Healthcare costs a still a political issue

With healthcare costs continuing to rise, the issue could prove to be a potent one in Georgia's upcoming election for governor.

Democrat Keisha Lance Bottoms has made it a core part of her campaign, blaming Republicans for refusing to accept Medicaid expansion as a solution.

Rick Jackson, her Republican opponent, agrees that rising costs are a problem, but he argues that increased access to commercial insurance is the solution.

A new survey of about 1,000 likely voters by the University of Georgia complicates the narrative.

Conducted in June for the Georgia Health Initiative, the survey found that more than 90% of Democrats and Republicans who responded had health insurance coverage.

Yet concerns about rising costs crossed party lines, with 54% of Democrats and 38% of Republicans saying they were very or somewhat worried about being able to afford their monthly premiums over the next year.

"Republicans on average, compared to Democrats or independents, tended to be slightly less worried about various healthcare-related costs," said M.V. Hood III, the political science professor in charge of the survey. But he said he found remarkable similarity regardless of party affiliation. GOP respondents "weren't quite up at the same level as Democrats or independents, but you're still talking about a very sizable number of people here."

Nearly three-quarters of Democrats and more than two-thirds of independents said healthcare in Georgia was not very affordable or not affordable at all. Fewer Republicans, but still just shy of half, felt the same.

Nearly half of Democrats and a quarter of Republicans said they had skipped or delayed care in the past year due to the cost.

Democrats were more exposed to the cost of private insurance — either through an employer or a personal policy, with a fifth of them on Medicare versus nearly a third of Republicans.

A minimal number of respondents, 2.5% of Republicans and less than 8% of Democrats, said their primary coverage was through Medicaid, the federal and state program that gives many low-income Americans access to healthcare.

That may be why affordability outranked healthcare as a major issue, with inflation and the cost of living being the top concern for respondents from both parties, followed by the economy and jobs.

Healthcare ranked third for Democrats, with 13% saying it was the single most important issue facing Georgia today. It ranked eighth for Republicans, with only 3% considering the issue that significant.

In short, ensuring access to healthcare for all is a bigger issue for Democrats, who were twice as likely as Republicans, at 86% to 43%, to say they thought it was very important for Georgia's next governor to focus on it.

That may be why Bottoms portrayed healthcare in Georgia as a crisis while speaking at a Georgia Chamber of Commerce event last week. Her solution is to expand access to Medicaid. The federal government would cover 90% of the cost, but the state would have to pay for the rest.

That would hit the state budget. But everyone, not just the poor, feels the consequences when hospitals close or when emergency rooms are overrun by people using them in lieu of a primary care physician they cannot afford without insurance, Bottoms told the businesspeople assembled at The Classic Center in Athens.

She blamed Georgia's Republican-led refusal to expand Medicaid for the closures of nine rural hospitals. "It's not a Republican, independent, Democratic issue," she said. "This is an issue that's impacting the strength of our state."

Bottoms also told the crowd that she had heard from small business owners this year about the rising cost of premiums to provide health insurance to their employees after the Republican-controlled Congress let enhanced Affordable Care Act premium tax credits expire.

Talking to reporters later, she leveraged the issue to attack Jackson, who built his personal wealth through the healthcare staffing company he created.

"I'm not mad about him being a billionaire," Bottoms said of Jackson. "God hasn't seen fit to make me one yet. But what I am mad about is that he's got a healthcare company and he doesn't want to expand Medicaid."

Jackson pushed back, telling reporters at that same event that he had the inside knowledge required to reduce healthcare costs.

"I will guarantee you that we will have the most cost-effective healthcare plan because I know how it works inside out," Jackson said. "I know what people do to game the system."

Rather than standard Medicaid expansion, he said he would pursue a federal grant to implement what he called "an intelligent Medicaid expansion." He said he would establish training programs that would give Medicaid recipients the skills to land a job providing insurance.

"I'm not going to measure our state by how many people are on Medicaid," he said. "I'm going to measure how many people are on commercial insurance. And the way to do that is reduce the cost of commercial insurance."

That plan may face headwinds if these newly employable workers wind up at a small company.

Firms with 50 or fewer full-time equivalent employees may see a median 14% increase in premiums in 2027, according to an analysis released last week by KFF, which reviewed federal data about preliminary rate filings by insurers across the country.

The nonprofit also reported that the number of people enrolled in the fully-insured small-group market fell by 41% between 2013 and 2024, down to 10 million.

Democrats and Republicans aligned on one nagging issue in the UGA survey: the lack of transparency in healthcare pricing.

At least 80% of partisans from both sides of the aisle said it was very or somewhat important for the next governor to make information about the cost of healthcare services more available.

Cindy Zeldin, a vice president with the Georgia Health Initiative, said focus groups conducted alongside the UGA survey indicate that people want to know in advance how much they will be billed for a medical service.

"That can really heighten the stress when you don't know what you're going to be charged," she said. "That seems to be a stressor for people across the board."

Hood, of UGA, speculated that consensus on the issue stems from the lack of an explicit price tag for demanding price transparency, unlike the public funding required to increase access to healthcare coverage.