Georgia Medicaid expansion chances dim again this year as key health care proposal passes without it

A late proposal to fully expand Medicaid received a surprise hearing in a Senate committee Thursday but was narrowly defeated, with the chairman who allowed the hearing casting the decisive vote to shelve it.

And negotiations also wrapped up Thursday evening over a high-profile health care bill that was seen as a potential host for a full Medicaid expansion add-on. Instead, that bill ended where it started last month: with a commission that will look at ways to expand health care coverage.

The whirlwind of developments Thursday seemed to shut the door on any lingering Medicaid expansion talks for this year. The legislative session ends next Thursday.

"There are days in this building that break your heart, and I think that today was a day like that for lots of us," Rep. Michelle Au, a Johns Creek Democrat, said Thursday evening.

This year's session had started with new bipartisan chatter about fully expanding Medicaid. Much of that can be traced back to House GOP leaders who signaled an openness to an Arkansas-style model that uses federal money to purchase private plans for those who are eligible. Lt. Gov. Burt Jones, for his part, didn't dismiss it.

But the barrier to those talks was always the governor's partial expansion program, which was launched last July after being delayed by the federal government.

About 3,500 people have signed up for the program, which has cost the state at least $26 million so far, according to a story this week from KFF Health News. More than 90% of the expenses have gone to cover administrative and consulting costs.

Just last week, Kemp said he remained focused on his health care plan, which he described as "a limited Medicaid expansion in a conservative way." He sued the federal government last month for more time to make the program work. As of now, the federal waiver authorizing the program is set to expire next fall.

Georgia is one of 10 states that have not fully expanded Medicaid under the Affordable Care Act.

'It does not work'

A bill that would have created a Medicaid program styled as PeachCare Plus was given a hearing in a Senate committee Thursday morning.

The proposal was modeled after the Arkansas-style of expansion, which would require federal approval. Under the bill, the state would not seek a new federal waiver until the expiration of Georgia's existing program.

Sen. Bill Cowsert, an Athens Republican who chairs the Senate Regulated Industries and Utilities Committee where the bill was considered, described the proposal as being like the state's existing partial Medicaid expansion but "more aggressive."

Cowsert ultimately came down on the side wanting to give Georgia Pathways to Coverage more time. He told reporters afterwards that the discussion was a healthy one but probably "a little premature," saying he wants to give Pathways a chance to work.

The committee vote was 7-to-6, with Cowsert causing the tie that blocked the bill from advancing. Sen. Ben Watson, a Savannah Republican who is a former member of the committee, showed up at Thursday's meeting to vote against the proposal.

"If it fails, then we'll be back in here next year talking about other alternatives," Cowsert said.

But Sen. David Lucas, a Macon Democrat who sponsored the Medicaid expansion proposal, did not hold back later when the certificate-of-need bill arrived at the Senate for final passage without an immediate plan for full expansion.

He argued that Pathways has had enough time to work, and he attributed his bill's failure in committee to the governor's influence.

Sen. David Lucas, a Macon Democrat, sponsored a bipartisan proposal to fully expand Medicaid. Jill Nolin/Georgia Recorder

"When you're the governor, you've got influence but his program don't work. It does not work," Lucas said. "And we've got $26 million invested in it. So, when these rural hospitals close when we leave session, I am going to blame it on you."

But Thursday's committee hearing still represented a rare public discussion on Medicaid expansion in a Republican-controlled legislative committee. Two Republicans, Sen. Matt Brass of Newnan and Sen. Carden Summers of Cordele, voted with the Democrats.

Brass, who chairs the gatekeeping Senate Rules Committee, offered a few changes, including the addition of a workforce development fund like the one adopted in North Carolina. But he also unsuccessfully proposed an amendment to fully repeal the state's health care business regulations.

Brass said he believes the governor's program can be successful, but it will always be limited to those who fall below 100% of the federal poverty line, or about $15,060 for a single adult. Participants must also complete 80 hours of work, school or other qualifying activity each month to gain and keep their coverage.

Brass said he was concerned about the rising insurance costs for people with health coverage and the strain on emergency rooms from uninsured patients. But he also said he changed his mind on Medicaid expansion because of his experience as a small business owner who cannot afford insurance for his employees and whose construction business does not consistently offer 80 hours of work each month.

"I pay them well, but on an hourly basis and sometimes, sometimes roofs leak, sometimes they don't," he said.

Bill with certificate-of-need changes goes to the governor

A separate proposal to ease some of the health care business regulations in hopes of attracting more medical services, particularly in rural Georgia, is now on the governor's desk.

The proposal originally came from House leaders, with Speaker Jon Burns the second signer and Minority Leader James Beverly a co-sponsor. The Senate then pushed for more changes, like an easier path for freestanding birth centers to open, and the two chambers settled on a compromise measure Thursday.

That final product was celebrated by conservatives who pushed for changes scaling back the state's certificate-of-need rules.

"For decades, CON laws have unfortunately represented a barrier to expanding quality healthcare," Lt. Gov. Burt Jones said in a statement. "Today, we took a step towards reforming CON in Georgia and alleviating the roadblocks Georgians face in their efforts to receive accessible and quality healthcare."

Burns said in a statement Thursday that the bill represented "significant action to reform Certificate of Need and expand access to quality, affordable healthcare in our state."

The measure also increases the cap for the rural hospital tax credit program to $100 million, devoting another $25 million to the program.

When it comes to Medicaid expansion, Rep. Butch Parrish, a Swainsboro Republican who sponsored the bill, framed his proposal as what could be accomplished this year. Parrish chairs the powerful House Rules Committee.

"Over in the Senate today, there was an attempt to pass a Medicaid expansion, and it did not pass. So, I think that what we need to do is do what we can with what we've got to work with to provide the services for as many people as we can around the state," Parrish said during Thursday's debate.

But Democrats blasted their GOP colleagues for not including full Medicaid expansion in the final version. The bill had found bipartisan support earlier, but Thursday's final votes largely fell along party lines in both chambers.

Rep. Sam Park, a Lawrenceville Democrat who serves as minority whip, said House Democrats had held out hope until Thursday that Medicaid expansion would still happen this year.

"This CON will not cover a single Georgian despite the fact that we have one of the highest uninsured rates in the country," Park said. "Today was yet another reminder of Republican cowardice and Republican failure of leadership by leaving hundreds of thousands of Georgians uninsured."

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The post Medicaid expansion chances dim again this year as key health care proposal passes without it appeared first on Georgia Recorder.