End wait-and-see on Medicaid expansion

In 2013, Georgia leaders had the chance to prepare to accept $3 billion in federal money to expand Medicaid at the state’s first opportunity the next year. Instead they decided to wait and see if 2014 national elections would undercut the Affordable Care Act.

The Affordable Care Act survived 2014 intact, so state leaders decided to wait and see if the Congressional turnover that took effect in 2015 ushered in repeal of the federal health care law. That delay forced Georgia to miss out on another $3 billion in federal Medicaid money in 2015.

Finally, in 2016, business leaders and state lawmakers launched an effort to find a palatable way for Georgia to expand Medicaid and accept the billions of federal dollars still available. But last November they abandoned the effort to wait and see how the presidential election results might change their calculations.

Fast forward to August 2017 and Georgia is well into another year of leaving billions of dollars on the table. Georgia’s now said “no thanks” to more than $10 billion in federal Medicaid investment, money that could give hundreds of thousands of low-income people access to a doctor and deliver an economic jolt to the state’s financially strapped rural health care system.

Today, about 300,000 people in Georgia make too much to qualify for Medicaid, but don’t earn enough to qualify for the subsidized insurance marketplace. Georgia’s rural hospitals struggle to keep their doors open as they stretch to treat uninsured patients, especially in communities with high poverty rates. People within a short ambulance ride to many of Georgia’s rural hospitals are at risk of losing access to care due to funding shortfalls. At least eight rural hospitals in Georgia closed since 2001.

Georgia’s health care crisis deepens as years go by. Medicaid expansion is an obvious way for the state to stop digging the hole.

State lawmakers can prepare this fall as if the General Assembly’s best health care option next January is still to pass a bill to expand Medicaid income eligibility. The 2010 federal health law still stands despite a concerted Congressional effort to gut it this summer.

State leaders said publicly in recent days that Medicaid expansion is back in the mix of policy solutions Georgia will need to change the trajectory of the state’s health care problems. Lawmakers can pull a template off the shelf to use as a starting point.

About this time last year, a Georgia Chamber of Commerce task force unveiled a plan for the state to access federal Medicaid expansion money through a waiver process. A state Senate study committee considered testimony on the plan last fall.

The chamber charted three paths. All require a federal waiver, since the plans deviate from the more cost-effective, traditional Medicaid expansion. One plan follows the lead of Arkansas, which received 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 gained access to a doctor that way. Other proposals contain roadblocks to coverage, including new work requirements, premiums and health savings accounts.

State business leaders and lawmakers will do well this fall to revive Medicaid expansion plans discussed last year. More than $3 billion will again be available to Georgia in 2018. That’s a 94 percent federal match instead of the 100 percent available since 2014. But 94 cents return on the dollar would be considered fantastic for any other state investment.

Medicaid expansion remains the single best step Georgia can take to help its uninsured people and shore up its health care system. Georgia’s welltested wait-and-see approach wastes time and leaves billions on the table.