Republicans debate Medicaid expansion

Moderated by Tom Sabulis

Republicans rule the roost in Georgia. Today, three GOP members offer views on Medicaid expansion. A former health company executive says expansion under Obamacare could create jobs and protect lower-income folks. A congressman from Athens and a state Senate floor leader argue against expansion while writing about what’s being done in Washington and at the Gold Dome to meet our citizens’ expanding needs.

Commenting is open below State Senator Charlie Bethel’s column. (There are three columns today.)

Ideology in the way of creating jobs

By Jack Bernard

As a Republican former office holder and proven fiscal conservative, I know there are real limitations as to what government can or should spend. But in the case of Medicaid, I am frankly at a complete loss. As my boss, the CEO of a national health care company, once told me, “The mark of a great nation is how it takes care of the less fortunate.”

For the uninformed, here is the issue. The feds are funding 100 percent of the Medicaid expansion for the first three years. Then, they are decreasing the funding to 90 percent over several years.

The decision to expand or not is made by each state individually. And that is where the fight begins.

Gov. Nathan Deal says that we cannot afford the $400 million annual match (eventually 10 percent) that it will take after the three years. But he is not looking at the direct and indirect benefits, totaling $8 billion a year to our state, per a recent Georgia State University report. Why let other states take the federal tax money that Georgians pay and use it in their states and not ours?

For example, Dr. Bill Custer of GSU found that over 70,000 health care jobs would be created statewide, over a third in metro Atlanta. Commendably, Gov. Deal has spent many millions on bringing plants here and creating jobs (Baxter, a medical supply firm, is the latest). Shouldn’t we also increase jobs at our own existing health-care institutions? As my party says, the best anti-poverty program is to create permanent private-sector jobs like these.

From a local government perspective, there is another reason to have the state involved in expansion. If it does not, more local tax money will be required to fund public hospitals that serve the indigent population. When Obamacare was first passed, it was known that governmental (Medicare) hospital reimbursements would go down as part of the law. However, hospitals were told that these decreases were to be offset by having Medicaid cover patients who were currently being served but not paid for by private insurance, Medicaid or Medicare.

Grady Memorial Hospital says it will have at least 30,000 more medical indigents covered by the expansion — patients who are now paid for through your local tax money via annual budget transfers from Fulton and DeKalb counties totaling $61 million. And it is not just big-city facilities that are affected.

My small county has three in-patients in our hospital, Jasper Memorial in Monticello, on a typical day. Our county currently gives the local hospital about $300,000 a year and has given them double that in many past years. Hospitals like these will need more money from local property taxes if Medicaid is not expanded.

The bottom line is crystal clear: The financial positives of expanding Medicaid in Georgia far exceed the negatives. Will Gov. Deal make the decision based on the facts, or will he let right-wing ideology get in the way?

Jack Bernard, former chairman on the Jasper County Republican Party, is a retired health care executive.

Only real reform will empower Medicaid

By Paul Broun

Last winter, I laid out for the AJC the reasons why Obamacare would mean big trouble for Medicaid and Peachcare in Georgia. I also offered a simple and viable solution: block-granting federal dollars for Medicaid and Peachcare back to Georgia.

Fast forward to today, and it’s clear my fears were correct. Obamacare is on track to make a bad situation much worse in our state. Last year, Georgia’s Department of Community Health, the department responsible for administering Medicaid, outspent its budget by $32 million.

Unfortunately, this proves that Georgia cannot afford to further expand our Medicaid program; it would cost $4.5 billion over 10 years. Yet in 2014, the president’s health care law will impose a penalty on the 600,000 Georgians who lack health coverage. If these individuals cannot afford to buy health insurance themselves, they’ll likely be forced onto Medicaid. Should this happen, it will be difficult to maintain a balanced budget in Georgia.

That’s not all. Obamacare also mandates establishment of health care exchanges, through which individuals may purchase health insurance. Gov. Nathan Deal chose to opt our state out, meaning that Georgia’s exchange will be run by the federal government. While I abhor federal control over health care, in this case, I couldn’t agree with him more. Under Obamacare, the federal regulations surrounding the exchanges will be so onerous that states will be unable to set up a marketplace geared toward the needs of their populations. I think that’s wrong. Georgia families deserve the ability to tailor their coverage to their own needs. Instead, they’ll find themselves in the middle of a massive, inefficient federal bureaucracy.

