Tim Sweeney

By Guest Columnist TIMOTHY SWEENEY, director of health policy at the Georgia Budget and Policy Institute

A rule of thumb holds that when something happens three times in short order, it’s a trend. So it’s fair to say that the melting resistance to Medicaid expansion among Republican  governors just changed from anecdotal to a full-blown trend.

Last week, two more Republican governors came out in support for taking advantage of new federal funding to ensure health coverage for more of their state’s residents.

Ohio Gov. John Kasich and Michigan Gov. Rick Snyder bring to six the number of GOP governors who have announced they will move forward to expand Medicaid through the national health care law known as the Affordable Care Act.

They join GOP governors in Arizona, New Mexico, Nevada and North Dakota in placing more importance on financial practicality over political ideology.

Even though both of the Midwest governors have been consistent foes of the Affordable Care Act, their broad opposition has not stopped them from realizing that using new federal funding to address health coverage needs will be a good financial deal for their states.

Tim Sweeney

Kasich noted Ohio is “…going to extend Medicaid for the working poor and for those who are jobless trying to find work. It makes great sense for the state of Ohio because it will allow us to provide greater care with our own dollars.”

Michigan’s governor points out that extending coverage makes for a better health care system, because “those who are uninsured are using the emergency room as their primary health care. That’s a flawed system.”

Georgia is home to the fifth largest uninsured population of any state in the country. Simple math shows Georgia has more to gain than the states where Republican governors have dropped their opposition to expansion.

Medicaid expansion would enable the state to cover hundreds of thousands of Georgians who will otherwise remain uninsured. Instead of continuing to tout inflated cost estimates, the state’s leaders should look more closely at the benefits other states will realize and move to ensure that Georgia benefits too.

Gov. Nathan Deal restated his opposition to the law at the outset of this year’s legislative session.

But Georgia could gain more than $30 billion in new federal funds over the next 10 years if he joins his counterparts across the country and accepts expansion.

Expanding Medicaid will increase access to health care for Georgia’s people and better enable Georgia to invest in its health care system. Over the next 10 years, Georgia’s modest state investment – less than a 2 percent bump in total state spending — will bring at least $9 in federal funding for each state dollar.

This is a return two-thirds greater than the $5.50 per dollar return the governor cited in his State of the State speech in January as justification for Georgia’s investment in the harbor deepening project in Savannah.

The new federal investment in Georgia’s health care system will greatly benefit the state as the new spending flows through the economy. The new spending will help people, and businesses, who buy private insurance by reducing uncompensated care and the cost shifting that results when hospitals and other health care providers treat patients without health insurance.

Want more examples of the reasoning the converted Republican governors are giving for their embrace of Medicaid expansion?

Consider the remarks of Arizona Gov. Jan Brewer, whose embrace last month of extending Medicaid to those earning up to 133 percent of the federal poverty line (about $31,000 for a family of four) will cover 250,000 more Arizonans and bring in nearly $8 billion in new federal funds over three years.

Carter Center seminar
Carter Center seminar

In December, Nevada Gov. Brian Sandoval was the first Republican governor to announce that his state will expand Medicaid to cover more than 78,000 low-income people. New Mexico Gov. Susana Martinez soon followed, announcing her state will also expand Medicaid in 2014 to generate nearly $5 billion in new federal funds and extend coverage to more than 200,000 people. North Dakota Gov. Jack Dalrymple also included the Medicaid expansion in a bill he sent to the legislature last month.

All six of these governors noted they were against Obamacare as a whole. But, they said, since the law is here to stay it makes more sense for their states to accept federal funds that will give a financial lift to hospitals and other health care providers, while increasing health coverage for their residents and boosting their economy.

Note to readers: Sweeney is a featured speaker at a panel discussion Thursday at the Carter Center: The Affordable Care Act’s Impact on Access to Mental Health Services in Georgia.

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  1. The Gov has probably gotten more ‘financial incentive’ from those beneftiing from the harbo expansion than the thousands who have no health insurance and turn to the ER as their PCP (primary care physician).  He (Deal), no doubt, is a product of Georgia’s not so hot K12 education engine and never did very well at math.  The last time I looked $9 federal dollars for every $1 spend on health care, beats $0 federal dollar for each spent.  The people who would benefit didn’t vote for Deal, perhaps he is trying to reduce the Democratic voting population as a means to get to a second term.  Sad.

