by Jay Bookman, Georgia Recorder, [This article first appeared in the Georgia Recorder, republished with permission]
September 18, 2026
Georgians strongly support Medicaid expansion to provide health insurance to their lower-income neighbors, and they have done so for years.
Yet somehow, their clear policy preference has not yet been translated into action. The state remains one of only 10 that have not accepted the federal government’s offer to expand coverage.
How do we know that public support for expansion is real?
Well, repeated polls have shown that between 70-75% of voters support extending coverage to hundreds of thousands of Georgians – most of them working people – who are currently uninsured. (Expansion would also draw billions of additional federal dollars to the state, strengthening our healthcare system and bolstering rural areas where doctors and hospitals are struggling to stay afloat.)
We also know Medicaid expansion is popular because for several years now, Republicans have offered lip service to some form of expansion, but without actually ever delivering it. Judging by their rhetoric, their internal polls deliver much the same message as public polls: Georgians believe access to healthcare is a right and see government as a legitimate, necessary means of providing it.
But it never happens. The taboo against “Obamacare” remains too strong.
Consider Gov. Brian Kemp’s Georgia Pathways to Coverage program, which he touted as a conservative alternative to Medicaid expansion that would be so effective that it would serve as a national model for other red states.
But if Pathways had been an actual healthcare proposal, you would have to consider it an expensive failure. Almost seven years after Kemp announced it, and three years after he signed it into effect, Georgia still has the second highest uninsured rate in the country, behind only Texas. (Not coincidentally, Georgia also has the fifth highest level of unpaid medical debt, which is a burden on patients and providers both.)
The Pathways program has been so ineffective – in part because of what appears to be purposeful bureaucratic neglect – that the Kemp administration recently announced that it may abandon it altogether. The number of Georgians enrolled in the program has never come close to initial promises, and the program has long been expensive to run.
However, the more accurate way to understand Georgia Pathways is as a distraction, as a proposal invented to sell an illusion of Medicaid expansion to voters, but without actually doing so. On those terms it has been somewhat of a success. No, it hasn’t reduced the demand for Medicaid expansion in Georgia; to the contrary, that demand has increased over the years. But it has succeeded in kicking the can a little bit further down the road.
So is Rick Jackson just another can kicker?
Like Kemp, the Republican candidate for governor balks at simply expanding Medicaid as federal law allows. Like Kemp, he’s telling Georgia voters that he has an even better idea. He’s not just offering an alternative to Medicaid expansion, he’s offering an intelligent alternative to Medicaid expansion.
Who could be opposed to that? It’s intelligent!
However, if you unwrap the intelligently tied bow from the intelligently gift-wrapped box and peer inside, what do we find? Honestly, not much. The Jackson campaign provides few details of its proposal. The plan is to use “better technology,” “cut out the middlemen” and “make Georgia a national model for high-quality, accessible and affordable healthcare.”
So intelligent.
To be fair, a big part of Jackson’s argument is that as someone who has made billions of dollars as a profitable “middleman” in the healthcare industry, he has special insight into how to do it better and cheaper. That’s certainly plausible.
It’s also plausible that the skill set, instincts and values required to wring billions from the system are different from those required to improve it. Those are two very different areas of expertise. And as demonstrated in our ongoing experience at the national level, government by billionaire doesn’t always work as well in reality as its paid advocates would have us believe.
Georgia Recorder is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Georgia Recorder maintains editorial independence. Contact Editor Jill Nolin for questions: info@georgiarecorder.com.