Georgia Republicans are caught in a trap, trying to adjust to a rapidly changing state while also trying to placate a party base that has no interest in change, and that is often aggressively opposed to it.
Put another way, they have to change, yet they can’t change, and nowhere is that dilemma more daunting than in health care.
More than ten years after the passage of Obamacare, Georgia is one of just 14 states that have not accepted an expansion of Medicaid. The decision has prevented as many as 500,000 lower-income working Georgians from getting health insurance and has kept billions of federal dollars annually from flowing into the state. Many of those left uninsured by that decision live in rural areas and small towns where hospitals are having a hard time keeping their doors open.
As a consequence, Georgia has the third-highest uninsured rate in the country, behind only Texas and Oklahoma, two other states that have balked at accepting the program. (Last year, after their own GOP governor and legislature refused to act, Oklahoma voters rebelled and went the referendum route, signing petitions and eventually approving a constitutional amendment to expand Medicaid that will take effect July 1.)
In addition, thanks to state Attorney General Chris Carr, Georgia has joined in a lawsuit now before the U.S. Supreme Court that if successful would abolish the Affordable Care Act altogether. Guaranteed coverage for pre-existing conditions would disappear. Subsidies for buying private coverage would disappear. An entire health-care delivery system that has evolved around the ACA would be shaken.
The base of the Georgia Republican Party is entirely fine with all of that. The general electorate is not.
In a Fox News exit poll of Georgia voters in the November election, 65% said they would support “changing the health-care system so that any American can buy into a government-run health-care plan.” Just 37% opposed the idea of a government-run health-care plan.
A pre-election poll of likely Georgia voters by the Commonwealth Fund produced similar numbers. It found that 63% believed Joe Biden would be more likely to ensure that those with pre-existing conditions had access to health insurance. Just 30% put similar faith in Donald Trump. And a Quinnipiac poll of Georgia voters in late September found that 52% of Georgia voters now back the ACA, with just 43% supporting its repeal.
Admittedly, those are just poll numbers. But Biden’s victory in November here in Georgia, and the subsequent victories of Jon Ossoff and Raphael Warnock in January, suggest that the sentiment those poll numbers describe is both valid and politically powerful. Republican attack ads describing Warnock and Ossoff as radical Marxists well out of the Georgia mainstream did not work, probably because it is the Republicans, not the Democrats, who are increasingly out of step with what the people of this state need and want.
In financial terms, in economic terms, in political terms and in terms of basic human decency, the arguments in favor of finally accepting Medicaid expansion in Georgia are overwhelming. The Biden administration is trying to sweeten the pot even more, pushing Congress to cover 95% of the expense for states that finally agree to accept expansion.
But GOP leaders in Georgia still won’t budge. To accept Medicaid expansion at this point would be to admit that they’ve been wrong to deny it in the past, and it would mean abandoning the longtime ideological centerpiece of GOP health care policy. In addition, Gov. Brian Kemp has already been targeted by a vengeful Donald Trump for defeat in next year’s Republican primary, which makes him even less likely than usual to risk bucking GOP orthodoxy.
So if you’re Stacey Abrams, that ought to be fruit ripe for picking by 2022.