Georgia Democrats see a window of opportunity to finally achieve full Medicaid expansion – a long-sought prospect that could benefit thousands of Black Georgians – now that Republicans, have expressed more openness to the idea.
For the second consecutive year, Democratic leaders say full expansion of Medicaid is their top priority for this year’s legislative session, which begins Monday. But unlike previous years, Democrats, including members of the Georgia Legislative Black Caucus, say Republicans may now be motivated by a dramatic increase in uninsured children across the state, a lackluster rollout of a GOP-backed replacement plan, and the possibility of steering business to hospitals that serve their own constituents.
Legislation addressing Georgia’s high maternal mortality rate, mental healthcare, reestablishing abortion rights, and enacting “common sense” gun safety measures in the state are also among Democrats’ top political concerns, according to Rep. Billy Mitchell of Stone Mountain, who serves as chair of the party’s House caucus. He said these issues were the highest priorities for party members who participated in recent meetings about their plans for the legislative session. All four issues have had disproportionate impacts on the state’s Black population, but Mitchell and other Democrats say expanding Medicaid is the most crucial. But another critical issue – a potential rent control measure that could address metro Atlanta’s swelling affordable housing crisis – may be on the back burner for now, legislators said.
Why Expanding Medicaid Is Important to Black Georgians
Medicaid is the government health insurance program for low-income people, which is funded by state and federal tax dollars. More than 81 million people in the U.S. rely on Medicaid for health insurance.
Nationally, Black folks make up about 19% of Medicaid enrollees, but in Georgia, only about 7% of Black adults under 65 were enrolled in Medicaid prior to the pandemic, according to the Georgia Budget and Policy Institute, a nonprofit that analyzes tax policies. Only 4% of white adult Georgians were enrolled in Medicaid at that time, the group found.
Georgia has a much lower rate of Medicaid enrollment than most of the nation because it’s one of only 10 states that haven’t adopted full Medicaid expansion. State Republican leaders have resisted expanding Medicaid in Georgia since the enactment of the Affordable Care Act, also called Obamacare, nearly 14 years ago.
Failing to do so may have cost the state billions of dollars in revenue. That, in turn, has contributed to a cascade of harmful impacts, Democrats and healthcare policy experts contend. Those include the closure of hospitals in poorer regions where more Black people live. Hospitals in areas with smaller populations that have less wealth and more uninsured people often don’t make enough money to stay in business.
Hospital closures, both in metro Atlanta and rural parts of the state, have had a greater negative impact on Black Georgians, who overwhelmingly support Democrats over Republicans in most political contests. Black people made up roughly 70% of emergency room patients at Wellstar Health System’s Atlanta Medical Center hospitals in Atlanta and East Point before they shut down more than a year ago, leaving an estimated six million people in the region with only one Level 1 trauma center, a 24-hour medical facility designed to service any type of injury regardless of its severity.
Mitchell says expanding Medicaid would allow hospitals to open in parts of the state where demand for medical services is higher, which includes Black communities, and to provide more preventative healthcare, which is more cost effective than waiting until health problems require emergency room visits and surgeries.
“Black folks, I should say, are traditionally more represented in those who are in communities that are under-resourced, who don’t have adequate access to a family physician preventive medicine,” Mitchell said.
Why are Republicans more open to Medicaid expansion now?
Republican legislators in Georgia and nationally have long opposed accepting federal funds to expand social safety net programs. The party tends to oppose initiatives that don’t require people to have jobs or attend school, believing such policies make people dependent on the government. But the GOP’s ideological stance against Medicaid expansion has softened somewhat recently.
Failure to expand Medicaid has also contributed to Georgia having one of the highest rates of uninsured people in the nation. The problem worsened last year when federal restrictions barring states from disenrolling people from Medicaid during the pandemic were lifted. Georgia resumed verifying Medicaid eligibility on April 1 as a result. By September, more than 149,000 children in Georgia lost their Medicaid coverage, according to data from the Centers for Medicare and Medicaid Services.
That’s the third-highest rate of child Medicaid disenrollment in the nation behind Texas and Florida.
In July, Gov. Brian Kemp launched Georgia Pathways to Coverage, a state-run program that allows qualifying low-income adults to receive Medicaid if they meet certain work requirements. Georgia also allows low-income children and other qualifying adults – including some elderly people, the disabled, and those who are pregnant – to receive Medicaid coverage.
Only 2,344 people had signed up for the program as of Dec. 15, far fewer than the anticipated 90,000 enrollees the governor’s office expected by the first of next year, according to WABE. Critics believe the work requirements are to blame while its supporters say the program needs more time for a fair assessment.
U.S. Health and Human Services Secretary Xavier Bacerra said he was “deeply alarmed” by the problem in a Dec. 18 letter to Gov. Kemp. State officials announced plans the same day to set aside $54 million in federal funds for a “strategic surge” supporting Medicaid renewal efforts in response.
Certificate of Need negotiations
In November, GOP leaders also hosted a hearing to discuss fully expanding Medicaid in exchange for eliminating regulations about where healthcare facilities can be opened, a policy commonly referred to as Certificate of Need, or CON.
Democratic state Sen. Gloria Butler, who represents DeKalb County and serves as her party’s minority leader in the chamber, said expanding Medicaid coverage in Georgia is also her top priority in January, but that it shouldn’t come at the expense of CON rules.
She said eliminating CON would allow hospitals to open in wealthier, often whiter, parts of the state instead of poorer, sometimes Blacker, regions where the need may be greater.
“There are guidelines that need to be followed,” Butler said. “You don’t just put in an application to start a new hospital. You’ve got to show why you need a new hospital.”
