What is Expanded Medicaid?
Expanding Medicaid means using available federal funds provided by the Affordable Care Act (ACA) to cover more people. This is because expanded Medicaid covers those earning up to 138% of the Federal Poverty Level (FPL) (the FPL is about $15,060 for a single adult and $31,200 for a family of 4; 138% of the FPL is $20,783 and $43,056), enlarging the pool of people who can receive the benefit. In addition to far more coverage at a much lower cost to a state that adopts it, the federal government through the American Rescue Plan provides an additional 5% incentive to expand Medicaid fully, which amounts to some $700 million Georgia would gain. Kemp created an alternative expanded Medicaid approach called the Pathways to Coverage. Not only does Pathways cover far fewer people but it is expensive. Adults earning less than 100% of the FPL are eligible. The state-run program that began Jul 1, 2023 has cost $26 million so far in administrative and consultant fees to enroll only 3,800 Georgians in nearly a year of operation. Georgian taxpayers are paying $2,500 per enrollee; with Medicaid expansion, each enrollee would cost about $496. And, expanding Medicaid would cover an estimated 400,000-600,000 Georgians. Georgia’s target in the first year is 65,000 (and the budget covers fewer). (Contrast this with North Carolina, which fully expanded Medicaid as of Dec 1, 2023 and has so far enrolled nearly 400,000 residents). If Georgia expanded Medicaid, another estimated half million Georgians would be covered, according to the Georgetown University Center for Children and Families. GA Work Requirements–Unique in Country Georgia is the only state in the country to require enrollees to prove they are working/studying or volunteering 80 hours per month under onerous timelines. Unlike other states, Georgia’s Pathways does not consider caregiving to count as work. Georgians already disadvantaged are asked to do more to get healthcare, bearing a burden called “fiscally foolish and anti-family”, by Joan Alker, executive director and co-founder of Georgetown University’s Center for Children and Families. The Pathways System has Roadblocks at Every Step Enrollment in the program is tedious, especially for anyone with irregular hours or who works independently. The Georgetown Center for Children and Families highlights this is by design: the Center for Medicare and Medicaid Services (CMS) directs, where states require such documentation, to rely on available data sources—not to put the onus on the individual. Compliance will get even harder when Georgia begins its next phase of Pathways this July, requiring enrollees to pay premiums according to a schedule that differs from the work documentation timelines. Lost Opportunities The low level of enrollment means hundreds of thousands of Georgians often turn to hospital emergency rooms for what become acute crises. This costs taxpayers more and prevents adult Georgians from wholly contributing to the workforce and to Georgia’s future. One estimate projects that full expansion of Medicaid would create over 56,000 jobs because more people would be healthy enough to participate full-time in the workforce. In the last legislative session, even some Republicans joined Democrats in pushing for bipartisan-backed Medicaid expansion, which Gov Kemp has criticized, saying it is fine to have a conversation about the topic, but not to bring a vote to the floor for a vote. He made clear he is a “hard no” when it comes to expansion. Threats to Already Burdened Rural Hospitals Georgia’s hospitals have already suffered closures, with 12 rural and urban hospitals closed in the last 10 years. Now, 18 rural hospitals out of 30 in the state risk closure–making Georgia 6th in the nation for rural hospital closures– according to a recent report citing Chartis, a healthcare advisory firm. Chief among the reasons for this is the state’s failure to expand Medicaid. Rural hospitals often care for the state’s poorest, many of whom are uninsured. Without expanded Medicaid, the hospitals pay for the care of the uninsured, and do not get the reimbursement that Medicaid would provide. Many Georgians are forced to drive to major cities, while hospitals stop providing vital care and treatment options to try to save money. Adding to the complexity, the heightened use of Medicare Advantage programs contribute to the plight of rural hospitals since the plans reimburse hospitals at lower levels. An Inhumane and Inefficient Choice Nearly 2,500,000 people in GA are already enrolled in regular Medicaid. Medicaid covers 2 in 5 children, 5 in 7 nursing home residents and 3 in 10 persons with disabilities in GA, according to a 2023 Kaiser Family Foundation report. Nearly 60% of all recipients are already working, and 68% are people of color. With the required re-enrollment process in 2024, 300,000 children are without coverage. The GOP majority’s refusal to promote the ACA is part of a larger continued effort to weaken and even dismantle federal entitlements which will be profiled in the next edition of The Kicker.
