Kemp and GOP Deny Healthcare to Poorest, Threaten Rural Hospitals

Not only does Georgia have the 2nd highest number of uninsured residents in the country (second only behind TX), but Governor Kemp’s long-running refusal to expand Medicaid is leaving an estimated 370,000 Georgians without insurance. And in turn, the lack of funding that expanding Medicaid would bring also threatens the solvency of Georgia’s remaining rural hospitals. Georgia is one of only 10 states refusing to expand Medicaid to all low-income adults.

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.
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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.