Highlight on Georgia: Medicaid expansion could be peachy

There is a coverage gap in the state of Georgia where 300,000 people do not qualify for either Medicaid or subsidies to buy insurance under the Patient Protection and Affordable Care Act (ACA) (P.L. 111-148). According to a report released by Georgians for a Healthy Future (GHF) and the Georgia Budget and Policy Institute (GBPI) this is due to the state’s decision not to expand Medicaid under the ACA. The result is that many individuals do not have access to necessary care or cost saving preventive services.

The Georgia state of Medicaid

Under Georgia’s current Medicaid program, 19 million individuals are covered and 64 percent of those covered individuals are children. The Medicaid and PeachCare for kids program in Georgia cover one in five of all Georgians and one in two children in the state. Georgia’s Medicaid eligibility is relatively strict with the state ranked 50th in spending per Medicaid enrollee and 44th in eligibility—meaning that only seven states make it more difficult to qualify for Medicaid. Due to factors like the fact that the maximum allowable income for a family of three is $7600, working parents can easily lose eligibility by earning slightly higher wages.

Coverage gap

The coverage gap affects several groups including veterans, working parents, and low-wage workers. According to the report, in the case of working parents, a single parent is only eligible if the parent makes $6000 or less annually. However, because that same parent would not receive subsidies under the ACA to purchase insurance on a health insurance exchange until they made above $15,390, the parent falls into a coverage gap where private insurance is too costly and they are ineligible for the state’s Medicaid program. A single adult or couple without children is completely ineligible for Medicaid in Georgia and would not receive assistance through ACA subsidies until their annual income reached $11,770 or $15,930, respectively.

Medicaid expansion

The ACA’s Medicaid expansion option allows states to increase Medicaid eligibility for adults up to 138 percent of the federal poverty level (FPL). In 2015, this is equal to an annual income of $16,200 for an individual and $27,700 for a family of three. In Georgia, the expansion of Medicaid under the ACA would aid parents and other working adults, who do not have access to health coverage through their job, and, due to their level of income, do not qualify for the ACA assistance. According to the report, if Georgia elected to expand Medicaid under the ACA, as many as 500,000 Georgians could enroll in quality, affordable health insurance. Additionally, expanding Medicaid would extend health insurance to nearly half of Georgia’s uninsured veterans and their spouses.

Economic benefits

According to the GHF and GBPI report, new revenues collected from existing funding sources would exceed the cost of Medicaid expansion in Georgia by $148 million. Additionally, because the federal government will cover most of the cost of expansion—two years of full federal funding and no less than 90 percent federal funding until 2020—Georgia will generate a $24.42 return for its economy on each $1 it invests in Medicaid over the next ten years. The report pointed to success in other states, like Kentucky, where closing of the state’s coverage gap brought a 59.7 percent decrease in uncompensated care charges in 2014. The report also stressed the trustworthiness of federal funding—highlighting the fact that the federal match rate for Georgia has remained stable since the Medicaid program began in the 1960s.

Value

In addition to bringing economic benefits to the state, the report suggests that closing Georgia’s coverage gap would lead to an improved ability of Georgians to pay medical bills and higher rates of people reporting excellent or very good health. Additionally, greater Medicaid coverage would mean greater access to care, in large part due to the fact that the rate of physicians accepting new Medicaid patients in Georgia is higher than the national average.

Support

Several members of the Georgia House Democratic Caucus have expressed support for expansion in their state, asserting that “Georgia families should not have to choose between putting food on the table and paying for medical bills, or be forced to forgo critical preventative care that may help them stay in the work force.” Democratic Caucus members urged that “it is time to put aside partisan differences and generate the political will to expand Medicaid in our state legislature. This is not just the compassionate thing to do—it is the only sensible economic path forward.” The White House also offered support for the position that Georgia should expand Medicaid. The Council of Economic Advisers issued a report in June 2015, stating that if the state expanded Medicaid, an additional 389,000 Georgians would have insurance coverage in 2016. The opposition for expansion is based upon the belief that the necessary state dollars are not available to make the expansion viable. State Sen. Charlie Bethel (R-Dalton) said that the issue is not a political one and that the issue, instead, is about money. Bethel said, “I don’t see how it’s practical in a responsible world.”