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.