Medicaid expansion

Moderated by Tom Sabulis

Top leaders in the Georgia Assembly are behind a bill to strip Gov. Nathan Deal of the power to expand Medicaid, as called for by the Affordable Care Act, and put that decision-making in the hands of the Legislature. Some Democrats are calling that political cover for the governor during this year’s election campaign. Today, we hear from Rep. Jan Jones, R-Milton, who is sponsoring House Bill 990, and Horacena Tate, D-Atlanta, chairwoman of the Senate Democratic Caucus.

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Give legislators Medicaid say

By Jan Jones

Georgians can be proud of their generosity toward the vulnerable and needy of our state. Individuals, churches, non-profits and governments dig deep to give relief to the less fortunate.

In fact, state taxpayers provide $3 billion annually in health care services through Medicaid to one in six Georgians. From covering 60 percent of the births in Georgia, to serving as de facto long-term care insurance for many, to providing end-of-life care in hospice, the state offers 117 categories of mandated and optional Medicaid services from cradle to grave.

Fighting for people, though, does not mean Georgia should increase the income threshold to expand Medicaid. The aftereffects would hurt far more people than they would help.

Last year, Gov. Nathan Deal wisely declined to expand Medicaid to those earning up to 138 percent of the federal poverty level. Under expansion, 650,000 individuals earning up to $16,000 a year could enroll, as well as any family of four earning up to $32,500.

Expanding Medicaid represents a major deviation from the intent of the program, which was to provide a safety net for the neediest households with children, those in nursing homes, and the disabled. Medicaid has never before covered able-bodied individuals based on income alone since its inception 49 years ago.

Georgia is one of the few states that do not require their legislatures to approve a decision of such financial magnitude. House Bill 990 would correct that. It will also make clear to Washington, D.C., that our state views unsustainable and unwise proposals with a healthy dose of skepticism. Without a comparable law, the governors of Florida and Virginia, a Republican and a Democrat, respectively, would have already expanded Medicaid. The South Dakota legislature rejected expansion just this week.

In the past 10 years alone, prior to any contemplation of Medicaid expansion, Medicaid’s price tag has increased 43 percent, far outstripping state revenue growth and the inflation rate. Obamacare will only exacerbate this trend.

If the state were to increase eligibility for Medicaid, it would hobble our state budget by costing upwards of $500 million annually in coming years, inevitably leading to reductions in funding for public education, colleges and universities, and other programs for the needy. With Medicaid, these functions already account for more than 80 percent of the state budget.

Proponents of expansion have yet to volunteer which of these vital services should be cut to fund Medicaid expansion, or what taxes should be raised to pay for it. Without stiff budget cuts, the higher income or sales taxes it would take to pay for expansion would affect Georgia’s ability to attract and retain jobs.

At an individual level, the expansion produces perverse results. If someone works 40 hours per week, making $7.50 per hour, this person would qualify. If he applies himself and is rewarded with a raise to $8 an hour, he would face an unpleasant choice: quit, work fewer hours, decline the raise, or lose health coverage through Medicaid. Expansion would trap the poor into entry-level or part-time jobs with fewer opportunities. A Republican-majority Congress and President Bill Clinton rejected that design with welfare reform almost 20 years ago.

Medicaid reimburses hospitals and health care providers for far less than the cost of care. Providers and patient advocates characterize the existing system as inadequately funded and with insufficient access to care. A recent Oregon study showed that Medicaid enrollees were 40 percent more likely to inappropriately use the emergency room. What will happen when even more people show up expecting services from even fewer health care providers willing to accept Medicaid?

Rather than doubling down on a flawed program, why doesn’t Washington allow Georgia to construct a more effective health care solution for those who truly need a helping hand?

We should continue to fight for people to have brighter, more productive futures through a targeted safety net complemented with education, innovation and job creation. Medicaid expansion is not the answer, and the Georgia Legislature should have a say in the matter.

Jan Jones, R-Milton, is speaker pro tem of the Georgia House or Representatives.

Scared Republicans offer up a poison pill

By Horacena Tate

It’s not a trick question. When Georgia says “no” to expanding Medicaid, it figuratively piles up billions of dollars and sets it on fire.

Republicans are floating HB 990 because they’re afraid you’ll figure out what they are doing.

HB 990 may seem straightforward enough; it attempts to require that the General Assembly give approval before the governor can expand income eligibility thresholds for Medicaid. What Republican leadership does not want you to know is that Georgians are already paying the tax for the Medicaid expansion. We have no choice about it. The money that would flow back to Georgia is tax money we have already paid.