“The AMA is steadfastly opposed to governmental interference in the practice of medicine, especially for well-established, medically necessary treatments,” added Dr. Resneck. Patients and physicians need assurances that they won’t be accused of crimes for medically necessary treatment.
Unfortunately, this is the post-Dobbs world we now face. The fact that medically necessary treatment can be criminalized speaks volumes about these misguided abortion laws. Arbitrary and Unscientific Timelines imposed In the chaos created by Republican politicians, physicians and other health care professionals must attempt to comply with vague, restrictive, complex and conflicting state laws that interfere in the practice of medicine. Georgia’s move from a 12-week abortion ban to a 6-week ban can often be before a woman even knows she is pregnant. By the time a woman is considered six weeks pregnant, she would have had two weeks, at most, to realize it. This means that just two weeks after a missed period, a woman is six weeks pregnant. Women with irregular periods are particularly at risk of not realizing they are pregnant. Georgia’s “heartbeat law” restricts abortion if fetal cardiac activity can be identified. At 5 weeks, a health care provider would not be able to use an ultrasound to confirm that a pregnancy is viable, because there would be no fetal cardiac activity yet, which leaves a woman “a very small window in which to confirm pregnancy,” says Dr. Michael Belmonte, an obstetrician-gynecologist and fellow at the American College of Obstetricians and Gynecologists. Legal Penalties for Health Professionals Recent changes in abortion laws have sown confusion that has prompted payers, pharmacies and medical offices to restrict the use of medically necessary treatments. Pharmacists have resisted filling needed medications on the basis that they could be used off-label for pregnancy termination, and they could face criminal charges. The Supreme Court has been asked to impose legal consequences on physicians providing emergency care for pregnant patients experiencing critical life-threatening complications in emergency rooms. Women have had to go to court to ask for lifesaving cancer treatment that could result in harm to the fetus, yet without it, the mother could die. While Republican politicians boldly assure women that their life will be respected over that of the fetus, they are all working diligently in Congress to pass HR431 The Life at Conception Act, which establishes personhood for the fetus at conception, putting both the mother and her physician at risk as they “criminalize any parties that disrupt that process.” A chilling effect on abortion bans can be seen in the 9.5% reduction of residency applications in Georgia. Physicians and Democrats are fighting for women’s rights for safe and accessible reproductive care. Make sure your representative joins them in this battle for democracy and a woman’s right to make decisions about her own body.
Why is this happening?
Challengers cite a need to ensure up-to-date voter rolls to fight against “voter fraud”, when in fact, voter fraud is exceedingly rare as proven in numerous court cases and audits. In fact, Georgia’s voter rolls are clean and well-maintained as the state is part of a national, interstate voter data program called ERIC that identifies voters who vote more than once in any election. ERIC provides Secretaries of State with additional information to identify voters that are no longer eligible to vote in their state. Thus, all of the additional work and taxpayer expense generated by these voter challenges have yielded no benefit to voter roll accuracy. Instead, GOP challengers’ actions point to something else: an aim to disenfranchise voters who typically vote Democratic: voters of color, voters who live in areas where changing demographics are turning the area purple and voters who find it hard to fight back (e.g., homeless, students living out of state, people who may be caring for family out of state, etc). In Georgia, challengers do not need to know the people whose registrations they challenge. They present scant evidence to disqualify voters. In fact, one man has attempted to use third-party software that is neither proven nor legally permitted to collect hundreds of voter names at one time to challenge. Recent challengers have admitted that they are not working alone, rather are part of a larger effort to remove voters from rolls. Violation of Federal Protection Furthermore, the National Voting Rights Act of 1993 states that no voter may be removed from a state’s rolls (canceled in the state’s database) until two federal election cycles have occurred, and after the voter has been notified that they are going to be removed. Election deniers bypass this NVRA requirement by challenging voters at the county election board level. Some counties, including Forsyth, are removing NVRA-protected voters without following the NVRA requirement, potentially violating voters’ 14th Amendment rights. In a state with elections as close as Georgia, removing a few hundred voters from the rolls matters. 