Despite the grim prognosis, Congress is working on solving the problems caused by Obamacare. Just a few weeks ago, U.S. Rep. Todd Rokita, R-Ind., reintroduced the State Health Flexibility Act, of which I am a cosponsor. This bill would freeze spending on Medicaid and the Children’s Health Insurance Program, the federal program which funds Peachcare.

At the same time, it would remove inefficiency by providing funds to states via flexible block grants instead of through the current, complicated payment and reimbursement structures. Such a move would allow states to determine the coverage terms which make the most sense based on their own demographics, free from all but the most basic directives from Washington.

Just as important, this bill would result in significant cost savings on both the federal and state levels while improving patient care. I believe this proposal will go a long way toward taking care of the most vulnerable in Georgia, and I am hopeful that this legislation will be voted on this year.

Obamacare is not the answer for Georgia’s broken Medicaid and Peachcare programs. Instead, we must look for real reforms, like those found in the State Health Flexibility Act, to empower states, salvage Medicaid and ensure cost-effective, accessible health coverage for all.

Congressman Paul Broun, a physician, represents Georgia’s 10th district.

Block grant Georgia’s share

By Charlie Bethel

Approximately 17 percent of the roughly 10 million people who call Georgia home receive health insurance from our state’s Medicaid program. That number is unfortunately growing due to an increasing number of Georgians enrolling in the wake of terrible economic times.

Combine that growth with the likely increase we can expect as a result of Obamacare’s individual mandate requiring everyone to purchase health insurance, and we can expect substantial growth in our Medicaid population.

Beyond the challenges of this growth, Georgia is now faced with the choice of expanding Medicaid by well over 600,000 people. This would leave nearly a quarter of Georgia residents on the Medicaid roles. Gov. Nathan Deal has declined the offer; we cannot afford to participate.

Some perspective on the choice before us: The state pays 35 percent of the cost of each Medicaid enrollee. Even with Uncle Sam paying the rest, this costs the state $2.5 billion every year. Whether the economy is good or bad, that spending crowds out other priorities for the state.

Expansion proponents point out that the federal government promises to pay 100 percent of the expanded population for the first three years, then slide to a 90-10 split between the federal and state governments. Setting aside concerns over empty promises and our federal government, the bigger problem is that expansion would cost the state approximately $4.5 billion in new spending over the next decade, even with those three “free” years. As the governor says, even with the federal government paying (or borrowing) for the meal, the state can’t afford to pay the tip.

We continue to crawl out of the crater created by the Great Recession. We are not feeling the recovery as much in some parts of the state as in others, but forward momentum is good. This January, state tax revenues increased 10 percent over last January.

This great news doesn’t support expansion. We must temper our celebration because the growth we have experienced has not been sufficient to keep pace with growth in budget demands across the board. The General Assembly is again struggling to balance our budget. Recent revenue bumps haven’t kept up with population growth, which pressures two of our biggest-ticket items: education and Medicaid.

Gov. Deal works with legislators to reduce spending in many agencies so that we can hold the line against cuts in school spending and patch the ever-expanding holes in our Medicaid budget. That said, Georgia is ready to have a serious conversation with the Obama administration about securing health coverage for more of our citizens.

Gov. Deal has petitioned the administration to block grant Georgia’s share of new Medicaid dollars. Our state taxpayers are federal taxpayers too, and we should get what all other states are receiving. With a $35 billion grant, Georgia could go a long way toward covering the expanded population without breaking the bank for state taxpayers. That’s real leadership.

State Sen. Charlie Bethel represents the 54th district in northwest Georgia.

18 comments Add your comment

Donnio 67

February 23rd, 2013
2:56 am

Jack Bernard writes, “70,000 health care jobs would be created”. How about this for a scenario? The 70,000 who would have been working in GA will be working in the states that expand their Medicaid, and GA gets none of their income taxes or sales taxes.

Those who worry about spending $400 million while refusing $8 billion, just proves the old adage that GA education ain’t that good, and too many have flunked math. But they do have great verbal skills for they did fool too many into voting for them.


February 22nd, 2013
1:58 pm

Guns for everyone, but not healthcare. Patriotism at it’s worst.


February 22nd, 2013
11:40 am

The Feds are only using the carrot and stick method to get all the “rubes” (States) suckered into a trap. Let’s look at the whole thing!!! Someone has got to pay for all of this anyway. You guessed it – - – it is the taxpayer. My pockets feel light already.


