The Need to Expand Medicaid in the State of Georgia

By Jessica Pasquarello

This article was originally published in the Georgia Political Review.

Miranda, a single, 52-year-old daycare employee, has been coughing and feeling fatigued for weeks; her co-workers urge her to visit a primary care physician, but without insurance, the phrase “I simply cannot afford it” has become her standard response.

Meanwhile, just a few miles away, Steve, a 27-year-old truck driver, faces similar problems. He severely hurt his back two months ago while lifting heavy boxes on the day he moved into a new apartment with his girlfriend, but like Miranda, he lacks the insurance coverage to visit a doctor.

Yet, for thousands of Georgians – 300,000 of them to be exact – these imaginary scenarios above have been an everyday reality, as a result of the “coverage gap” that has emerged in our post-Obamacare world. 19 states, Georgia included, have not yet opted to expand Medicaid for their residents as the Affordable Care Act initially stipulated.

However, by choosing not to expand Medicaid, Georgia lawmakers are not only exacerbating the burden of those low-income individuals who are directly affected, but are also severely hindering the state’s economy.

Let me explain.

In the state of Georgia, Medicaid is restricted primarily to low-income families, pregnant women, seniors, and disabled individuals. Yet, even individuals within those categories are forced to meet very stringent income requirements in order to reap the benefits of Medicaid, as Georgia has some of the strictest provisions in the nation. For example, under current regulations, a family of three in Georgia must earn $7,600 or less in order to be deemed eligible for Medicaid. Such an income is well below the Federal Poverty Level (FPL), meaning that families who earn even slightly more than the state-regulated baseline and are still technically under the federal poverty level are nevertheless deemed ineligible to receive Medicaid.

To make matters worse, low-income single adults between the ages of 19 and 65 are completely left in a lurch, as they are banned under state regulations from reaping any of the benefits that Medicaid could offer, despite meeting the aforementioned strict income regulations.

So what could be done to alter this problem? The 2010 Affordable Care Act initially required that each state provide Medicaid to all individuals who earned an income up to 138 percent of the Federal Poverty Level. This would mean that, if, for example, the federal poverty line for a household of two is $16,020, any families of two earning up to 138 percent of that amount would be eligible for Medicaid. This would have greatly expanded the number of persons eligible for Medicaid. However, in 2012, although the Supreme Court upheld the constitutionality of the Affordable Care Act, it denied the ability of the federal government to force states to adhere to it.

Since then, 32 states (including the District of Columbia) have expanded Medicaid to the extent the Affordable Care Act originally stipulated, but Georgia is one of the 19 states that has failed to do so, an interesting fact considering that Georgia consistently ranks among the states with the highest numbers of uninsured residents.

State officials often argue that they do not want to expand Medicaid for fear that it would be too expensive. However, such a claim lacks validity. The federal government has stated that it would permanently pay no less than 90 percent of the costs of expansions, while paying even slightly more than that during the initial years of expansion.

Most taxpayers would argue that they would prefer to see the majority of their federal tax money returned to their state, and expanding Medicaid would funnel approximately $33 billion of that money directly back into Georgia. In broad terms, by refusing to expand Medicaid, the state is turning down an extensive government subsidy– essentially, for every $100 that a state spends on Medicaid, the federal government would provide $900. These new federal dollars would be passed through multiple hands, from physicians to employees to local shops, providing a broad impact on the economy.

Pumping this much money into the Georgia economy would result in new jobs, as studies have found that Medicaid-expansion states experienced 30 percent faster growth in health sector jobs in 2014 in comparison to states that have not expanded Medicaid.

Although there has not been extensive research specifically related to the consequences of potentially expanding Medicaid in Georgia, similar studies have been undertaken in regards to other states. For example, the consulting firm Deloitte issued a report stating that expanding Medicaid in Kentucky would result in over 40,000 new jobs and an $820 million budget gain for state and local governments. While further studies have not yet taken place to see if this economic growth has actually happened since expansion, countless other reports have been written discussing potentially similar positive impacts in other states, such as Florida, Alabama, and Missouri.

Aside from focusing on economic data, supporters of Medicaid also advocate moral and ethical arguments. Expanding Medicaid would ensure that the 300,000 Georgians in the current “coverage gap” could finally receive the insurance that they need (Figure 1). When the Affordable Care Act was created, it was assumed that all of the states would have to enforce Medicaid expansion, and when certain states such as Georgia did not, countless individuals were left uninsured. These people do not earn an income large enough to be eligible to make purchases in the Healthcare marketplace (where the federal government lists subsidized insurance options), but they also do not earn an income small enough to be considered eligible for Medicaid under current state conditions. Expanding Medicaid would provide the coverage that the uninsured in this “gap” were originally supposed to have.

Expanding Medicaid would also improve the standard of living for many women, as well as members of the LGBT community and racial minority groups, whom studies have shown are at greater risk for being uninsured.  

In summary, the need for expanding Medicaid is palpable. For some Georgia lawmakers, the issue is beginning to cross over partisan lines: although expansion has typically been associated with the Democratic Party, now even Republicans such as Georgia State Senator Renee Unterman have described[KG1]  the need to accept the proposed federal funding for expansion, saying, “We can no longer close our eyes and hope this problem of accessibility goes away…We can no longer prop up our current budget with only state medical care dollars.”

This matter should also be of particular interest to college students who, while drowning in the seas of student debt, may be potentially eligible to receive Medicaid benefits as an alternative to paying the traditionally extravagant costs of health care. However, as stated before, Medicaid expansion would be a boon affecting a wide range of public interests – providing a stage in which the economy could flourish, hundreds of new jobs could be created, and the thousands of individuals like Miranda and Steve who have been left in the coverage gap could finally receive the medical care that they need.