All of that tax money – roughly $3 billion in 2015, or about $850 per Georgia household – could stay in the state and benefit Georgians. It could employ doctors and nurses and therapists and pharmacists here. It could make people healthy enough to work harder here. Or it can go somewhere else. That’s a choice.

We could simply lose the money if the governor refuses the expansion. We won’t get $850 per household back. It doesn’t go to some other critical state services. Our money just disappears.

And it’s not like the state proposes as a statement of moral purity to send back the rest of the $5 billion it gets from the federal government to cover Medicaid — any more than we’re ready to send back the $1.26 billion we get for federal transportation money, just because some folks think we are splendidly capable of managing our highways without Washington’s interference.

No, Republican legislators aren’t doing this because they feel a solemn duty to carefully consider a contentious spending question.

A majority of Georgians – 57 percent – favor Medicaid expansion, according to a poll released by the AJC in January. The same poll showed Gov. Nathan Deal with a lead over his likely Democratic challenger, state Sen. Jason Carter, by 22 points, with a third of the electorate undecided, a lead nervous Republicans may not consider insurmountable. In a poll released this week by Public Policy Polling, Deal’s lead has narrowed to a statistical dead heat.

The fallout over ethics charges, teachers irate over their health care benefits plan and the mishandling of winter weather advisories has rendered Deal vulnerable in November. More voters want the Medicaid expansion than not, today. If that figure grows over time, those voters may give Carter a victory.

So, Republicans have introduced a poison pill. They’re afraid Jason Carter might beat Deal in November. And if Carter does beat Deal in November, why not render him powerless. The HB 770 authors have calculated cynically that they can protect Deal by taking away his power to protect their politics in the future.

Alas, HB 770 does more than that. It hampers the governor – Carter, Deal or anyone — from crafting any kind of real-time fix for many of the state’s real-world problems.

Four rural hospitals have closed in the past year, largely because of federal funding changes. Grady Memorial Hospital remains a ticking financial time bomb. The state will still have about 600,000 poor people with a federally mandated right to walk into a hospital for emergency medical care and without the health insurance to pay for it.

It also robs you, the voter, of an honest choice. It’s not like the legislature plans to give voters a referendum on Medicaid expansion, because they’re afraid it might pass.

So, the governor’s race is your referendum, unless this bill passes. I suppose it’s a shame that Republicans don’t trust Georgians enough to make a carefully considered choice of your own.

Horacena Tate, D-Atlanta, is chairwoman of the Georgia Senate Democratic Caucus.

3 comments Add your comment


February 28th, 2014
11:28 am

Well put Matt! I was planning on writing a response myself and am glad that someone had the time to do so before I could get to it. Ms. Jones gets my award for the worst reasoning displayed by a republican so far this year (quite a high bar)!

Matt P.

February 28th, 2014
10:37 am

Jan Jones just served up an excellent example of misdirection and handwaving, It’s worth looking at in detail, starting with the first sentence, where she says the Georgia “…governments dig deep.” Really? How? Not expanding Medicaid because of the cost is the opposite of digging deep. And look at how numbers are twisted and presented without any meaningful basis for comparison:
-We spend $3 billion annually – is that a lot, or a little, in a state that has a gross state product of $400 billion a year? Does it matter that the feds spend 63 cents of every Medicaid dollar in Georgia?
-Compares Medicaid spending growth to inflation and revenue – but not population growth or health care inflation (which has outstripped core inflation).
-Talking about a $500 million price tag (an unsourced number the governor threw out there) without any comparison to the state budget.
-Saying our state budget would be hobbled without saying we’d be unable to do – or why we couldn’t just raise further revenues to do these seemingly crucial things (are they important enough to be “hobbled,” but not important enough to raise taxes for?)

And then, we get to the real cruel part. Able-bodied, eh? Well, so what if you can’t afford food, drug, or medicine. You’re able bodied, so you die in the street. That’s the Christian way, right? Pretty sure that’s in the Sermon on the Mount. Never mind unemployment, never mind that you may in fact have a job already that is slowly breaking your able body but doesn’t afford you enough money to live – the state of Georgia isn’t interested in you.

There’s more fudging of the numbers, including a really incredible criticism of an income cut-off line (incredible because the current system has a cut-off line and all those perverse incentives you bemoan). But really, why bother going on? If Jan Jones were interested in the truth, she wouldn’t have written that column in the first place.


February 27th, 2014
10:00 pm

Have not seen this written anywhere but consider this: The republican leadership seems to think there is an outside chance Jason Carter will defeat Deal for Governor. Now They know a Governor Carter will approve a medicaid expansion, so take the authority to do so out of the Governor’s hands.