The idea of expanding Medicaid in Georgia is an idea whose time has come, and it’s time for the state’s Republican leaders to seriously consider it.
The option to expand Medicaid to adults up to 138 percent of the federal poverty level, which most states have approved, would extend coverage to hundreds of thousands of low-income Georgians. A state has the option to decline or accept expansion of Medicaid, but its plan for expansion must get U.S. government approval to qualify for the additional federal funds.
Critics of expansion in Georgia say cost is their main concern. In his State of the State speech in January, Gov. Nathan Deal, a Republican, said expansion would have cost Georgia more than $200 million in the fiscal 2017 budget. “That number would only continue to grow exponentially,” he told a joint session of lawmakers. The GOP-controlled General Assembly, for its part, has passed a law making any future expansion harder to enact.
Yes, expansion could lead to higher costs in the future. But it also could mean some savings over the short term, as more federal dollars flow into Georgia.
There’s no question that expansion would be a boon to many of Georgia’s hospitals, especially those like Memorial Hospital in Savannah that treat a considerable number of Medicaid and poor patients.
The Georgia Republican Party, at its recent convention, passed a resolution calling for GOP legislators to “show their continued support of responsible state budgeting by publicly voting against and aggressively oppose any expansionary form of Medicaid pursuant to the Affordable Care Act (Obamacare) in the state of Georgia.”
Unfortunately, too many Republican leaders have framed the issue of Medicaid expansion as support for Obamacare, which is misleading. While people can freely debate the pros and the cons of the so-called Affordable Care Act, Georgians are still going to get sick and require medical care. And medical providers will still need to get paid for their services to cover their costs. Otherwise, some provider will have to cut back on services or close their doors.
The grim possibility that many Georgia hospitals may face closure, throwing people out of work and forcing Georgians to drive greater distances for needed care is causing some Republican lawmakers and other leaders to rethink their knee-jerk opposition to Medicaid expansion. They’re also looking at the experiences in other states that expanded their Medicaid programs. For example, Louisiana is banking on an extra $184 million in savings. Kentucky had data predicting an $800 million budget gain as its governor launched expansion there in 2014.
Meanwhile, a study released in March found that data in 11 states — Arkansas, California, Colorado, Kentucky, Michigan, New Mexico, Oregon, Maryland, Pennsylvania, Washington state, and West Virginia — and the District of Columbia confirm that states continue to realize savings and revenue gains as a result of expanding Medicaid. The study, sponsored by the Robert Wood Johnson Foundation and conducted by Manatt Health, concluded that every expansion state should expect to achieve savings related to previously Medicaid-eligible people being moved into the new adult group under expansion. The enhanced federal match for those individuals would be at least 90 percent, versus a current 67 percent in Georgia.
Expansion would also bring in additional revenue from existing insurer or provider taxes, the study added.
No similar study of potential savings from Medicaid expansion has been done in Georgia, industry experts say. But the findings of such an analysis look favorable. “I am confident it would show significant savings,” said Bill Custer, a health insurance expert at Georgia State University.
In Georgia, much of the savings would come from adult mental health and substance abuse funding, experts say. That’s now dominated by state dollars. The state budget for adult mental health services is more than $350 million for this fiscal year.
Many of those patients have low incomes and are currently uninsured and would qualify for the new coverage, experts say.
In addition to savings, there would be other important benefits. Drug addicts and people suffering from mental illness would be more likely to get the treatment they need, potentially boosting public safety.
And therein lies the problem. Georgia’s Republican leaders must look beyond blind opposition to President Obama when it comes to Medicaid expansion. They must eliminate the political rhetoric and instead focus on the bottom line.
Supporting Medicaid expansion at this juncture does not equate to supporting Obamacare. But to go beyond partisan politics will require an honest, independent and apolitical assessment of what expansion would mean for Georgia.
The time to do this is now, as there is no guarantee the additional federal dollars will be around forever.
In addition, GOP leaders should consider where many of those federal dollars come from — the pockets of every taxpayer in Georgia. Instead of shipping that money off to other states that have expanded their Medicaid programs, it seems to make more sense to expand Medicaid here and keep those dollars closer to home.
The issue of Medicaid expansion must be focused on what’s best for Georgia, not national politics or what may be best for the Republican Party.