As health care costs mount and the Affordable Care Act begins to take hold, one aspect of the sweeping law has divided Georgia’s medical community and politicians.
Under the law, also known as “Obamacare,” all states have the option of expanding Medicaid, a program jointly funded by the federal government and states that provides health-care benefits for some low-income individuals and families.
Expansion would mean that anybody earning 133 percent of the federal poverty level or less would be eligible for Medicaid.
In Georgia, that would mean about 650,000 more people would be added to the Medicaid rolls, which already have about 1.7 million people.
Political leaders, including Gov. Nathan Deal and U.S. Sen. Saxby Chambliss, R-Ga., say the state cannot afford that expansion, according to The Atlanta Journal-Constitution.
“No, I do not have any intentions of expanding Medicaid,” Deal told Georgia reporters at the Republican National Convention, held in August in Tampa, Fla. “I think that is something our state cannot afford. And even though the federal government promises to pay 100 percent for the first three years and 90 percent thereafter, I think it is probably unrealistic to expect that promise to be fulfilled in the long term, simply because of the financial status that the federal government is in.”
According to the Georgia Public Policy Foundation, the state would pay about $4 billion over the 10-year period if it participated in the expansion. The foundation, Deal and other opponents of expansion expressed serious doubts about whether the federal government can hold up its end of the bargain – 100 percent funding for the first three years and 90 percent after that.
Those who say Georgia should expand Medicaid, and accept the federal money that comes with it, say that not expanding the program will end up costing everyone more in the long run.
The American Academy of Actuaries released a brief in September – about two months after the U.S. Supreme Court upheld the Affordable Care Act but made state’s participation in Medicaid expansion optional.
The academy says states that do not expand their Medicaid programs could see individual market premiums rise because they would have a higher percentage of uninsured patients compared to states that do expand Medicaid. Hospitals that provide emergency room treatment for uninsured patients – usually their only option, rather than less-expensive doctor’s office visits – spread the cost of those patients who cannot pay to the insured patients who can.
Dr. Thad Riley, a family health physician in Statesboro, said that like other family physicians, a small number of his patients do not have the money to pay for the care they need.
“As family physicians, we see this scenario play out daily,” the Georgia Academy of Family Physicians, of which Riley is a member, wrote in a letter to Deal. “Each week, Georgia Academy of Family Physicians members provide free care or reduce their fees for an average of eight patients who don’t have insurance or the financial resources to pay for their care. Our members’ experience is the foundation for the (Georgia and American Academy of Family Physicians’) 20-year policy advocating for health care for all. It’s also the reason why we encourage you to consider participation in a program that would pay 100 percent of the cost for Georgia to expand Medicaid to 721,558 Georgians who would qualify.”
The Medical Association of Georgia hasn’t officially taken a position on whether the state should expand Medicaid, though its CEO did express concerns about the possible expansion in an interview with Georgia Public Broadcasting in October.
Tim Sweeney, the director of health policy for the Georgia Budget and Policy Institute, said the state should take the federal money – at least for the first three years, when federal dollars would pick up 100 percent of the cost. Also, he said, if Georgia rejects the federal money, other states that do expand Medicaid could receive more funding that otherwise might have gone to Georgia.
“It’s financially a better deal for Georgia to get in early because the first three years are fully funded,” he said. “You wouldn’t want to join two years into it and miss those years of full funding.”
As for those who doubt the federal government’s ability to pay its promised share, Sweeney said history shows Medicaid is a priority in Washington.
“I think it’s an unrealistic expectation that federal share would dramatically drop,” he said. “That sort of is the historical experience with Medicaid and (Children’s Health Insurance Program) is that, if anything, the match rates get more generous over time. In particular, the federal government has increased Medicaid funding during the economic downturn to help out the states. There have not been reductions in the base Medicaid matching rate since the program was established.”

Jason Wermers may be reached at (912) 489-9431.