by Jill Nolin, Georgia Recorder [This article first appeared in the Georgia Recorder, republished with permission]

January 10, 2024

House Speaker Jon Burns publicly opened the door to a conversation about fully expanding Medicaid through a “private option” that skirts traditional expansion but still extends health insurance to significantly more uninsured Georgians.

Burns, a Newington Republican who is in his second year leading the House, said in remarks to the state’s business community Wednesday morning that the chamber’s leading lawmakers on health care were in a fact-finding phase.

“When it comes to health care, there has certainly been a lot of discussion of late about Medicaid expansion,” Burns said at the Georgia Chamber of Commerce’s Eggs and Issues event.

“Expanding access to health care for lower income working families through a private option in a fiscally responsible way that lowers premiums is something we will continue to gather facts on in the House,” he said.

Republican leaders have steadfastly rejected full Medicaid expansion under the Affordable Care Act for more than a decade, so the recent chatter represents a potential shift on the issue here. But there is no concrete proposal and any movement this year is far from certain.

Georgia is one of 10 states that have not fully expanded Medicaid. Instead, under Republican Gov. Brian Kemp, the state expanded eligibility to low-income Georgians – but not to the extent traditional Medicaid would – and required people to complete 80 hours every month of work, school or other qualifying activity to gain and keep coverage.

Georgia’s program has had about 2,300 people sign up since its July launch. The governor’s office had projected that about 345,000 people could be eligible. 

And Georgia, like all states, is also going through the process of checking the eligibility of all 2.8 million Georgians covered by Medicaid after the end of a pandemic-era federal rule protecting coverage during the public health emergency. Hundreds of thousands of people are expected to lose coverage.

Georgia also has one of the highest uninsured rates in the country.

A special House panel created to look at hospital regulations last year met with officials from Arkansas, which pursued a waiver that allowed the state to expand coverage to the newly Medicaid-eligible through private insurance on the marketplace.

Any potential Medicaid expansion proposal is expected to be paired with proposed changes to the state’s certificate-of-need program, which controls how many medical services are allowed to be provided in an area.

Later Wednesday afternoon, Burns said the governor’s partial Medicaid expansion program was working and added that he thought it was at least “going in the right direction.”

“We’re allowing the governor’s objective and his plan to work, but certainly we’re looking at other ideas, gathering facts, and we’ll continue to do our work,” Burns said to reporters.

As Burns was holding a press conference with reporters, House Democrats were holding a Medicaid expansion hearing across the street in a packed legislative meeting room. Democrats heard from health care experts on the potential impact of full Medicaid expansion on both the state’s economy and the wellbeing of Georgians.

“It’s not just that we have really poor health outcomes – that would be enough – but we also have unconscionable inequities,” Dr. Harry Heiman, a public health professor at Georgia State University, said at the meeting. “The rural people in our state, the low income Black and brown people in our state, they’re suffering. And they’re suffering needlessly because we failed to act in ways that we should.”

Democrats blasted the governor’s partial expansion plan, called Pathways to Coverage.

Rep. Tremaine Teddy Reese, a Columbus Democrat, panned the program as a “pathway to failure.” Rep. Scott Holcomb, an Atlanta Democrat, said it would be “policy malpractice” to continue to resist full expansion.

Rep. Michelle Au, a Johns Creek Democrat and anesthesiologist who led Wednesday’s meeting, struck an optimistic tone about the potential change in direction this year.

“As we start this 2024 legislative session, it is my hope that all options are on the table,” Au said.

Garrison Douglas, a spokesman for the governor, declined to comment on whether Kemp was open to an Arkansas-style Medicaid expansion. 

But Douglas did offer a comment touting the governor’s health care plans, including a reinsurance program that has found bipartisan support.

“The governor has championed and continues to support Georgia Pathways to Coverage and Georgia Access, which have provided Medicaid coverage to Georgians in need, reduced premiums across the state, and helped hundreds of thousands of Georgians sign up for private sector health insurance plans,” Douglas said. 

Georgia Recorder reporter Ross Williams contributed to this report. 

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