22By Guest Columnist LAURA HARKER, who joined the Georgia Budget and Policy Institute in 2016 as a health policy analyst. She is responsible for researching and reporting on Georgia’s health policies and related spending
A ranking Republican Georgia senator who long panned the idea of expanding Medicaid is working on legislation to make it happen. The conservative Georgia Chamber of Commerce just made an economic case for Medicaid expansion as the best way for the state to get a handle on its health care costs and boost struggling rural hospitals.
The chamber’s recommendations come with some strings that are not conducive to getting as many people as possible access to a doctor. But it’s worth taking stock of how far we’ve come in a short time.
Just two years ago state lawmakers created legislative roadblocks that made it harder than ever to envision the day Georgia might extend Medicaid coverage to hundreds of thousands of uninsured Georgians. A few nonprofits like mine took a clear public stand in favor of closing the coverage gap through Medicaid expansion. But many in the business and health professional community deemed a favorable public stance as politically risky.
In May, Renee Unterman (R-Buford), chairwoman of the state Senate Health and Human Services Committee, began telling reporters she’d had a change of heart since she helped shepherd through a law that blocks the governor from expanding Medicaid on his own. A month ago the chamber released recommendations after months of study that sketch out three paths through which Georgia can accept billions of dollars through the Affordable Care Act.
The moral case to close the coverage gap to help hundreds of thousands of uninsured Georgians get access to a doctor was always clear. So was the economic case for anyone who crunched the numbers. Georgia is projected to gain from $8.68 to $9.42 from the federal government for each dollar the state spends on new Medicaid eligibility.
This growing support deserves a grateful nod, but let’s take a look at the pluses and minuses of the three paths the chamber recommends.
All require a federal waiver, since the plans deviate from the traditional Medicaid program. Six other states received federal waivers to expand Medicaid eligibility. In Arkansas, the state got federal approval to use Medicaid expansion money to insure people through the commercial market instead of directly through the program. That adds unnecessary costs in the middle of the process. Still, hundreds of thousands of poor Arkansans got access to a doctor that way.
As Georgia lawmakers review the chamber’s proposals with an eye toward the 2017 General Assembly, it is important to look to lessons from other states.
One path is a partial expansion option that leaves behind many Georgians otherwise eligible under federal guidelines. It also risks Georgia leaving a lot of federal dollars on the table.
The other two proposals make more economic sense and cover all eligible Georgians. These two alternatives offer the best starting point for lawmakers. Still, in order to offer a plan that can be described as conservative, the chamber recommends solutions that don’t take full advantage of the opportunity to shrink the number of uninsured Georgians. Some restrictions can cause people to lose coverage or get limited benefits. Roadblocks to coverage include new work requirements, premiums and health savings accounts.
Many Georgians are out of work because they are unhealthy and can’t afford treatment, so leaving them uninsured is counterproductive. Many low-income people are unfamiliar with the complexities contained in commercial insurance plans, like the ones almost all of us get from our employers. Making them puzzle over health savings accounts and premiums is unlikely to move Georgia closer to the general goal of getting as many people as possible better access to a doctor.
The restrictions are also expensive for states. Arkansas saved $6 million in administrative costs when it eliminated health savings accounts for people living below the poverty line. Other states eliminated non-emergency medical transportation for people get to appointments or omitted dental and vision services to cut expansion costs. That might seem pennywise, but these services prevent conditions that will be costlier to treat in an emergency room later on.
Georgia’s state lawmakers and business leaders are now part of a growing chorus calling for Medicaid expansion to close Georgia’s coverage gap. That is a huge step in the right direction. Now it’s time to create best path for both the financial health of the state’s hospitals and the well-being of hundreds of thousands of uninsured Georgians.