February 22nd, 2013
11:37 am

Deep Cover @ 8:38 am – You are one uninformed individual regarding your comments. Mayor REED is a former State Of Georgia Legislator for many years. This Mayor has more Power and Influence than any other mayor in Atlanta’s History with State Government. We have two major glaring actions of advocacy performed on behalf of Mayor Reed for Gov.Deal currently and within the past year.

The now failed T-SPLOST vote and the current defrauding attempt of the Atlanta Voters to support the building of a New Stadium for Mr.Blank. Both projects were wildly and with enthusiasm supported by Governor Deal and under his direction and approval. Besides Dr.King has set a greater example of Leadership of representing the POOR and Needy and he never held any political office or had any personal contact with the Governor of Georgia as Mayor Reed.

Mayor Reed in the interest of his own political ambition refuses to openly and publicly
disagree with his friend the Governor for fear of retrebution on something he may need at a future date. this Mayor has access to this Governor but his SILENCE is perplexing and very disappointing of all who have supported the cause of DR.King and his Legacy. If it were not for the BOLD actions of Dr.King, Mayor Reed would proably be a mailman on the southwest of Atlanta this very moment.

It is Mayor Reed’s duty and reponsibility to speak out on behalf of the citizens of Atlanta when the Governor is out right refusing Federally funded healthcare at 100% for the millions of Voting citizens here in Atlanta who are currently uninsured and undersinsured. To remain Silent is plain OLE WRONG! Yet on any given Sunday morning, we can Mayor Reed on the major sunday Talk shows grining and laughing, cheerleading the President and his legislation. When at home, he is quiet as a church mouse. Saying NOTHING! This Mayor speaks with a forked tongue!

We ALL should vote “NO” to this Mayor and Governor in the Next Election and say it LOUDLY!


February 22nd, 2013
9:51 am

Re the “State Health Flexibility Act” introduced in the US House – will it pass the House and will it pass the Senate with the required 60 votes? If not, it is not worth the paper, etc, etc, etc.

Deep Cover

February 22nd, 2013
8:38 am

Bernie @ 7:04

Kasim Reed and Dems are “silent” on this issue b/c they have no POWER. In case you haven’t been following state politics lately, the GOP has a SUPERMAJORITY IN BOTH CHAMBERS!!! What this means is that Dems have absolutely NO INFLUENCE on ANY state level legislation. Remember, you have the city of Atlanta and then you have GEORGIA. They ARE NOT the same thing. Politics change SIGNIFICANTLY the further you venture away from I-285.

The way the Supreme Court decision came down, the decision is made ON THE STATE LEVEL whether or not to expand Medicaid. You can’t do it on a city (or county) level. Since the GOP controls EVERY facet of state government, there isn’t a DAMN THING Mayor Reed can do on this issue.


February 22nd, 2013
7:12 am

I used medicaid when it was in its infancy 50 years ago. I went to a dentist for a filling. The filling would have cost $10.00. The dentist said, why have a filling, I will give you a crown[made out of gold].
He said, why not have the best, the state is paying for it? I knew then, medicaid would be a collasal issue for funding as the years went by. Even now, people on social security as their ownly income, have multiple hip replacements, and soforth. Now, I hear society is judged by how it acts towards the least of its citizens. Very true, however, citizens should take some of the responsiblity for their health by living healthy lives rather than thinking government will solve all their problems.
I voluntere in a church serving meals to the poor as well as others, I find it enormously rewarding, if Drs, served the needy without expecting gargantuan payment they would find it even more rewarding.


February 22nd, 2013
7:06 am

Let’s see. We can spend 400 million and get back 8 billion and as a bonus, we create thousands of jobs that will reduce the ranks of those that may need government aid as well as provide care for 600,000 currently in need of help. Hmmm. Surely those opposing have something to counter that with. A study perhaps. Some actual data maybe. Anything. Oh. I see. Broun, et al, want the money. They just do not want to be constrained to spend it on those in need. Meanwhile, what happens to those 600,000. Do they just magically cost the taxpayer nothing as a consequence of ignoring them. I think not. Surely our Republican leadership can elaborate for us rather than simply presenting their quite deceptive proclamation of, “Oh! That will cost money!” Then again.