Democrats have long tried to persuade red states to expand the federal Medicaid program and bring health insurance to more than just their poorest residents. The Biden administration has sweetened the pot in 2021 with additional federal money, but GOP officials, including Kemp, are reluctant to accept the offer unless they can tie the benefits to work.
Slow uptake in Georgia’s program has done little to change the state’s double-digit uninsured rate, one of the highest in the U.S. And it could hold back other red states that have yet to expand Medicaid, including nearby Alabama, Mississippi and South Carolina from following Georgias footsteps even as they come under increasing pressure from the health care industry to expand the government-run health insurance program.
Some in Georgia, however, maintain that it is too early to draw conclusions about the program and that many people may still not know the program exists.
Ive got my fingers crossed its going to be a good solution, said Georgia state Rep. Lee Hawkins, a Republican who chairs the House health committee. Getting the word out is always difficult with any new program.
Georgia is the only state with a Medicaid work requirement, even though Kansas Gov. Laura Kelly, a Democrat, is the one to attract the Republican legislature. Arkansas Republican Gov. Sarah Huckabee Sanders is awaiting federal approval for a similar idea.
Work requirements are a feature of the Trump administration’s plans to overhaul Medicaid, and the Centers for Medicare and Medicaid Services have approved them in 13 states. But court rulings and the Covid-19 pandemic derailed implementation, and the Biden administration subsequently revoked the approvals. However, Georgia won a challenge in federal court in 2022 allowing it to implement the policy while partially expanding Medicaid.
The move follows years of public debate over whether to expand the low-income health insurance program, with Democrats making it a centerpiece of the 2018 and 2022 gubernatorial campaigns.
Kemp, who won both elections, chose instead to limit expanded coverage to adults earning up to the federal poverty line of $14,580 for an individual or $30,000 for a family of four. But coverage for this new group is only available to people who document that they work, study or volunteer 80 hours a month.
It’s like a political compromise between people who want expansion and people who don’t want expansion, Pope said. And it’s been a pretty slight expansion.
Georgia Republicans are urging patience and remembering that the state Medicaid agency is busy reviewing eligibility for millions of people for the first time since the pandemic.
As with any newly launched program, we expect enrollment to build over time, said a health department spokesperson.
Kemps’ office did not respond to a request for comment.
For those on the right who have long wanted to limit Medicaid, the low enrollment numbers are proof that too many people are content to rely on government help they don’t need instead of looking for work or going to school.
Since there are too few adults willing to work, train or volunteer even part time to qualify for the Pathways program, it is clear that full expansion would destroy jobs for people who could work and risk resources for real low income needs. children and people with disabilities, said Jonathan Ingram, vice president of policy and research at the Foundation for Government Accountability.
There is bipartisan agreement that lack of awareness about the program likely contributes to low enrollment as well.
Its still early, and I think people need to be educated, said Rep. Buddy Carter (R-Ga.). I wouldn’t read too much into that at this point.
For opponents of the limited expansion, the slow start has led to renewed calls for the state to enact a full Medicaid expansion, covering people earning up to 138 percent of the poverty level without work requirements.
Pathways to Coverage costs Georgia more money and covers fewer people than if the state had simply joined 40 other states in expanding Medicaid, Sen. Raphael Warnock (D-Ga.) said in a statement to POLITICO. While state politicians continue to play with people’s lives, Georgians are dying because they cannot afford the health care they need.
The final verdict on the Georgia program could determine whether red states try to reimpose Medicaid work requirements, especially if a Republican wins the White House.
Making sure the path is cleared, and states like Georgia leading the way, can help create a new path that is seen as less fraught with obstacles and obstacles, said Nina Owcharenko Schaefer, director of the Center for Health and Welfare Policy at the Heritage Foundation. It is important to have these kinds of experiments. We need to learn from them. Theyre not intended to be, hit it out of the ballpark in one hit.
In Kansas, Kelly’s proposal to add a work requirement reported once a year is a concession that comes after five failed attempts to convince the Republican-led legislature to expand Medicaid.
The governor’s office rejected the idea that its program would face a similar fate to Georgians.
The reason they’re struggling to get some enrollees is because of the bureaucratic hurdles people have to go through to prove they’re working, said Kelly spokeswoman Brianna Johnson.
Arkansas has an application pending before CMS to reinstall work requirements, but beneficiaries will not lose coverage for noncompliance. Instead, beneficiaries will receive greater coordination of care, services and outreach.
The state imposed the requirements in 2018, and more than 18,000 people lost coverage within seven months. A federal judge struck down the program in 2019, ruling that the work requirements undermined Medicaid’s core mission of providing health care.
Courts have also struck down work-requirement programs in New Hampshire and Kentucky. Other states such as Arizona and Indiana have paused their programs due to actions in other states.
Liberals hope the slow uptake of Georgia’s programs gives states pause before trying anything similar under a future Republican administration.
“Given where we are in enrollment, it seems like it would be very silly,” said Joan Alker, executive director of Georgetown University’s Center for Children and Families. Never say never, but the fact that no one is covered doesn’t respond to the pressures that are said to be felt.
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