State lawmakers on both sides of the aisle responsible for making decisions around health care policy seem to agree that Medicaid, and whether or not the state will choose to expand it, will be a major issue this legislative session. 

The first days of the 2024 legislative session have seen Democrats and Republicans engaging in conversations around the policy shift that would have major implications for the health care industry in Georgia. 

Georgia is one of 10 states that hasn’t adopted full Medicaid expansion. 

“Its role has only been cemented as really the backbone of our health coverage system,” said Joan Alker, researcher with the Georgetown University Center for Children and Families, about Medicaid during a recent event. 

According to Alkers research into national insurance coverage data, Medicaid provided substantial coverage for children, mothers and people in rural communities during the height of COVID-19. 

Now, since neighboring red state North Carolina voted to cover hundreds of thousands more through Medicaid expansion last year, policy makers and stakeholders in Georgia are asking what will happen here. 

That’s unclear, but seemingly up for debate. 

During a recent event hosted by health care advocacy group Georgian’s for a Healthy Future, Republican State Rep. Sharon Cooper pointed to a Senate subcommittee recommendation to repeal hospital certificate of need laws in exchange for expanding Medicaid. 

“Legislators don't like to be told and the governors especially that. you know, ‘We’ll do this if you do this,’” Cooper said. 

Cooper, who serves as a member on several health-related committees and is a former nurse, went on to say that expanding Medicaid would not solve the health care problems facing Georgia. 

“It's not the best program in the world, anywhere in this country,” said Cooper. 

Republican state Sen. Ben Watson, a former primary care physician from Savannah, said rather than focus on full expansion, he thinks the Legislature should consider more ways to offset costs for marketplace plans for people in the coverage gap. 

“For the most part, insurance has better coverage, better care, [and] is more accountable relating to the care for that patient,” said Watson, referring to coverage under the ACA marketplace. “It's a win for the patient, it's a win for the hospitals and the providers.” 

Watson also said he hopes to work out kinks and increase enrollment in the Pathways to Coverage program, which went into effect last year after Georgia won legal negotiations against the federal government clearing the way for the implementation of the Medicaid waiver. 

Pathways  to Coverage offers health care coverage to adults up to 64 years with a household income of up to 100% of the federal poverty level, or around $14,500 a year, as long as they fulfill 20 hours of work a week, which includes volunteer hours and academic work. 

Full Medicaid expansion would increase eligibility to those under 138% of the federal poverty level, without other eligibility requirements. 

So far, Pathways has enrolled far fewer than its original estimate of 100,000 people in the program’s first year, at just 2,344 enrolled by mid December 2023. 

Health care advocates have been asking for Medicaid expansion for a while now. So have state Democrats. 

“There's never been a year where we are not talking about Medicaid expansion,” said Democratic Sen. Sonya Halpern on Thursday. “I think if we're all in agreement that there's a way to get there, that's a good thing. We can call it kind of whatever we need to call it, but let's get it done.”

During a Wednesday hearing hosted by the Georgia Democratic Caucus, physicians, public health workers, advocacy groups and hospital administrators all testified in favor of Medicaid expansion. 

The hearing at the state capitol lasted over four hours with back-to-back testimony on how Medicaid expansion could help ease health care disparities. 

If Medicaid was fully expanded, more than 440,000 uninsured people in Georgia could get picked up under the program, according to nationwide estimates from the Urban Institute. 

Being uninsured limits access to even basic care, like for chronic diseases or to prescriptions. 

Clay County doctor Karen Kinsell said, for the sake of her patients and health care in Georgia, it's time to move past the politics around Medicaid. 

“Some hospitals are — consider this such a political issue that they're afraid to advocate for themselves,” Kinsell said. “But this is an issue that very well could close that hospital and severely damage that town.” 

Twelve hospitals have closed in Georgia over the past decade, most in rural communities. 

“Those margins that the hospitals do have that are positive are increasingly shrinking,” said Anna Adams, lobbyist for the Georgia Hospital Association. “Ensuring that we have at least some reimbursement for those patients who need to be at the hospital will certainly help with that.”

At the Wednesday hearing, Minority Leader from North Carolina, state Rep. Rober Reives II, explained what got his state over the finish line on expansion. 

“I felt like it was a moral obligation for us to make sure these folks were insured,” Reives said. “I felt like that was also a sensible economic decision for us.”

Gov. Brian Kemp did not bring up Medicaid expansion or Pathways in his annual State of the State address on Thursday.

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