  2. Governor Deal has not jumped on the Medicaid expansion bandwagon because he is (so far successfully) trying to avoid drawing a primary challenge from his right political flank (most particularly from the Tea Party flank to his right).
    Deal is receiving extreme and constant pressure from his political right not to expand Medicaid as he heads into a 2014 re-election campaign in which he has so far avoided any challenges from his political right, a political right which has grown increasing hard-edged in recent years.
    For those who are unhappy that Governor Deal is refusing to endorse any expansion of Medicaid (particularly those on Deal’s political left), any movement on the Medicaid issue would have to come after Deal was elected to a second term in the Governor’s Mansion.
    If Deal were to endorse any expansion of Medicaid before earning re-election, he would very-likely draw a hard and intense challenge from his political right and might even likely lose in the Republican Primary to a candidate from the far right of the Republican Party who would be completely unlikely to make any movement on Medicaid expansion after defeating Deal over the issue in the primary and winning a general election in which Georgia Democrats are totally-unprepared and not yet ready financially and organizationally to compete in.
    With weekly and sometimes daily meetings with the Tea Party contingent of the Georgia GOP, Deal politically cannot even mull the possibility of expanding Medicaid at this time, lest he risk a primary challenge from his hard-right and significantly lessen the chances of what are now an increasingly likely re-election to a second term.

      1. @GraceD
        Georgia’s rapidly-evolving demographics say that Georgia Democrats should already be highly-competive and maybe even dominant in some respects as the state of Georgia, despite being completely-dominated at the statewide level by a very-conservative and predominantly-white Republican Party, has racial demographics that are very-similar to that of the Democrat Party-dominated state of Maryland.
        Georgia has a statewide population that is roughly 45% non-white, Maryland has a statewide population that is roughly 46% non-white.
        The South Atlantic state of Georgia also has nearly 70% more population than the Mid Atlantic state of Maryland as Georgia has 10 million residents and Maryland has 5.9 million residents.
        The demographic numbers say that Georgia should be highly-competitive at the statewide level NOW, not in a decade or so.
        The biggest problem for Georgia Democrats is that they currently have no money on hand (as the Georgia Democratic Party engages in virtually no fundraising as an organization statewide), no cohesive statewide structure, and no semblance of an organization at the statewide level.
        In addition to having virtually no funding, no organization and no statewide party structure, Georgia Democrats also seem to have extreme difficultycultivating and fielding candidates at the statewide level at the moment. 
        Despite having very-advantageous demographic numbers that are unquestionably going their way, it likely won’t be as simple as Georgia Democrats going out and beating Georgia Republicans in 2014 or anytime soon if Georgia Democrats continue to not have even a fraction of the financial and organizational resources that a less-than-stellar and not exactly robust Georgia Republican Party has at the moment.
        It is so bad for Georgia Democrats as an organization right now that, at the moment, it is not out of the realm of possibility that Georgia Republicans could run unopposed in high-profile statewide races for the U.S. Senate and the Governor’s office in 2014.
        At the moment, it appears to be somewhat increasingly not-inconceivable that not only Governor Deal could run unopposed in the 2014 GOP Primary, but he could also run unopposed in the 2014 General Election.
        The 2014 U.S. Senate race is a slightly different animal than the Governor’s race, but the early-on development of very hard-right conservative Republican U.S. Congressman Paul Broun being the first to declare for the race in a GOP Primary in which only the most-hardcore conservative will appeal to a definitively right-of-center electorate that is increasingly unhappy with anything that looks even remotely moderate, has likely chilled other more politically-moderate candidates from wanting to enter the race.
        With Georgia Republicans being highly-funded, highly-organized and very highly-motivated, especially within the far-right and Tea Party flanks of the party, after the re-election of Georgia Republicans’ most-hated enemy in Washington in President Obama and after successfully pressuring a sitting U.S. Senator into retirement that many Georgia Republicans saw as increasingly too-moderate in Saxby Chambliss, 2014 does not necessarily look to be all that great of a statewide election year for an organizationally-dysfunctional Georgia Democratic Party.
        Though, there could be some hope for Georgia Democrats in 2016 if Hillary Clinton runs for the Presidency and does well in Democratic Primary and makes it to the General Election as the Clintons, with their traditionally Southern political heritage and intimate knowledge of Southeastern politics (being that Bill Clinton was Governor of Arkansas and knows how to fundraise and relate to an audience dominated by Southern Conservatives), would likely, under the right circumstances, be willing to invest money and capital to rebuild the Democratic Party structure and organization in a large Southeastern state in which the demographics are unquestionably changing in favor of the Democrats.
        A successful Hillary Clinton Presidential run in 2016 in which the National Democratic Party spends money rebuilding what is right now a totally non-existent statewide organization in Georgia could also portend well for a better performance for Georgia Democrats in the 2018 Governor’s race.
        Though the 2018 Governor’s race will also be very-tough for Georgia Democrats to compete in with such highly-popular statewide Republican heavy-hitters as Georgia Attorney General Sam Olens (highly-popular from his days as an exceedly-competent Chairman of the Cobb County Board of Commissioners) and Lt. Governor Casey Cagle (a very well-liked politician statewide, especially within the North Georgia political scene that currently dominates Georgia politics) figuring heavy into the equation.
        Needless to say, 2014 will in all likelihood be a rebuilding year for Georgia Democrats in which the party probably completely bottoms out and likely finally completes its decade-plus long slide to rock-bottom.

