The defeat of health care legislation in the U.S. Senate last week marked a milestone in the effort to protect health care coverage in Georgia. People across the state raised their voice to protest proposed drastic cuts to Medicaid and the loss of health care coverage for hundreds of thousands of Georgians. Medicaid serves 2 million low-income Georgia children, seniors and people with disabilities. The Affordable Care Act extends health coverage to almost 500,000 Georgians in the individual market and provides Georgians with important protections such as assured coverage if you have a pre-existing condition. Georgia can now seize the opportunity to build on the success of Medicaid and the Affordable Care Act to extend health coverage.

Georgia is still home to one of the highest uninsured rates in the country at 14 percent. About 300,000 Georgians fall in the so-called coverage gap. These Georgians lack a viable health coverage option because they make too much income to qualify for Medicaid and too little to receive subsidies in the health insurance marketplace. Georgia is one of 19 states that failed to expand its Medicaid program to close the coverage gap. But last year, Georgia lawmakers were talking more earnestly than ever about options to close the coverage gap and shore up the health care system. Many Georgians are not able to see a doctor and several rural hospitals have closed or are facing financial difficulties. Since the 2010 federal health law remains in place, now is the time for state leaders to take action on health care. Medicaid expansion is the major option still available to bring an influx of dollars to the state’s health care system.

Federal money was available to cover the entire cost of new Medicaid expansion enrollees from 2014 to 2016. The federal share gradually declines to 90 percent in 2020 and beyond. Medicaid expansion states including Arkansas, Kentucky and Louisiana expect net budget gains in the coming years and that holds true even when the federal share decreases. The gains are primarily from reductions in uncompensated care and higher revenue from existing state taxes on health plans. Rural hospitals will also benefit from lower uncompensated care costs and the increase in revenue from more patients carrying health coverage. Medicaid expansion states also experience improved treatment for mental health and substance abuse disorders and better quality of care for low-income adults.

Giving more people health coverage through Medicaid is an important next step for Georgia and so is protecting the health coverage held by nearly 500,000 Georgians in the insurance marketplace. Only one marketplace insurer is available in 96 of Georgia’s 159 counties. Without competition to hold down premiums, large rate hikes could lead people to drop coverage they can’t afford. A major cause of these rate hikes is insurers are uncertain federal payments for cost-sharing reductions will continue. Concerns are growing that the federal government will stop making these payments to insurers. Any action that destabilizes the individual health insurance market will make it even more difficult for Georgians to find an affordable plan, or any plan at all. Leaders in Washington will need to work on solutions to stabilize the marketplace, such as continuing the cost-sharing reduction payments and funding reinsurance programs.

Closer to home, Georgians cannot afford to wait any longer for federal lawmakers to agree on changes to national health care policy. State lawmakers can take the step now to expand coverage and support the state’s rural hospitals by closing the coverage gap.

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Laura Harker
Laura Harker joined GBPI in 2016 as a health policy analyst. She is responsible for researching and reporting on Georgia’s health policies and related spending. She holds a master’s degree in public health policy from Emory University and a bachelor’s degree in health policy and management from the University of North Carolina at Chapel Hill. Laura can be reached at (404) 420-1324 x 103.

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