This year, the path to disagreement goes through healthcare

Healthcare has become the nexus through which most of the serious politics of the General Assembly moves. Which is much different from saying that healthcare is a subject the General Assembly has done much about.

Just as they have in so many previous sessions, the House and Senate have found something to argue about in their closing days together. The party in the minority, with the help of some in the majority, has attempted a Hail Mary pass. Not to say it’s all a ritual, but some things happen over and over.

In the past, these rituals might have been reenacted through the nexus of a transportation bill, sometimes an education bill, or maybe a law enforcement bill in an election year. This year it has been healthcare bills, chief among them the certificate of need overhaul which passed both chambers last week after some sparring, which have provided the pathway to disagreement. A major Republican goal, the school voucher bill, passed after several years of effort but with much less drama.

Healthcare has become the soft earth into which other issues fall as sine die approaches. Sex education, transgender students and school libraries all, obviously, have to do with education. But this year they were all loaded onto a measure that was originally intended to provide for mental health screenings for student athletes. Again, it’s about finding a way to disagree.

Healthcare has come to function this way in the legislative process for a few reasons. The pandemic politicized healthcare in an unprecedented way, transforming formerly non-controversial matters like vaccinations into flaming partisan issues. But healthcare is where it’s at in Georgia this year chiefly because of the lingering suspense over Medicaid expansion.

“Why shouldn’t we give the governor a chance to see if Pathways can succeed before you cut his legs out from under him?” Sen. Bill Cowsert, chairman of the Senate Regulated Industries and Utilities Committee, asked before casting a vote that created a 7-7 tie and killed a last-gasp effort by Democratic Sen. David Lucas Thursday to expand Medicaid with a plan similar to one enacted in Arkansas.

One answer to Cowsert’s question is that there are other legs involved besides the governor’s. Georgia Pathways to Coverage, the program designed by Gov. Brian Kemp as an alternative to Medicaid expansion, has so far enlisted fewer than 4,000 participants at a cost of $26 million.

A year from now, what would success look like in a state where the needs are estimated to be in the hundreds of thousands of people in need? What cost estimate could compete with the money that would come with expansion into the federal program?

Cowsert had to use his chairman’s vote to kill the measure because two Republicans voted with five Democrats to pass Lucas’ bill. Democrats claimed that Republicans violated a commitment to allow a vote on Medicaid expansion this year. If that’s true, it only describes a delaying tactic. Medicaid expansion will be back as an issue next year, and without any party primaries looming overhead, that tied committee vote might move slightly in another direction next time.

The hospital bill gave Lt. Gov. Burt Jones a significant legislative victory ahead of his planned race for governor in 2026, but the same bill could give his future opponents to raise questions about possible conflict of interest. Past that example, it’s hard to see many clear winners or losers from this session. But we speak in the past tense, and there still are two days left.

With the proportion of Georgians 60 and over growing faster than any other part of the population, healthcare with all its attendant parts could be the nexus of General Assembly politics in more years to come. On the other hand, we could be arguing about electric cars. 

Whatever the nexus, however, we can be sure the House will fall out with the Senate, and somebody will try another Hail Mary.