Federal budget cuts could push Georgians off ACA healthcare rolls

Federal budget cuts aimed at Medicaid and the Affordable Care Act could eventually cost 16 million Americans their health insurance coverage, and Georgia would not be immune from the impact, a health care advocacy group is warning.

The state already lags most of the country in The Commonwealth Fund's performance indicators.

Their new report, 2025 Scorecard on State Health System Performance, ranked Georgia 45th — behind all of its neighbors. The scoring is derived from indicators such as health care access and affordability, infant mortality rates and potentially avoidable emergency room visits.

The rankings are based on 2023 data, when 16% of Georgians from age 19 to 64 were uninsured compared with a national average of 11%.

Health care cuts in the budget reconciliation bill by the U.S. House of Representatives would reduce the insured population in two ways, the report says.

It predicts more than 8 million would become uninsured in less than a decade if Affordable Care Act premium tax credits are allowed to expire and new marketplace enrollment requirements are implemented.

And it says about 8 million more would become uninsured if proposed Medicaid work requirements and more frequent eligibility checks are enacted.

Georgia already has work requirements for its Pathways to Coverage program, a limited form of Medicaid expansion rolled out by Gov. Brian Kemp in 2023.

If the rest of the country imposes such work requirements, other states will see higher administrative costs and lower enrollment, said Sara Collins, a vice president at The Commonwealth Fund.

Georgia enrolled a relatively small number in Medicaid "at an enormous federal and state expense that far outweighed what it would have cost just to do a normal Medicaid expansion," she said.

Kemp has declined to expand Medicaid more broadly, fearing — perhaps prophetically — that Congress would reduce funding and force states to shoulder a larger share of the costs.

But Georgia still won't be immune if the cuts come, Collins said. Because fewer Georgians had access to Medicaid, more of them chose the marketplace subsidized by the ACA tax credits.

They may face big premium increases as soon as November, with many falling off the ACA rolls by next year, she said.

"The passage of the bill would still have a very big effect on people in non-expansion states like Georgia," she said, adding that hospitals, doctors and other medical providers who rely on insured patients would also be affected.