This weeks call to action:
The importance of your vote for John Barrow for State Supreme Court judge
All but one of the current justices have been appointed, using a procedural loophole that allows justices to be appointed by the Governor in the event of another judge’s retirement. The Georgia Supreme Court rules on issues that directly affect you and your family, such as gun safety related laws, voter rights (e.g. voter suppression efforts), gerrymandering by the State Legislature, women’s reproductive rights and care, workers’ rights, and child labor laws. Furthermore, with the Dobbs decision, the US Supreme Court has handed reproductive choice back to the states, and the Georgia Supreme Court will be the “court of last resort” for this issue in the future for Georgians. The Court acts as a check on the State Legislature, ruling on the constitutionality of state statutes, disputes related to elections including challenges to election results, electoral integrity and resolving contested outcomes. We expect voting to be a major issue in the 2024 elections as the State and GOP ramp up efforts to contest voter eligibility and to contest election results as evidenced by the recent passage of 3 voter suppression laws which we will review in the next issue. Why Voting in the Primaries is so important. Early voting for the May 21st primary has already started. Attendance thus far has been slow. As of the latest report from Forsyth County Voter Registrations & Elections, 470 democrats (19.7%) and 1875 (79%) republicans have voted.
Even though our slate of candidates are running uncontested, a strong showing in the primary provides more exposure, which gives them a big boost for fundraising. It not only helps them identify potential donors, but essential volunteers for their campaigns from those that pull a “D” when voting. 
In the aftermath, Forsyth Sheriff Ron Freeman praised (rightly) the bravery of the student who spoke out, and reiterated the importance of the district’s “see something, say something” policy of identifying threats to student safety. Another version of this story unfolded last week in Wisconsin, only in that case, police fatally shot the 14 year-old who’d brought the gun to school. It’s a horrible reminder of what could have happened here.
Lots of Forsyth parents were left feeling that this situation represents multiple systemic failures: How did this child gain access to this gun, and are the gun owners going to be held responsible? The sheriff’s office commented only that “the parents had their gun safely stored,” but if a child was able to get it and take it to school, it wasn’t safely stored. Gun violence is the number one cause of death for children and teens, in Georgia and in the US as a whole. We feel that Sheriff Freeman squandered an opportunity to educate parents and people in the community about the bare-minimum responsibility that comes with the right to own guns--that they must be kept out of the hands of children. Eighty percent of school shooters obtained their guns from the home of a parent or relative, these are preventable tragedies. This is common sense gun safety to everyone except our elected Republican leadership. In the 2024 Georgia legislative session, Representative Michelle Au sponsored HB 161, the Pediatric Safe Storage bill, which would have held gun owners criminally liable for their guns being accessed by children. It was the first piece of common sense gun legislation to get a hearing in Georgia in ten years. She also introduced HB 971, a bill that would have given tax credits for the purchase of biometric gun safes (which would’ve prevented the Little Mill incident). Nobody in our Forsyth delegation supported any of this legislation. For those who say this isn’t a gun issue, it’s a mental health issue, our Forsyth students are getting little help there either, as extremist voices in our county have targeted programs that promote emotional intelligence in our kids and combat bullying. Across the country, as well as here in Forsyth, radical groups like Moms for Liberty have targeted programs that promote Social and Emotional Learning. Many Forsyth parents loved programs like the 7 Mindsets curriculum, which helped kids learn to regulate their emotions and replace negative self-talk with positive statements of growth. Isn’t the fact that in just a few weeks we’ve had a student bring a gun to school, and yet another student brought a knife onto the bus, evidence that our kids need more emotional support at school, not less? As Dr. Au said, “Children are a special class of people that need protection, which is why we have gates around pools, child-safe medication bottles, and car seats.” The Forsyth Dems are proud to support a slate of candidates who will put the safety of our children first by promoting common sense gun legislation, like Rep. Au’s Safe Storage Bill, that places the responsibility for gun safety where it belongs, on gun owners, coupled with more investment in our schools, not less.
Georgia Republicans’ House Bill 481 bans abortions after six weeks of pregnancy, before most women know they are pregnant. This is one of the biggest causes of maternal deaths in Georgia.
Recent data shows states that have restricted abortion have fewer maternity care providers, more maternity care deserts, and higher rates of maternal mortality and infant death, particularly among women of color. Whitney Rice, DrPH, MPH, Emory University, estimates what the potential consequences of Georgia’s early abortion ban could be.
Republicans’ failure to fully expand Medicaid has left 60% of our rural hospitals on the brink of failure. Georgians who currently have no choice but to travel multiple hours just to see a doctor need real health care and real leadership: they’re getting neither from Brian Kemp and Republican leadership who again refused to expand Medicaid this legislative session. |
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