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Medicaid expansion discussed


  • By Sarah Fay Campbell
  • |
  • Sep. 03, 2016 - 5:05 PM

Since 2012, Georgia Gov. Nathan Deal and the Georgia General Assembly have refused to expand the state’s Medicaid program, leaving more than 500,000 low-income Georgians in the Obamacare “coverage gap.”

The design of the Affordable Care Act called for Medicaid eligibility to be expanded to all Americans with incomes at or below 138 percent of the poverty level. Those with higher incomes can receive subsidies designed to make health insurance affordable.

Lower-income Georgians aren’t eligible for the subsidies.

The federal government pledged to fund the expansion at 100 percent through 2016, and at 90 percent through 2020.

In 2012, the U.S. Supreme Court ruled that the federal government couldn’t require states to expand Medicaid.

Georgia is one of 19 states that hasn’t expanded Medicaid. Six states have done the expansion through a waiver, which allows the states to expand coverage on their own terms.

Another part of the Affordable Care Act is the reduction in the federal subsidies that hospitals get to help pay for “uncompensated care.”

This steady reduction in “disproportionate share” payments to rural hospitals has led to the closure of some hospitals in Georgia.

“The whole design of it was that the money that had come from the disproportionate share payment would be made up, and then some, from the Medicaid expansion,” said State Rep. Bob Trammell, D-Luthersville. Trammell’s district includes a portion of Coweta.

The Georgia Chamber of Commerce this week released a report outlining three ways that the state could achieve a Medicaid expansion through a waiver.

The report was put together by a health care task force created by the chamber.

The first plan would expand Medicaid to childless adults who are at or below 100 percent of the poverty level, which is $11,770 annually for a single person. The Centers of Medicare and Medicaid Services, which would have to sign off on any plan, has never approved a plan that doesn’t extend coverage up to 138 percent of the poverty level, according to WABE News.

The second plan would expand Medicaid to cover all Georgians with incomes up to 138 percent of the poverty level.

The third would expand Medicaid for those at or below 100 percent of the poverty level, and would use Medicaid money to buy private insurance plans, through the healthcare exchanges, for those between 100 and 138 percent.

Trammell said he’s pleased that the chamber is making the effort and willing to move the discussion forward.

“We have a definite issue that we have to address in Georgia,” Trammell said. “I think that the chamber’s proposal looks at it, also, from a business perspective – and the costs of inaction to the state from the business perspective are simply too big to ignore.”

Trammell said four rural Georgia hospitals have closed in the past few years, and there are estimates that over a dozen are on the verge of closing, unless something changes. For the most part, the half-million Georgians in the coverage gap end up using emergency rooms for medical care, and ERs are the most expensive option.

State Rep. Lynn Smith, R-Newnan, said she hasn’t seen the report or heard many details, but she expects to hear more before the legislative session begins in January.

Before anything can happen in the legislature, someone will have to introduce a bill, Smith said.

Smith and Trammell both said that the results of the presidential election in November will likely have a big impact on what happens.

“Really, it’s just premature all the way around,” Smith said. However, “I appreciate the fact that the state chamber spent their resources and their time to enter into the debate.”

“Our whole country is in a healthcare crisis,” Smith said.

In the 2016 session, a bill was passed to give state income tax credits to businesses and individuals who contribute money to rural hospitals.

“The rural hospital crisis is real, and it is so complicated,” Smith said. “It’s not that your legislators aren’t aware of the problem. If the solution were easy, we’d be doing the solution.”