TAMPA — Firming up his earlier stance, Gov. Nathan Deal said Tuesday he “would not have any intention” of expanding Georgia’s Medicaid rolls with federal money from Obamacare.
The expansion to cover anyone who earns one-third more than the federal poverty level, which the law made virtually mandatory by threatening to withhold current Medicaid funds from states that did not cooperate, became optional thanks to a Supreme Court ruling this summer that said Congress had overstepped its bounds in making such a coercive threat. Immediately after the court issued its ruling, Deal said he would wait until November to decide about the expansion, under which the feds would foot 100 percent of the cost of expansion from 2014 to 2016 and less in the years after that.
Tuesday morning in Tampa, during an interview with the AJC, 11 Alive and Politico, he indicated the expansion is off the table:
No, I do not have any intentions of expanding Medicaid. I think that is something our state cannot afford. And even though the federal government promises to pay 100 percent for the first three years and 90 percent thereafter, I think it is probably unrealistic to expect that promise to be fulfilled in the long term, simply because of the financial status that the federal government is in. I am told that that expansion for the federal government will be somewhere in the neighborhood of $100 billion a year. I quite honestly don’t think Congress can find an extra $100 billion a year.
Asked whether this was a change of heart, he replied:
I think for the time being, assuming that things are as they currently are, I would not have any intention of advocating expanding our Medicaid rolls. The reason for saying wait until November is to see whether or not there are going to be legislative changes at the federal level. And we do have a time frame for making the decision that I think, especially on the exchanges, we have just a few days after the election in order to make a final determination on that.
What kind of changes might prompt a reconsideration? “I can’t think of any right now that would induce me to say that we’re going expand our Medicaid population up to 138 percent of the federal poverty level,” he said, adding that the most recent cost estimate puts the state’s portion of the cost at $4.5 billion over a 10-year period.
“We obviously do not have that kind of money,” he said.
One way the state might be able to change its coverage provisions would be if Washington were to change Medicaid into a program where it sends a chunk of money to Georgia and lets the state decide how best to use it. This “block grant” approach was used in the 1990s welfare reform to good effect, and GOP vice presidential nominee Paul Ryan has proposed just such a change for Medicaid.
Deal sounded very supportive of doing so:
I think there are a lot of things in terms of reimbursement rates, in terms of coverage, if a block grant were given to our state, that we could tailor the program to what we think is most appropriate. As you know, it is pretty much a one-size-fits-all [program]. We [in Georgia] are in one of the more modest Medicaid programs in the country. Those states that have seen fit to expand their Medicaid populations, quite honestly I don’t understand how they’re affording it in this downturned economy.
So, what we would have in mind is it would give us the opportunity to design the program as we think is appropriate. We would be trying to find as much efficiency as possible, and perhaps to provide coverage for areas that we currently know are very expensive to us. The aged, blind and disabled category of course is the largest expense category of our Medicaid population, and we think we might be able to come up with some innovative ways to serve that population better and at the same time save money.
Deal was set to return to Georgia this afternoon.
– By Kyle Wingfield