GBPI Continues to Weigh In on Patients First Act

Access to Quality Health Care Hearing for SB 106 – ‘Patients First Act’

Though our Georgia legislators are confident the federal administration will support a partial Medicaid waiver, the Georgia Budget and Policy Institute still believes a better waiver design will cover more people. Laura Harker provided testimony to try to influence a better plan for more than 400,000 Georgians without access to health care.

Testimony of Laura Harker, GBPI Health Policy Analyst, March 20, 2019

“Thank you, Chairman Smith and members of the committee. I am Laura Harker and I serve as a policy analyst at the Georgia Budget and Policy Institute where I research the health care budget and related policies.

SB 106 takes a first step toward a health coverage solution in Georgia, but the bill is in need of a change to allow the Governor and Department of Community Health to explore all of the possible Medicaid 1115 waiver options to improve health care.

Every Medicaid waiver state receiving a 9 to 1 federal match, including Kentucky, Arkansas and Indiana, has extended income up to 133 percent of the federal poverty threshold. Capping the income threshold at 100 percent of the federal poverty level could leave the state paying more while seeing fewer people get coverage. At 100 percent of the poverty level, the state risks only getting 67 percent of the costs covered by the federal government instead of 90 percent.

Even if federal guidance were to take a big change and allow an unprecedented deal, Georgia could end up creating a new kind of gap that does not exist in any other Medicaid waiver state.

Wisconsin is an example of a state that capped income at 100 percent of poverty and did not receive the 90 percent match. A study found that if they moved the income threshold up to 133 percent of the poverty level, 80,000 more people would be covered at a net savings of $190 million per year for the state’s taxpayers. All of their neighboring states increased Medicaid eligibility up to 133 percent and saw larger drops in their uninsured rates.

Even if federal guidance were to take a big change and allow an unprecedented deal, Georgia could end up creating a new kind of gap that does not exist in any other Medicaid waiver state. This includes Georgians making between 100 and 138 percent of the poverty line (between $12,000 and $17,000 a year for an individual) who would have to pay more money out of pocket on the marketplace compared to if they were able to enroll in Medicaid. Even with the marketplace subsidies available to people between 100% and 400% of poverty, Georgia still has about 230,000 people between 100 and 138 percent of poverty that are uninsured. We should not continue to make the cost of health coverage a barrier for this group to access health services.

Given the uncertainty about the costs of this proposal and no fiscal note provided along with the higher out of pocket costs people near the poverty line would face, Georgia Budget and Policy Institute recommends that SB 106 provides full flexibility for the Department of Community Health to submit a waiver that goes up to 133 percent of poverty. Thank you.”