  3. Deal will not accept Medicaid funds that would create a projected 79,000 plus jobs! And would provide very needed health care to Georgians!  Yet he gives away tax relief & special concessions to big business!
    And then you try to tell me that republicans care about people!
    Sorry, guys, your actions speak louder than your words.

    1. @GraceD
       Politically, Governor Deal cannot even broach the possibility of accepting Medicaid funds because doing so would incur the wrath and the ire of a Tea Party movement that is much more active and much more dominant in Georgia than in any of the other states mentioned in the article where GOP governors are accepting Medicaid funds.
      If Governor Deal were to make a move on accepting Medicaid funds, it would have to come after his re-election and in his second term.

    The states that except so much money from the fed.s remind me of adult children excepting money from a demented parent that can no longer pay their own bills. It might not be fun to see the other children getting all that money, but I would rather be the child that truly cares about the parent and not just my own interest.

  5. Those complicated IRS and taxation issues are very important for any business and I am very glad every time I read interesting tax law blog post. Thank you for this post. I think that there are lots of attorneys among your friends. If I am right, many of them can submit contacts to Attorney Directory for free. Rubric of Georgia tax attorneys http://attorney-online.info/dir/tax/georgia/911 is supposed to be the most appropriate one, but there are many others. By the way, I wish such good author as you to publish articles and blog posts on Attorney Online.

  6. Dear Georgia being that i’m from your sister state Florida,i just want to say pay no attention to the poster saying that you have no way of unseating that bigoted idoit govenor of yours.First you have to make the masses realize how important this is to your children and just your quality of life! These people thrive on spreading falsehoods,threats, and the obvious voter suppression efforts.Rick Scott is doomed here,even the most ardent klansman has admitted as much.It’s not hard to do, a motivated and well eduacted public (on the issues) is hard to beat.With 45% of the people there nonwhite you will find that the 55% balance half really want him out as well! So get cracken spead the word, i know your tired of living under tea baggers,ayran nationalist, segragationist and the like.

  7. AshkiiGarrett Like there was no funding for the $118 million a YEAR deal he made by changing the SHBP benefits plan? Google it. That’s what he was doing when the Medicaid 10 were arrested. He is a crook! That is why there is no funding. Does he realize that the federal government pays 90% of the bill? Or that it could help hundreds of thousands of working poor in this state? I’m sure he does but he doesn’t care. Idiots will still believe that the poor are moochers. People are poor because that’s what they are worth, or they are lazy. Not because there is wage inequality, or a terrible economy, or jobs that you are OVER qualified for. That REALLY sucks. What about the $9 billion dollars that the fast food industry costs this country every year or the $900,000 that EVERY Walmart store costs us a year by paying poverty wages and subsidizing their profits with government assistance? You can google that one too. All you idiots that think Republicans care about anything other than big business and their corporate sponsors are out of your f*cking minds. Pardon my French but I work in a doctors office, Neurology to be exact, and see how people struggle everyday. Republicans are making things so much worse for Georgia but these idiots can’t see it because all they know is red or dead. As an independent, I weep for you.

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