Georgia can’t afford feds’ bad Medicaid expansion
By Nathan Deal
Growing health care costs, whether through employer-provided health plans or the Medicaid and PeachCare programs, increasingly crowd out other state priorities in our budget.
Obamacare has exacerbated the problem. Like all private-sector businesses in Georgia, the state government is seeing its costs grow for employee health plans because Obamacare’s coverage mandates have driven up prices. We’re talking hundreds of millions of dollars.
As expensive as the mandates are, they are chump change compared to the costs of Medicaid expansion. After the Supreme Court ruling, states can choose to accept or reject the Medicaid expansion. I’ve stood strong against expansion because the state can’t afford it as it is currently configured, and there’s little reason to believe that our debt-soaked federal government will continue to pay 90 percent of the cost far into the future. Expansion will exacerbate the problems of an already unsustainable program.
I recently signed into law a second layer of protection for taxpayers. Now, instead of a governor single-handedly deciding to commit the state to billions in new spending, any Medicaid expansion must also pass the General Assembly.
This puts into law what already existed in fact. Governors can’t spend money if legislators don’t appropriate it. A large commitment of public dollars, such as Medicaid expansion, should have the support of both the executive and legislative branches before it moves forward.
Obamacare negatively affects the state budget no matter which way we turn.
If we accept Medicaid expansion, we have a new entitlement that grows no matter how state revenues or the economy are performing. That means less money for our top priorities such as education, which is more than half of the state budget.
Expansion, which would add hundreds of thousands to the Medicaid rolls, wouldn’t be a slam dunk win even for low-income Georgians. Coverage isn’t the same as access. Those kicked off their private health insurance would now have little choice in coverage or doctor and would have to wait to see the limited number of providers willing to accept Medicaid, which reimburses below the cost of care.
That competition for limited spots would spell trouble for the 1.8 million children, pregnant women, seniors and those with disabilities in our current Medicaid program.
If we don’t expand, the federal government makes darn sure we’re punished. The Obama administration refuses to allow a block grant approach, which would spur state-level innovation. Giving flexibility would go a long way toward covering the affected demographics without piling a huge new financial burden on states. Adding insult to injury, the administration will soon cut the payments to safety net hospitals that serve a disproportionate share of Medicaid patients, on whom they lose money.
Leaving those cuts in place when nearly half of the states have decided against expansion exemplifies how the Obama administration has refused to acknowledge that the Supreme Court changed the playing field. Rather than working with us, the federal government has relied on strong-arm tactics to crush dissent.
We’re plotting a sustainable path forward for Georgians, but the “one size fits all” approach that Washington demands is ironically hurting the very cause it claims to champion.
Nathan Deal is the governor of Georgia.
Medicaid expansion best option for coverage gap
By Tim Sweeney
A quick scan of recent headlines could leave you with the impression two state laws approved this year all but end any conversation about Medicaid expansion in Georgia. Fortunately that isn’t the case, for the sake of more than 500,000 uninsured Georgians, the state’s health care providers and its economy.
No question, the new law to require approval of Medicaid expansion by state lawmakers to prevent the governor from acting on his own adds another step in the path to adoption. And a related law is designed to make it more difficult for government employees to say positive things about the federal health care law.
But clinging to the status quo in Georgia is not a realistic or humane option. Georgia, after all, is the state with the country’s fifth-largest number of uninsured people. Many of them wind up in emergency rooms after postponing treatment because they can’t afford it. Hospitals are obligated to treat a sick person who can’t pay, which causes financial struggles for many of Georgia’s care providers.
These problems did not go away April 29, when the governor signed off on the two new laws.
State lawmakers said they should be included in any discussion about expanded Medicaid eligibility, so let’s hope they start a serious conversation about ways to improve access to health coverage for Georgians who go without it. To date, state leaders haven’t presented an alternative to Medicaid expansion that systematically increases access to health care for low-income, uninsured Georgians.
Any new competing plan should be evaluated against the great health improvements people in other states are getting through expanded coverage.
Massachusetts provides a great example, with its eight-year track record of health reforms that served as the universal coverage model echoed by the national health care law. Coverage expansion in Massachusetts reduced “mortality amenable to health care,” or deaths that could be prevented by medical care, by 4.5 percent, according to a study just published in Annals of Internal Medicine.
The study’s authors found mortality improvements are greatest in areas with higher uninsured rates and lower incomes prior to the coverage expansion. Georgia’s policymakers should find this compelling, as it suggests people in Georgia’s communities with the greatest needs stand to gain the most from expanded coverage.
Georgia lawmakers often limit the Medicaid expansion conversation to affordability within the state budget. No question, it is their responsibility to make sure the state can afford it. I’ve done the math. The feds will pay at least 90 percent of the cost of expanded eligibility. That’s a great financial deal for Georgia.
The Massachusetts example shows expanding health coverage can make a real difference in people’s lives.
More than 500,000 low-income Georgians in communities from Blue Ridge to Valdosta now go without health care coverage. Medicaid expansion promises them better access to health care for prevention and after they get sick. It could even help them live longer.
That should also be part of the conversation when lawmakers tackle the future of Georgia’s health care policy.
Tim Sweeney is director of health policy for the Georgia Budget and Policy Institute.