For Republican lawmakers in Georgia, Medicaid expansion could still be a risky vote

The prospect — albeit still dim — that Georgia could absolutely increase Medicaid has prompted Democrats and affected person advocates to show up the strain on Republicans in the state legislature to behave.

But political specialists, advocates and coverage analysts say GOP lawmakers face vital headwinds to approving a plan they’ve lengthy derided as wasteful, and that could finally doom the trouble.

“There’s reason to be a little more optimistic than one year or two years ago, but there’s not a groundswell of support and willingness to change the status quo on the part of the Republican members of the legislature,” mentioned Harry Heiman, a well being coverage professor at Georgia State University.

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The largest impediment is Georgia Pathways, the state’s restricted Medicaid expansion that features the nation’s solely work requirement for Medicaid recipients, mentioned Laura Colbert, govt director of the advocacy group Georgians for a Healthy Future.

Republican Georgia Gov. Brian Kemp has championed this system, which launched in July. Though it’s off to a rocky begin, with just below 2,350 folks enrolled as of mid-December, the Kemp administration has sought to increase it previous its September 2025 expiration date.

“Governor Kemp has put a lot of political capital into Pathways,” Colbert mentioned.

Colbert mentioned she was optimistic that Georgia lawmakers would ultimately approve a fuller expansion of protection for low-income adults, however not essentially this yr.

Georgia Gov. Kemp is seen right here leaving the House chamber after delivering his State of the State speech in Atlanta, Jan. 11, 2024.  (AP Photo/Brynn Anderson)

Kyle Wingfield, president of the conservative Georgia Public Policy Foundation, mentioned he, too, was skeptical Kemp would be prepared to retreat from Pathways.

He additionally warned that Republican lawmakers could face backlash for any Medicaid deal from Republican major voters.

Expanding Medicaid to low-income adults who make as much as 138% of the federal poverty stage, with the federal authorities selecting up 90% of the fee, was a key a part of the Affordable Care Act. Georgia is amongst 10 states that haven’t finished it.

Wingfield mentioned he thinks Republicans in Washington, and to a lesser extent in Georgia, have accepted that the Affordable Care Act is right here to remain, however that acceptance might not be shared by rank-and-file GOP major voters.

“When it comes to the voters in a Republican primary, I don’t think I’d want to be the one finding that out,” he mentioned.

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But Brian Robinson, a Republican political advisor who counts the Georgia Alliance of Community Hospitals and House GOP caucus amongst his shoppers, says he thinks Republicans face little threat from major opponents in the event that they vote for Medicaid.

“The political issue of the danger has faded over the time,” Robinson mentioned. “We’ve had some mini-expansions in Georgia and there’s been no blowback on Republicans. In fact they’ve proudly touted it for groups like new mothers.”

Republicans in Georgia additionally threat alienating the conservative group Americans for Prosperity with a vote to increase Medicaid protection.

The group is against expansion, at the same time as a part of a deal that will repeal allowing necessities for hospitals and well being providers, mentioned Tony West, the group’s Georgia State Director. That kind of deal has emerged as a attainable compromise between Republicans and Democrats.

West needs lawmakers to focus solely on repealing the allowing necessities and go away Medicaid expansion by the wayside.

“I think we’re taking our eye off the ball,” he mentioned.

Conversely, Wingfield raised the likelihood that some Democrats could balk at a deal, noting that Medicaid expansion has been a key political problem for the social gathering in Georgia.

“What do they gain from taking one of their signature issues off the table and letting the Republicans claim a large share of the credit for it?” he requested.

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At least for now, Democrats in the General Assembly do not seem involved about dropping their means to hammer the GOP on Medicaid. The Democratic caucus organized a prolonged listening to Wednesday centered on the financial and well being advantages of expansion that featured well being care suppliers, advocates and coverage specialists.

In opening remarks, Democratic state Rep. Michelle Au, a physician, famous Georgia had one of many highest charges of uninsured residents in the nation and a few of its worst well being outcomes.

“As we start this 2024 legislative session, it is my hope that all options are on the table,” she mentioned.