Map drawing and Medicaid: yin and yang under the Golden Dome

Last week the Republican-majority General Assembly got up on its hind legs and passed a couple of maps that seemed to dare a federal judge to strike them down, and this week it seems set on doing the same thing with the congressional map.

The legislative maps seemed designed to create as much discomfort as possible for Democrats while complying with District Court Judge Steve C. Jones’ directions regarding the creation of more black-majority districts. The two parties differ sharply over whether their maps really do meet the judge’s requirements, but no one is denying the discomfort. The House map throws three pairs of Democrats into the same districts and only one pair of Republicans. The Senate map creates new black-majority districts by eviscerating the districts of two white Democrats, Elena Parent and Jason Estevez.

The congressional map, which was introduced Monday, seeks something similar by creating a new black-majority district in west Metro Atlanta while making life difficult for U.S. Rep. Lucy McBath, who has been at the center of a lot of line-drawing decisions over the past few years.

It’s up to Jones to determine whether the maps really do what he directed, but it’s fair to say that a map that creates a new black-majority congressional district while hanging on to a 9-5 Republican majority in the delegation is one that was drawn with no concerns about being overruled. Recent court rulings have stirred a kind of long-ball mentality in some legislative circles, a growing willingness to create judicial tests of voting rights questions.

That attitude seems to have prevailed in the deliberations that produced these maps, although the mapmakers took pains to distinguish their careful and deliberate efforts to comply with the judge’s ruling from the undignified and reckless way in which the Alabama legislature drew the maps that another court tossed out.

So there’s a charged political atmosphere under the Golden Dome these days, but for all that fulminating, this really isn’t the biggest story developing there. Last month, the House Study Committee on Certificate of Need Modernization held a hearing in which several speakers testified about the Medicaid expansions in Arkansas and North Carolina.

That may not sound like much, and indeed, it’s a small crack in a big iceberg. But resistance to Obamacare in all its forms has been a bedrock Republican legislative issue for more than a decade. Throughout that time, one red state after another accepted the expansion and the billions of federal dollars that came with it until only 10 states, including Georgia, were left.

That Medicaid expansion came up in connection with the time-honored subject of hospital certificates of need is especially significant. The expansion in North Carolina involved a deal on certificates of need, and that seems the likely path for a deal in Georgia.

The guest speakers at the hearing spoke of how uninsured rates have plunged and hospital closings have slowed to a trickle, all of which “sounds incredibly good and sensible,” said Rep. Lee Hawkins, a Gainesville dentist who is an important voice on healthcare issues.

With starkly different outcomes in neighboring states, it’s becoming increasingly hard to justify holding out longer. Pathways to Coverage, the limited Medicaid expansion with a work requirement championed by Gov. Brian Kemp, has so far failed to attract more than a couple thousand enrollees, and hospitals are in urgent need of a support system.
Medicaid expansion might seem to have nothing to do with map drawing. But there may be more than meets the eye.

It’s probably not an expressly conscious decision to balance a move that’s expected to be deeply unpalatable to the party’s conservative base, however inevitable it may be, with some decorous defiance on subjects, like maps, which in the end may be decided by courts anyway. It’s just the gee-and-haw of politics or the yin and yang if you esteem it that highly.