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Guest Column

Georgia facing healthcare fiscal cliff if it refuses federal Medicaid expansion

By Guest Columnist PAT GARDNER, state representative for House District 57 (D-Atlanta)

Two important healthcare issues loom large for the General Assembly beginning January 14th.

Legislators will engage in a hot debate and intense negotiations over the renewal of a hospital assessment fee.

They will also consider a related issue — whether Georgia takes advantage of federal funds available to families newly eligible for Medicaid. And that one seems a nonstarter at this point. Why? Short term vision.

On one fact there is no debate: far too many Georgians are uninsured.

Pat Gardner

Currently, one in five Georgians has no health insurance. Unfortunately, this lack of coverage does not mean that these families go without healthcare when they get sick. Instead, they pile into public hospitals and emergency rooms, creating a debt of uncompensated care.

Georgia taxpayers must foot the bill one way or another.

Yet when offered a way to expand healthcare coverage to more Georgians and control insurance costs, the proposed solution is to refuse to accept billions in federal funding already paid by Georgians in taxes.

Instead, talk immediately turns to the same old “market-based” initiatives that have failed our state for more than a decade.

On the first day of the new year, our nation stood at the brink of a fiscal cliff. Americans were terrified by the headlines of an ensuing crisis that would burden families with the possibility of a $2,000 tax increase.

Here in Georgia we face a healthcare fiscal cliff created by an underfunded trust fund for the poor and growing healthcare costs. If our state continues to refuse Medicaid expansion, Georgia’s taxpayers will take the dive.

It is time to be pragmatic and instead take practical action.

Under the Affordable Care Act, an expansion of Medicaid would result in 650,000 low-income Georgians receiving health insurance coverage with federal dollars paying more than 90 cents of every dollar.

According to the Kaiser Family Foundation, this expansion would bring over $33 billion in federal money to Georgia over the course of a decade. Kaiser also estimates state expenditures on Medicaid expansion would equal less than 1 percent of Georgia’s general fund spending. In terms of good business sense, the funds represent an extraordinary return on investment to our bottom line.

If Georgia refuses its fair share of funds for Medicaid expansion, it would devastate our economic well-being and public health. A working individual making $14,404 a year or a family of three with wages of $24,352 will lose access to affordable coverage.

If we say yes, the modest cost to the state is, in reality, a long term savings and sustainability plan. Georgia simply cannot afford to continue its failed “don’t ask – we won’t help” approach to healthcare for the poorest Georgians.

We consistently rank among the worst performers across a number of public health indicators. According to the American Public Health Association, Georgia has the 4th highest infectious disease rate and the 11th highest rate of cardiovascular death in the United States. Our state is also ranks in the top 10 for number of uninsured.

Georgia stands on the brink of a healthcare disaster, and we are ignoring the signs that direct us to safety.

Ultimately, the uninsured pass the cost on to employers through lost productivity, and to everyone else through higher insurance rates through cost shifts that continue the never-ending cycle of premium increases, higher co-pays and deductibles.

Medicaid expansion is the smart business move for our state’s health and our financial bottom line. And it is the smartest move we can make to avoid our own healthcare fiscal cliff.


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  1. Burroughston Broch January 14, 2013 1:08 am

    Rep. Gardner neglects to mention the financial “gotchas” that come with the proposed Medicaid expansion. They are:
    1. The Federal Government share of the costs will be 100% for 2014-2016, decreasing thereafter. By 2020 it will fall to 90%.
    2. The Federal Government can unilaterally choose to reduce its share of the costs; this is not unlikely if the Federal Government financial condition continues to deteriorate.
    3. Once the State agrees to expand Medicaid, it cannot undo the expansion.
    Hopefully the Governor and Legislature will pass on this unappetizing opportunity to expand the size of State government and expand welfare.Report

  2. Joanne Lee Mathis January 14, 2013 7:01 pm

    So proud of my State Representative!Report

  3. Nadia S January 22, 2013 2:04 pm

    Mr. Broch – To your concerns, #1 – that may be true, but our tax dollars are already headed to the feds to pay for the expansion… 90% is a much higher match than “typical” Medicaid and refusing expansion just means refusing $33 billion in “our” money coming back to us (more than we pay in probably since we have so many low-income people here)…. #2 – The federal government has never unilaterally reduced matching to Medicaid and there’s no reason to believe it will start.  In fact, states that don’t expand will cost the federal government more overall because of how many people will be sent to more-expensive exchanges with subsidies attached, #3 – This is false.  Georgia can always (legally) undo the expansion.  It might be tough from an ethical or political standpoint but they absolutely can decide to back off it costs come too high.There’s a petition for the folks who agree with Rep Gardner – http://www.change.org/petitions/governor-deal-medicaid-expansion-is-a-good-deal-for-georgia.  #expansionisagooddeal  #covergeorgiaReport

    1. Burroughston Broch January 22, 2013 9:48 pm

      1. Why throw away good money after bad? We are forced to pay the 90% to the Feds, but it’s our choice whether to pay the rest.
      2. The Federal Government has never had this much debt before, and the end of the accumulating deficit is nowhere in sight. If the Congress can, the Congress may. For example, they have held hearings about nationalizing IRAs and 401ks, like Argentina, to reduce the accumulated debt. Don’t ever think it can’t happen here.
      3. Once the camel has his nose in the tent, pretty soon the entire camel is in the tent and you are on the outside. Getting politicians running for re-election to renege on entitlements is not possible.Report


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