As the battle over Medicaid expansion ends, the war over healthcare continues

For all we talk about the importance of healthcare as an issue, it’s a rare day in politics when the cost of staying alive matters more than the price of a gallon of gas. That’s why last week felt a little like an inflection point.

Here in Georgia, Rick Jackson announced he has a plan for an “intelligent” Medicaid expansion. You might complain that he really didn’t say what the plan was, except that it would involve a block grant, an idea which has failed to pass muster before. That this was just a thinly-veiled attempt to blur the issue which Keisha Lance Bottoms has made the cornerstone of her campaign.

Even so, Jackson’s announcement means that both the Democratic and Republican candidates for governor now support the Affordable Care Act’s Medicaid expansion, even if in name only. This doesn’t necessarily mean Georgia will really accept the Medicaid expansion, because when the state first refused it back in 2014, the Republican-majority legislature was so adamantly opposed to Obamacare that it removed the governor’s authority to accept it at any time in the future without legislative approval.

But politically, this long, bitter battle is effectively over. For more than 12 years, Georgia has subsidized the 40 states that have accepted the expansion as the cost of its refusal to participate. Now both candidates are willing to ask for what’s left of what was offered years ago.

It fell to Jackson as a Republican to defend this long resistance, even as he was abandoning it. How he did so offered an interesting perspective on the way the CEO of a healthcare company turned candidate for governor would define the problem.

“If we had taken the Stacey Abrams and Obama expansion back when, we would have 600,000 fewer people on insurance right now,” Jackson said at his announcement press conference.

All those people would have had their healthcare covered by Medicaid, but in Jackson’s mind they would also have been on welfare, the degraded state from which he pulled himself up to become a billionaire.

“Why don’t you go ask doctors and hospitals if they would like to see a half million people come off of insurance and go on Medicaid?” Jackson said.

The contrast between the interests of doctors and hospitals and those of their patients is at the root of another story from last week with political implications. The New York Times researched the records of U.S. Sen. Roger Marshall, an obstetrician/gynecologist who practiced for decades in rural Kansas. It found that Marshall had filed suit against more than 700 former patients for outstanding bills, and that 81 of these patients were subsequently arrested for missing court dates. Patients were charged an annual 18 percent on their outstanding balances.

The last time Kansas elected a Democratic senator was 1932, but Marshall does have an opponent in Democrat Adam Hamilton, the senior pastor of the largest United Methodist congregation in the country. He’s also catching heat for his support of President Donald Trump’s tariff program, and polls have tightened.

In response to the Times story, Marshall’s campaign has characterized his collection efforts as an effort to keep the lights on in a struggling rural hospital. In campaign ads, Marshall has highlighted his role as the only doctor in hundreds of miles who would accept Medicaid patients.

Writing in Forbes magazine, Dr. Richard Menger, a neurosurgeon and author, argued the Marshall story “cuts both ways.”

“Marshall’s clinic did not invent American collections law. It used it. One may argue the tactics were harsh, especially the interest rate and the path to warrants, without arguing that physicians must work for free,” Menger wrote.

Whatever happens in Marshall’s race, the impact of this story is likely to be felt far beyond Kansas.

“One of the things you need to understand,” Jackson said at his announcement event last week, “Not having insurance in Georgia does not mean you don’t have health care… I want you to tell me people that don’t get healthcare when they need it.”

One of the things Jackson needs to understand is that it’s going to take a lot more convincing before most Georgians will be willing to buy that proposition. So much hangs on the phrase “when they need it.”