, in Kansas, Republican lawmakers have rejected Democratic Governor Laura Kelly’s campaign for expansion, despite her efforts to address Republican concerns.
Georgia Republicans have historically resisted participating in Medicaid expansion, even passing a law in 2014 that required the governor to obtain their approval before expanding the program. In July, Republican Governor Brian Kemp introduced a limited expansion program that offers coverage to able-bodied adults earning up to the poverty line. However, eligibility for Georgia’s Pathways program, which is part of the expansion, requires documentation of 80 monthly hours of work, study, rehabilitation, or volunteering. As a result, enrollment has been slow, with fewer than 1,100 people signed up as of October.
Opposition to broader expansion in Georgia has started to waver, with state House members holding a hearing on how Arkansas uses Medicaid funds to purchase private coverage for residents. The success of Arkansas’ approach, which includes copayments of $5 or less for most services, has been highlighted as a potential model for Georgia. Advocates of extending health coverage in Georgia remain hopeful, as they believe more Republicans are now open to the idea.
The Kaiser Family Foundation (KFF) estimates that over 430,000 uninsured Georgia adults could gain coverage if Medicaid is expanded. Among them, 250,000 individuals do not qualify for subsidies to purchase individual policies, leaving them without access to both Medicaid and subsidized marketplace policies. KFF also projects that if all states expanded Medicaid, approximately 3.5 million uninsured adults across the nation would become eligible for coverage.
However, any expansion of Medicaid in Georgia would occur as the state, along with others, is removing millions of individuals from the Medicaid rolls due to the need to prove continuing eligibility. Democratic state Senator Nan Orrock of Atlanta criticizes Governor Kemp’s refusal to expand Medicaid while many people are being purged, calling it a failure of governance.
In addition to expanding health coverage, a potential deal in Georgia could also involve reducing or eliminating permitting requirements for hospitals and health services. This has been a priority for Lieutenant Governor Burt Jones, who presides over Georgia’s Senate. However, the House has been reluctant to loosen certificate of need rules. A similar deal was instrumental in securing expansion votes in North Carolina last year.
Although the more ideologically conservative Georgia Senate Majority Leader Steve Gooch is not in favor of a full-blown expansion of Medicaid, he believes that an Arkansas-style plan could be successful. Governor Kemp, who invested significant effort in a legal battle with President Biden’s administration over the Pathways work requirement, could potentially veto any expansion plan. Nevertheless, if Biden wins re-election, Kemp may face a challenging renegotiation on Pathways.
It is worth noting that bills not signed or vetoed by the governor can automatically become law in Georgia. However, without vocal support from the governor, the expansion of Medicaid could face significant opposition from entrenched opponents. This is particularly relevant as all 236 legislators in Georgia will face elections in 2024, adding a political dimension to the decision-making process.
In conclusion, President Biden’s rejection of the GOP Medicaid work requirement proposal highlights the ongoing debate surrounding Medicaid expansion in Georgia. While there are signs of growing support for expansion in the state, challenges and political considerations remain. The potential expansion of Medicaid could provide coverage to hundreds of thousands of uninsured Georgia adults, but it will require strong leadership and buy-in from key stakeholders to overcome opposition and implement effective policies.
