Georgia candidates campaign on Medicaid expansion

According to a study by the Kaiser Family Foundation, Georgia currently ranks fifth in the nation for highest percentage of uninsured people at 12%. Much like during the 2018 Georgia gubernatorial race, rhetoric around Medicaid expansion is constant.

In the continued saga of the COVID-19 pandemic and widespread economic hardships due to recent inflation surge, the need for health care is ever pressing. And according to recent polls, a majority of Georgians agree. Health care needs a face lift.

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Statewide health care reform is something both political parties agree on. The divide involves the details, which continue to be rooted in partisan values.

Republicans want to expand Medicaid using a waiver system that includes a work, volunteer or school requirement along with a health care provider reinsurance program, an approach that incentivizes Georgians to better themselves financially and get off of Medicaid. Democrats want full expansion with "no strings attached."

How much that argument resonates with the electorate will be determined at the polls. Here's what else you need to know about health care-related issues and how candidates are using Medicaid expansion to drive turnout.

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For many voters, who to vote for comes down to the party designation next to their name on the ballot. Convincing those voters to go to the polls is the top priority for most candidates.

USA TODAY Georgia journalists identified the social issues that hopefuls are talking about on the campaign trail and explored how those topics might impact turnout.

High-profile candidates toe party lines

Georgia is one of 12 states that did not adopt Medicaid expansion when the Affordable Care Act's (ACA) Medicaid expansion passed at the federal level in 2014.

Incumbent Gov. Brian Kemp (R) has continued to stand his ground on the matter of Medicaid expansion, promoting partial expansion that he argues will increase coverage statewide and curb health care costs. His opponent, Stacey Abrams, asserts that full expansion will be a step toward not only better health care coverage for a larger population of Georgians, but a better overall health care system statewide.

Kemp and Abrams are not the only high exposure candidates staking claims on Medicaid. The expansion debate made its way to the senate election as incumbent Sen. Raphael Warnock, a Democrat, faces Republican challenger Herschel Walker.

Warnock does not veer from partisan principals, echoing similar sentiments as Abrams in full support of expansion. Walker, on the other hand, has not been clear about his stance on the matter. Historically, he has toed the party line in opposition to full expansion but in a recent interview with Fox 5 Atlanta, Walker said, "I believe everyone should be given what we promised to give them."

Where that puts Walker on the matter remains ambiguous.

Medicaid expansion explained

While knowing who stands where on health care reform helps at the polls, for many voters the question still remains – what does Medicaid expansion mean?

Where Medicaid funding comes from, and how it impacts taxpayers' wallets, has been an emphasis across both parties when discussing the proposed expansion. Medicaid is jointly funded by both state and federal governments. The amount of federal funding a state receives for Medicaid is dependent on the state's average income. States with a higher average income, such as Connecticut or Massachusetts, receive less federal funding than states with a lower average income, like Alabama or Mississippi.

This funding ranges from 50% to 80%, known as the Federal Matching Assistance Percentage (FMAP). In Georgia, the FMAP is 66.2 %.

Should Georgia pursue full Medicaid expansion under the ACA, the funding formula would remain the same. The only change would be an increase in overall Medicaid spending as more people qualify.

Rudiments of Medicaid funding aside, the primary question voters have is, Who will be eligible under which expansion plan? Angie Snyder, the director of health and health care financing at Georgia State University, explained the basics of what eligibility in Georgia looks like now, what it will look like should partial expansion be implemented and how that compares to full Medicaid expansion.

"Low income children, pregnant women, the disabled, and elderly [are eligible for Medicaid]," said Snyder. "It is not enough in Georgia to simply be low income. You have to be low income and something else. There is also some coverage for parents of children who qualify for Medicaid but the income qualification is so low, that most cannot qualify.

"In general, childless adults who aren't disabled do not qualify for Medicaid in Georgia no matter how poor they are."

Current eligibility and income requirements can be found on Georgia's Medicaid website.

In comparison, should Kemp secure a second term and push through a partial expansion, approximately 50,000 more people would qualify for Medicaid. However, eligibility requirements are even more rigid than current Medicaid qualifications. Under the new proposed partial expansion, those eligible must be at or below 100% of the federal poverty level (FPL) and must complete 80 hours of work, job training, education or other qualifying activity monthly.

The projected cost of partial expansion was $120 million. Of that sum, $36 million would come from the state with a 67% match from the federal government.

While partial expansion would gain coverage for a substantial group of people, full Medicaid expansion touts coverage for an additional half-million Georgians. Coverage would expand to previously ineligible non-elderly adults with incomes up to 133% of the FPL.

According to a study from the left-leaning Georgia Budget and Policy Institute, full expansion would cost an estimated $336 million for two years with a 90% federal contribution.

Both proposed plans for Medicaid expansion would broaden health care coverage across the state.