Medicaid expansion looking dim

Democrats to Republicans: We don’t need another long study; let’s help people now.

Democrats in the Georgia House, disappointed with the status of Medicaid expansion, called on Republican leaders to act with urgency to pass legislation that would insure more Georgians with health care plans.

Under House Bill 1339, filed Tuesday by state Rep. Butch Parrish, a Republican from Swainsboro, discussions about expanding Medicaid, the government health care program for poor and disabled people, would be sent to a study commission.

The nine-member commission would then develop a report related to “quality improvement of health care for Georgia’s low-income and uninsured populations” by Dec. 1.

During a news conference Wednesday, Democrats said the study commission is a waste of precious time while more people go without health care.

“We don’t need more meetings. We don’t need another study committee. We do not need another joint commission to tabulate and recalculate the numbers that we already have,” said Rep. Michelle Au, a Democrat from Johns Creek. “Why are you still so afraid? What are you waiting for?”

Georgia is one of just 10 states that have not accepted federal funding to expand Medicaid under the Affordable Care Act.

Some holdouts in other states are showing more interest in expansion.

Mississippi Lt. Gov Delbert Hosemann said last week that he would support a bill brought forward that would expand Medicaid to about 230,000 working Mississippians. Other Southern Republican-led legislatures, such as in Arkansas and North Carolina, have broadened health care coverage through some form of Medicaid expansion.

Georgia House Speaker Jon Burns, who is backing legislation to ease hospital certificate of need requirements, told The Atlanta Journal-Constitution on Tuesday that he and other House Republican leaders remain “100% supportive” of a more limited Medicaid expansion backed by Gov. Brian Kemp and he would be open to discussing a broader expansion next year.

Parrish’s bill addresses the regulatory process, known as the certificate of need process, that determines whether enough need has been substantiated to open new hospitals. His legislation would roll back CON regulations in counties with fewer than 50,000 people if certain criteria are met, including that hospitals must provide instruction to medical students and provide psychiatric treatment.

Although the bill would also require hospitals seeking exemptions to provide 5% of their total revenue toward charity care, providing services to people who cannot afford to pay, Au said that provision misses the point.

The problem, she said, is that more than 400,000 Georgians do not have health insurance, and many of those people live in rural areas. Rural hospitals are often already providing uncompensated treatment to those patients, but there are not enough paying patients in rural areas to offset those hospital costs.

“Revising CON alone does not increase care access for patients in the coverage gap,” she said, referring to the number of people in Georgia who make too much money to currently qualify for Medicaid but don’t earn enough money to pay for health care premiums on the Affordable Care Act exchange. “Just like opening 20 new restaurants would not address chronic hunger in those who cannot afford to buy food.”

Patients who pay for health care would allow hospitals to recoup more of their costs, and Au said the best way to insure more rural Georgians is by expanding Medicaid.

Democrats have limited resources to force Republicans to tie CON rule changes to Medicaid expansion and pass it this session.

Democratic Minority Whip Sam Park said voters should hold Republican elected officials accountable and elect people “up and down the ticket who are willing to do the right thing to make sure that all Georgians have access.” Yet elections would not occur until after the end of this legislative session.

Democratic Minority Leader James Beverly said he believes a “majority” of Republicans would be willing to expand Medicaid but fear of a primary election challenge by another Republican prevents them from doing so.

He also said he’s exploring what “leverage” Democrats have regarding their support for HB 1339, related to CON rules, to force Republicans to expand Medicaid.

Beverly did not say Democrats would walk away from CON discussions altogether, particularly since the bill includes provisions to allow more obstetric services to open in rural areas.

“We will remain open to working with Republicans and providing them accurate information and try to create as much space and as much grace for folks to come across the aisle,” he said.