Expanding Medicaid coverage in Georgia has benefits, experts say

Sept. 25--The state of Georgia will eventually expand its Medicaid program "because the numbers are so compelling," a health care economist for Georgia State Univer­sity said Thursday at a policy forum in Augusta.

Dr. William Custer spoke at the "Coverage and Access to Care: Local Focus on Augusta" forum on the potential for Medicaid expansion in Georgia. It was held by Georgians for a Healthy Fu­ture and the Georgia Bud­get & Policy Institute, which both advocate for the expansion.

Under the Affordable Care Act, people at or below 138 percent of the federal poverty level were supposed to be covered by a mandatory expansion of Medicaid, but a 2012 U.S. Supreme Court decision made that voluntary and most Southern states, including Georgia and South Ca­ro­lina, opted not to expand.

But those at the federal poverty level or below don't qualify for subsidies to buy health insurance in the federal marketplaces, and in Georgia childless adults do not qualify for Medicaid regardless of income. Others face very low income thresholds -- a single mother cannot earn more than $6,000 a year or she will not qualify for Medicaid.

Because of those restrictions, about 300,000 people in Georgia fall into a "coverage gap." Most of them are working adults, said Tim Swee­ney, the deputy director for policy at the Georgia Budget & Policy Institute.

"There's a lot of people in this state out there working who don't make enough to qualify for a subsidy" to buy insurance, he said. That includes about 56,000 people working in restaurants and food service, 30,000 working in construction and 12,000 working in grocery stores, Sweeney said.

"There's an overriding state interest to see that people in those jobs have access to coverage, too," he said. "This touches Georgians of all walks of life and around the state."

It also includes an estimated 32,000 veterans and their spouses who do not qualify for health benefits through the Department of Vet­erans Affairs or face significant barriers to getting care through the VA, according to the institute's report.

Covering all of those people through expanding Medicaid could have a tremendous impact, particularly in areas including Augusta, he said. In the 13-county region surrounding Augusta, there were an estimated 62,000 uninsured. Expanding Medicaid would cover 29,000 of them, and in many counties such as Burke, Jefferson and Jenkins it would cover 54 percent or more of the uninsured, according to an analysis by the institute.

The group estimates that increased coverage could mean as much as $180 million in new revenue for health systems in the region, generating $340 million in economic activity and about $5 million more in local tax revenue. In increasing that health care workforce, "that's where we're going to get the job growth," Custer said.

Georgia already spends about $2.6 billion caring for the uninsured, he said. They pay about 20 percent of it themselves, about $520 million in self-pay. The other $2 billion or so is split between taxpayers, mostly state and local taxes, and other health care consumers who pay the cost in higher health care costs and higher premiums, "which means we all bear the cost," Custer said.

In terms of taxes, expanding Medicaid shifts that burden more to federal taxes "and it is spread over a wider group," Custer said. Covering the uninsured allows better control of costs and reduces that cost over time because people get better care and preventive care as opposed to letting a problem fester, Custer said.

"Health insurance cost, as it rises, takes away from wages and reduces economic growth," he said. "You reduce health care costs, you are going to reduce premiums. That is a benefit to everyone."

It would be particularly beneficial to those lower- wage workers employed by small businesses who can't afford to offer insurance to their employees, Custer said.

"For small employers, Med­i­caid expansion allows them to attract and retain a workforce that is more productive and lower cost than they would face without Medicaid expansion," he said.

Medicaid expansion has faced fierce opposition in the past, particularly from those who believe it would be too costly to the state and those who see it as an unwarranted expansion of government, advocates acknowledge.

"It's going to take a hero," Custer said.

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