Georgia Gov. Brian Kemp (R) proposed a limited form of Medicaid expansion that would offer coverage to some low-income adults who work, volunteer or go to job training 80 hours a month.
The proposal stops short of the full-scale Medicaid expansion supported by Democrats, which would cover thousands more low-income adults regardless of their employment status.
Kemp’s proposal, called Georgia Pathways, would cover adults who meet the work requirements and who are at or under 100 percent of the federal poverty level — about $12,490 a year for an individual.
“Unlike Medicaid expansion, which will literally cost billions of dollars, Georgia Pathways will not bankrupt our state or raise taxes on our families or our businesses,” Kemp said at an event Monday morning.
Dozens of states have expanded Medicaid under ObamaCare to cover adults making less than 138 percent of the federal poverty level — about $17,236 for an individual.
Georgia lawmakers have resisted a full-fledged Medicaid expansion for years, arguing it would cost the state too much money. The federal government picks up 90 percent of the costs, while states pay the rest.
Kemp sees his plan as a compromise that would help reduce the state’s high uninsured rate — about 1.38 million people lack insurance in the state.
But it’s not clear if the plan will receive the required approval from the Trump administration.
The Department of Health and Human Services rejected a similar proposal from Utah in August, telling state officials it would only pay for 90 percent of the program if it were a full expansion of Medicaid.
By that point, the Georgia legislature had already passed a bill directing state health officials to submit the proposal to the Trump administration.
And while the administration has approved state’s requests for Medicaid work requirements, they have been blocked in federal court.
Kemp ran a competitive race for governor last year largely focused on health care against Stacey Abrams, who supports a full Medicaid expansion. He campaigned against a full expansion but vowed to improve health care access.
In states that haven’t expanded Medicaid, including Georgia, millions of people have fallen into a gap where they make too much to qualify for traditional Medicaid but are too poor to qualify for ObamaCare’s insurance subsidies. That gap was created when the Supreme Court blocked the provision of ObamaCare that required states to expand Medicaid to more low-income adults.
Thirty-six states and D.C. eventually opted to accept expansion, but the remaining states refused, eschewing anything to do with ObamaCare. As a result, more than 2 million people fall in that coverage gap, according to the Kaiser Family Foundation.
Kemp’s plan could reduce that gap, but only for people who meet the work requirements. Kemp’s office estimates that of the 408,000 Georgians eligible for Medicaid under the expansion, only 52,000 people will be enrolled in the program after being in effect for five years.
Arkansas is the only state where work requirements were in effect before being blocked in the courts, and evidence there suggests beneficiaries had trouble complying with the reporting requirements.
People might also be deterred from enrolling because of the required premiums, said Eliot Fishman, a Medicaid expert at Families USA.
"The proposal incorporates work requirements, premiums and a variety of barriers to actually getting people covered. It's going to limit the number of people who can benefit from this," he said.
In Kemp's remarks Monday, he put an emphasis on people who work but still cannot afford health insurance, an attempt to ease the concerns of conservatives who see any form of Medicaid expansion as a handout.
“This is not a free handout,” Kemp said.
“Hard-working Georgians who qualify will have skin in the game,” he said, noting that they will still pay a monthly premium based on their income.
That money will then be used for other health care premiums, including prescription drugs, eyeglasses or gym memberships.
The plan would also allow people who qualify to keep their employer-sponsored health insurance, with the state paying the premiums.
“Right now in Georgia there are hundreds of thousands of Georgians working, training or volunteering and they can’t afford needed coverage but have run out of realistic options,” he said.
“We will bring hope to what many think is a hopeless situation.”
Kemp unveiled another health care plan Friday that would allow Georgians to use ObamaCare subsidies for short-term and association health plans that tend to be cheaper than ObamaCare but cover fewer benefits. That plan also needs approval from the Trump administration.
—Updated at 3:36 pm.