ATLANTA — Starting Saturday, Georgia will offer some adults without health insurance a new discount that the state will cover if they go to work or school.
Proponents, however, accuse the plan of covering far fewer people than the full expansion of federal Medicaid programs and being unnecessarily restrictive and costly.
The program is likely to draw attention as Republicans in Congress push for states to require some current Medicaid participants to work. Georgia will be the only state to require Medicaid recipients to meet employment requirements.
Madeline Gass, a senior policy analyst at KFF, a nonprofit that studies health issues, said it was unlikely that Democratic Joe Biden administration would approve the labor requirements, but a future Republican president could. Stated.
“Georgia will get a lot of attention,” Gass said.
Georgia has not extended Medicaid eligibility to individuals and families up to 138% of the federal poverty line, or $20,120 a year for a single person and $41,400 a year for a family of four. one of the states.
Expanding Medicaid was a key part of President Barack Obama’s health care reforms in 2010, but has been opposed by many Republicans in Congress, including Republican Governor Brian Kemp of Georgia.
Instead, Kemp limits the expansion to adults earning up to 100% of the poverty line ($14,580 for a single person and $30,000 for a family of four). Also, coverage is only available to able-bodied adults who prove they work 80 hours a month, volunteer, study, or undergo vocational rehabilitation.
This fits with Mr. Kemp’s argument that the Republican Party needs to show the public tangible conservative results, trying to separate the party from former President Donald Trump.
“In our state, we want more options for patients and more people to have insurance coverage at a lower cost,” Kemp said in a State of the Union address in January. .
Those earning more are eligible for subsidized coverage in the federal market, often with no premium. The Kemp administration argues that commercial insurance is better because it pays health care providers higher rates than state Medicaid rates.
The Trump administration eventually gave 13 states permission to require work for some Medicaid recipients. The Biden administration will rescind all these waivers in 2021, and adjudication work is not the primary purpose of Medicaid. But the Kemp administration won a federal court battle to keep Georgia’s plan last year, in part because it applies to new Medicaid recipients, not current Medicaid recipients. That was it.
Community Health Commissioner Kayleigh Nogle told the Associated Press this week that Pathways to Coverage is a “unique Georgia approach” that could cover up to 100,000 people in its first year.
But that 100,000 figure is far less than the approximately 450,000 uninsured Georgians who the Urban Institute estimates could be covered under full Medicaid expansion.
Some say about $118 million in state funding and $229 million in federal funding is not enough to cover 100,000 people. The liberal-leaning Georgia Institute for Budget Policy estimates that the fund could cover fewer than 50,000 people.
And state taxpayers pay much more per person. At the request of Democratic Georgia Senator Raphael Warnock, the federal government is proposing to pay 95% for full Medicaid expansion for two years and 90% thereafter. In exchange, Georgia will reject large federal spending, continue to pay 34.2% of state contributions to existing Medicaid programs, and reject additional federal funding that has been promised.
In a statement to the Associated Press, Warnock said, “The mislabeled ‘Road to Coverage’ will cost more and cover more coverage than if Georgia joined the other 40 states to expand Medicaid. “There will be fewer people,” he said.
“Georgians are dying because they can’t afford the medical care they need, while state politicians continue to play the game with their people’s lives,” he said.
Noggle and other Georgia officials say work, study and volunteerism lead to better health and are an important argument for why these requirements should be part of the health insurance program.
But those treating the uninsured say many are unable to work due to poor health.
“They’re having challenges not being able to work because they have a mental illness or have a medical condition that’s impacting their ability to work,” says the addiction lead. Dr. Pitre said: A psychiatrist and interim chief medical officer of Mercy Care, a federally-funded nonprofit in Atlanta.
Pitre said enrolling people in the new program was a priority for MercyCare, but no one could qualify until a month after establishing compliance with labor requirements. pointed out.
The Kemp administration hopes the program will help not only students, but also those in low-paying jobs that are not covered by employment insurance. The state is also requalifying the 2.4 million adults and children currently covered by Medicaid.
Georgia is delaying decisions on people who aren’t eligible for regular Medicaid but may be transitioned to the Pathway program, Noggle said.
Either way, when you join a new program, you must meet activity requirements or you will lose coverage starting the next month, potentially affecting thousands. When Arkansas mandated work for some adults in 2018, more than 18,000 people lost their insurance in less than a year.
Georgia would be different, argued Noggle. The recipient only needs to prove compliance with the activity requirements during his first six months of the year.
“We want to make it as easy as possible for members to verify their eligibility,” she said.
But time will tell. Mr. Kemp’s plan to expand his business in Georgia could serve as a blueprint for other states and Republicans considering more demands for Medicaid recipients.
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This article was revised to reflect that Medicaid recipients must prove six months of work requirement instead of three, and that the name of the medical nonprofit is KFF, not Kaiser Family Foundation. has been updated to
