Highlight on Georgia: Residents Favor Medicaid Expansion, Still Oppose ACA

Although certain implementation of the Patient Protection and Affordable Care Act (ACA) has been set in motion over the past year, a survey undertaken by the Healthcare Georgia Foundation observed Georgia residents’ division of support for the ACA with 42 percent approving and 46 percent disapproving of it. The survey of 400 adults also found that more than 70 percent of Georgia residents believe that there has been no difference in their access to health care and quality of services over the past year, which saw the full rollout of the ACA. Generally, the Georgia residents’ disapproval of the ACA stemmed from the key provision related to penalties for not purchasing health insurance. Conversely, there was noted support for the ACA’s prohibition of health insurers denying individuals coverage for pre-existing health conditions and the requirement for insurers to cover some preventative care services at no cost to the patient.

Regarding ACA implementation, the state of Georgia made two key policy determinations: (1) no to expansion of Medicaid and (2) no to offering a state marketplace for health insurance. The survey found that 90 percent of Georgia residents believe that Medicaid was important for healthcare in Georgia, with 75 percent finding that Medicaid was very important. Not surprisingly then, 60 percent of surveyed Georgia residents expressed their disapproval of the state’s decision not to expand Medicaid. In contrast, Georgia residents were evenly split on the state’s decision not to  offer a state marketplace for insurance, with 44 percent approving and 44 percent disapproving.

In August, Gallup reported that states with the largest declines in uninsured rates from 2013 to mid-year 2014 expanded Medicaid and established a state-based marketplace exchange or federal partnership. These states reduced their uninsured rates three times more than states that did not implement these mechanisms. For instance, the state with the largest reduction, Arkansas, saw a 10.1 percent decline in its number of uninsured residents, from 22.5 percent to 12.4 percent. In contrast, Georgia saw its uninsured percentage only drop 2.2 percent from 22.4 percent to 20.2 percent.

However, Georgia is unlikely to take up Medicaid expansion in the foreseeable future.  Georgia lawmakers did not expand Medicaid during the 2014 legislative session, instead passing legislation (HB 990) that prohibited Medicaid expansion without prior legislative approval. The governor and other state officials opposed to Medicaid expansion cite added costs to the state, with estimates of more than $2 billion over 10 years.

The Georgia Budget and Policy Institute (GBPI), factoring in new state revenues that the expansion would trigger, puts the figure much lower, at an estimated net expansion cost of about $350 million over the same time frame. In September, the GBPI had argued that almost 50,000 uninsured Georgia residents in a 10-county region could get guaranteed health coverage if the state accepted new federal money to expand Medicaid eligibility. The number of uninsured residents covered would be the third largest number of residents in any of Georgia’s 12 state-designated regions. Without Medicaid expansion, many uninsured Georgia residents with income below the federal poverty level will remain stuck in a coverage gap, according to the GBPI, as their income is above Georgia’s current Medicaid threshold, yet too low to qualify for new federal insurance subsidies. The institute noted that throughout the state, more than 400,000 uninsured adult residents fell into the coverage gap.

Georgia’s decision not to expand Medicaid has played a role in how residents access healthcare services. Forty-two percent of respondents in the Healthcare Georgia Foundation survey reported that they wanted to seek care for a health-related issue, but chose not to for some reason, including cost, distance to doctor’s office or time spent. Cost was cited as a major reason by 68 percent of these respondents. In part, this focus on cost not surprisingly results in the survey finding a majority of residents favoring Medicaid expansion.