by Ariel Hart, Georgia Recorder, [This article first appeared in the Georgia Recorder, republished with permission]
October 23, 2026
Keisha Lance Bottoms stood outside the DeKalb County elections headquarters facing more than 20 reporters and news cameras as early voting got underway earlier this month. Flanked by U.S. Sen. Raphael Warnock, who had just voted for her, Bottoms rattled off the reasons Georgians should vote for her, too. She didn’t mention Medicaid expansion, the driving force for Democrats in Georgia state races since 2010.
Under questioning by a reporter, Bottoms quickly retrieved the issue, reiterating what she’s said before on the campaign trail: Medicaid expansion is a core issue of hers. But the moment was telling. Has Medicaid expansion lost its fire as a Democratic campaign issue?
“Medicaid still remains a top priority in this state,” Bottoms insisted. “It continues to be a priority and will be a day-one priority for me to prepare our state agencies for that expansion.”
More than 1 million Georgia adults lack health insurance as of the latest data in 2024. Of those, more than 300,000 are in poor or low income groups and many more lack health insurance and have too little income to buy it themselves, according Georgia Budget and Policy Institute researcher Leah Chan. Giving them Medicaid, the government health insurance program for poor and low-income children and some elderly and disabled adults, is a solution proposed under the Affordable Care Act.
But Medicaid expansion as an issue has become more complicated following the passage of President Donald Trump’s One Big, Beautiful Bill Act in the summer of 2025. That law took the Georgia concept of work and activity requirements and mandated them nationwide for all states with Medicaid expansion.
To complicate matters more, Bottoms’ opponent, Rick Jackson, says he, too will expand Medicaid – but calls it “intelligent Medicaid expansion.” By that, part of what he meant is that he would not expand it as fully as other states, or as Bottoms says she would.
The lure of Medicaid expansion
The basics remain: Full Medicaid expansion would still insure more people, even under the new federal law. Studies are under way to estimate how many more people, but the numbers remain substantial.
To boot, 90% of the bill would be paid by the federal government, bringing in billions of dollars to the state health industry – a point that cheers Democrats, and that gives conservatives mixed feelings.
“Every time we ask the question about Medicaid expansion, a majority of respondents say they favor it,” said Trey Hood, a University of Georgia professor of political science who polls Georgians for the Atlanta Journal-Constitution.
At the same time, those voters have not held the lack of Medicaid expansion against Gov. Brian Kemp, a Republican who stood firm against expanding it and instead created the Pathways to Coverage Program that has never lived up to his expectations.
“He has like a 69% approval rating,” Hood says, “That’s phenomenal in this day and age … They’re probably thinking more about the economy in Georgia, and the tax rebates and the tax cuts and all that kind of stuff” that Kemp has implemented as governor.
Then and now
Medicaid expansion was the signature issue of Stacey Abrams, a Democrat who ran unsuccessfully for governor twice, and it helped propel her to within 55,000 votes of beating Kemp in their first contest in 2018.
Since then, Georgia’s uninsured rate remains nearly the worst in the nation. This year that’s even more important to elections, as the price of healthcare piles on to the affordability crisis. Medicaid expansion – giving Medicaid to everyone in a state who is below the poverty line and just above it – would solve a big chunk of that uninsured coverage gap.
Under Rick Jackson, a big difference would be what happens to the several hundred thousand Georgians who are just above the poverty line. Under Kemp, they are eligible for subsidized private plans on the Affordable Care Act exchange. Jackson said he doesn’t want to take those plans away.
However, it appears that large numbers of those low-income ACA policyholders can’t afford even the tiny co-pays and cost-sharing that hit them after Trump and Congress allowed pandemic-era subsidies to expire. With the subsidies gone, several hundred thousand Georgians dropped their plans. Many of those might remain uninsured under Jackson.
And where Jackson relies on the longheld reputation of private insurance as better than Medicaid, that’s not always how patients see it.
Private insurance is losing its luster: In a 2023 survey by the health research nonprofit KFF, 83% of Medicaid enrollees rated the overall performance of their health insurance as excellent or good. In contrast, only 73% of those with ACA plans and 80% of those with employer health insurance had the same feeling.
And for those just above the federal poverty line, the paperwork requirements to show they qualify for Medicaid expansion might not be that bad. Under the new federal law, all it would take for those people to get healthcare is showing they make more than $580 per month – which they do because they’re above the poverty line.
Working across the aisle
The thornier issue, experts say, is whether Bottoms would be able to enact her health promises with a Republican-controlled Legislature.
Jackson and Bottoms are running neck-and-neck, according to recent polls. The Georgia Legislature, though, is likely to stay in the GOP’s hands.
No Georgia governor can fully expand Medicaid without a vote from the General Assembly. And priorities that need to be funded through the budget require their cooperation, too.
Bottoms has a detailed six-page wish list of healthcare priorities if she becomes governor. A lot of them take money. They include targeted premium support for ACA premiums, investing in enrollment assistance, increasing reimbursements for rural healthcare, expanding health availability from perinatal care to food assistance and more.
Andra Gillespie, associate professor of political science at Emory University, called it a “a reasonable assumption” to expect Republicans to retain control of the Legislature.
In that case, Gillespie said, “I think what Bottoms should expect if she is elected governor … is that she’s going to have to work across the aisle in order to achieve healthcare. And that there will probably be some compromises involved in terms of policy.”
But a doctor who is also a health policy professor noted that the political uncertainty cuts both ways.
Dr. Stephen Patrick, who’s both a practicing doctor and chair of health policy and management at Emory University’s Rollins School of Public Health, took time away from treating premature babies in the ICU this week to address the Georgia Recorder’s question on that issue.
“There is still a strong incentive to expand Medicaid,” Patrick said. Yes, there’s the increased federal dollars to the state, as well as the possibility of covering more people.
But he noted that the complications voted in by the Trump administration and its allies also might not last. That One Big, Beautiful Bill law slashed Medicaid spending nationwide by $1 trillion, and that’s going to start being felt very soon by lawmakers and the at-risk hospitals, clinics, doctors and patients that they represent.
“I wouldn’t predict a full repeal anytime soon,” Patrick said. “I also think we should be cautious about assuming the federal changes to Medicaid are permanent.”
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.