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Georgia Governor Basically Kills Medicaid Expansion

Gov. Nathan Deal signs legislation to take the power to expand Medicaid away from the governor and give it to the General Assembly. The move ensures that even if a Democrat were elected governor, he couldn't expand Medicaid without obtaining legislative approval -- an unlikely event in Georgia.

By Misty Williams


Gov. Nathan Deal on Tuesday signed into law the biggest roadblock yet to expanding Medicaid in Georgia under the Affordable Care Act -- leaving hundreds of thousands of poor Georgians uninsured and with limited access to medical care indefinitely.

The legislation, House Bill 990, takes the power to expand Medicaid away from the governor and gives it to the General Assembly. The move ensures that even if a Democrat were elected governor, he or she couldn't expand Medicaid without legislative approval -- an improbable scenario as long as Republicans remain in power.

Tuesday marked the end of the 40-day period the governor had in which to sign into law bills passed by the Legislature earlier this year.

Deal and top conservative leaders have said that Georgia can't afford to grow a Medicaid program that is already broken and too costly. The governor estimates expansion would add 650,000 people, mostly adults without kids, to the Medicaid rolls at a cost to the state of $2.5 billion over a decade. (Obamacare supporters argue the actual cost would be far less.) Georgia Medicaid already covers about 1.7 million low-income children, pregnant women, the elderly and disabled.

"If we don't start protecting our own taxpayer resources from this federal overreach, it's going to start eating into our education budget, our transportation budget," said Rep. Jason Spencer, R-Woodbine, who sponsored a second bill targeting the health care law. "The more that health care budget expands, it's going to be more difficult to figure out how we're going to balance our budget."

Deal also signed House Bill 943, which contains Spencer's proposal, on Tuesday. That measure prohibits state or local governments from advocating for Medicaid expansion or from creating a state-run health insurance exchange. Under the new law, the University of Georgia will be forced to shut down its health insurance navigator program, which has helped people across the state sign up for new coverage options created by the federal health care law.

"These bills are so disappointing because they send a message to our state's low-income uninsured that their elected officials have made a deliberate decision to block their access to basic health care services," said Cindy Zeldin, executive director of Georgians for a Healthy Future, a consumer advocacy group.

Deal said that giving legislators authority over a Medicaid expansion was the appropriate thing to do.- "I'm glad to share the responsibility of making those decisions with the members of the General Assembly who, quite frankly, would have had the opportunity to do that through the budget process anyways," he said.

The governor's comments on Medicaid came at a signing ceremony for a bill to put a statue of Martin Luther King Jr. on the statehouse grounds. Civil rights leaders, including Rev. Raphael Warnock, used the occasion to call on Deal to expand Medicaid.

"We are grateful for the monument," said Warnock, who heads Ebenezer Baptist Church. "But Dr. King's work has to do not with the building of monuments but with the building of a better world where everyone has health care. Dr. King deserves this monument. But I would call it a glaring and offensive contradiction to sign into law a monument in memory of Dr. King and deny health care for whom Dr. King died."

While HB 990 has stifled Georgia's chances to expand Medicaid, it also means those who have rejected expansion have the responsibility to come up with an alternative plan to extend coverage to the Georgians who would have benefited from it, said Tim Sweeney, a health care expert at the Georgia Budget & Policy Institute.

"Georgia's leadership has kicked this problem down the road for years," Sweeney said. "This failure of leadership is even more baffling in light of the federal funding available to expand coverage right now."

Deal didn't elaborate Tuesday on whether or how he will secure coverage for the uninsured.

Expansion is a pillar of the Affordable Care Act and its aim to provide health coverage to uninsured Americans. The U.S. Supreme Court ruled in 2012 that the federal government couldn't force states to expand. Georgia is among 19 states that have rejected expansion; meanwhile, 26 are moving forward and five are still debating it, according to the Kaiser Family Foundation.

Six in 10 Georgians support Medicaid expansion under the Affordable Care Act, according to polls conducted for The Atlanta Journal-Constitution over the past 16 months.

While states can choose to expand at any time, the federal government has promised to cover the entire cost for the first three calendar years -- 2014, 2015 and 2016. After that, the feds' share eventually drops to 90 percent. That's millions of dollars in new federal funding Georgia is turning away each year.

But even if Georgia does pass up those extra dollars in the initial three years, Medicaid expansion would still be a big plus for the state, experts say.

Growing Medicaid would funnel more than $30 billion in new federal funding into Georgia over a decade. That would create 70,000 new jobs and generate $8.2 billion in statewide economic impact, according to a study by Bill Custer, one of the state's top health care experts and a professor at Georgia State University.

"The economic benefits to the state of that expansion ... are so large that it is likely some future legislature will eventually enact Medicaid expansion," Custer said.

(c)2014 The Atlanta Journal-Constitution

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