Kemp Medicaid plan omits hundreds of thousands of uninsured Georgians

Gov. Brian Kemp's recently announced plans to improve health care access for Georgians got a cool reception at a Macon hearing this week. He's shown here announcing his proposal for a partial expansion of Medicaid at the Capitol last week. Jill Nolin/Georgia Recorder

Gov. Brian Kemp has unveiled a plan that aims to slightly expand access to Medicaid in Georgia, adding 50,000 people to the program’s rolls.

The $120 million plan – $36 million of which is the state’s share – would allow adults earning up to $12,000 annually to sign up for health care coverage through a program dubbed Georgia Pathways.

“This plan reflects our priorities and values,” Kemp said. “This health care reform will put hard-working Georgians first.”

But the plan – which critics say doesn’t go far enough – also includes provisions that have proven controversial in other states, including a requirement that participants work, undergo job training, volunteer or participate in some other qualifying activity for 80 hours a month in order to receive the aid.

The Republican governor said his proposed waiver application would also require participants to have “skin in the game.” That means requiring them to pay copays and monthly premiums based on a sliding scale, with the premiums going into a health savings account available for prescription drugs and other health care costs.

“Today, too many hard-working Georgians struggle to afford any type of health insurance. These folks are working. They’re trying. But they can’t find a way to make ends meet,” Kemp said. “When sick or injured, they head to the emergency room. Or they just stay at home and pray for the best.”

But other state plans that have expected Medicaid enrollees to hold a job or satisfy other requirement haven’t fared well in court. Some states, like Indiana, have recently backed away from such requirements as a result. Georgia officials, though, say the state’s plan will take a different tack.

The state is also asking for the higher nine-to-one federal dollar match available under traditional expansion – something Utah was recently unsuccessful in doing. But the $156 million price tag released by Kemp’s office Monday is a nod to that reality, showing that the state expects to pick up a greater share of the cost than requested for its partial expansion.

The state Department of Community Health’s board promptly gave the plan initial approval, kicking off a public comment period that will end on Dec. 3. The federal government must sign off on both waivers, which the state plans to submit next month after a series of public meetings are held across the state. The legislature must also approve the cost next session.

Blake Fulenwider, who is the state agency’s chief health policy officer, told the board Monday that the required “employment-related activities” are meant to encourage people to work their way beyond the 100% of the federal poverty level, where lawmakers capped any potential expansion effort earlier this year. At that point, people would be eligible for a subsidy in the commercial market.

“It’s really to provide that ‘hand up’ for folks who are in need of assistance and promoting work as a key way to help everyone,” Fulenwider said. “There’s research that shows that people who are working are happier, they’re healthier, and we firmly believe that to be true.”

Statewide, about 408,000 people would be eligible, but the actual number of new enrollees is expected to be much lower, according to the governor’s office. About 25,000 people are expected to sign up the first year, with that number likely growing to 50,000.

That enrollment projection prompted immediate criticism from proponents of full Medicaid expansion, saying full-time caretakers, the mentally ill and others would likely be left out.

Kemp opposes full Medicaid expansion and, anticipating the criticism, railed against it in his prepared remarks at Monday’s press conference. He also argued that fully expanding Medicaid would also do nothing to lower private insurance premiums, as his broader plan seeks to do.

House Minority Leader Bob Trammell, a Luthersville Democrat, called the plan “beyond disappointing” on Twitter.

“A deliberate choice not to cover Georgians who could be covered through Medicaid expansion,” Trammell said. “(To be honest), a choice not to even cover as many Georgians as could have been covered with an 1115 waiver.”

Backers of full Medicaid expansion gathered outside the state Capitol after Kemp’s press conference to critique shortcomings in the governor’s plan. Taifa Butler, executive director of the Georgia Budget and Policy Institute, said work requirements and premiums can be barriers to people getting health coverage.

“This is an important step forward to help more Georgians access care,” Butler said of extending access to some low-income adults. “But there is more work that remains to be done to support the hundreds of thousands of Georgians who still do not have access to affordable coverage.”

Butler argued that fully expanding Medicaid “remains the best moral and economic case and option” for Georgia. State budget analysits have put the price tag at between $188 million and $213 million to extend coverage to about 500,000 people.

Monday’s unveiling came just days after Kemp announced another waiver that is designed to make private insurance premiums more affordable, particularly in rural Georgia where rates are especially high and where often just one provider is available. The governor plans to do that through a reinsurance plan – something that’s been done in at least a dozen other states – that would cost more than $300 million. That proposal calls for the state to chip in $104 million, while the federal share would be $264 million.