Adopting Full Medicaid Expansion in Georgia

As one of ten states that have not adopted full Medicaid expansion, Georgia leads as one of the country’s top states for uninsured rates. While the uninsured rate in Georgia has seen a downward trend over time, the trend has been too slow to account for the critical necessity for immediate action.[1] Today, 1.2 million non-elderly Georgians are still without medical insurance coverage, making healthcare unaffordable and inaccessible to nearly 12% of the Georgia population.[2] Despite nationwide efforts to expand Medicaid to cover those who fall below 138% of the poverty line, policymakers have missed the mark in constructing a bipartisan agreement that will ensure the best interest and basic needs of Georgia residents are adequately met.[3] Failing to adopt the full Medicaid expansion that other states have already adopted will continue to erode Georgia’s public health and quality of life by failing to meet the basic needs of residents.

The Affordable Care Act’s Medical expansion sought to expand Medicaid to all adults earning 138% of the federal poverty line.[4] Instead of adopting the expansion, Governor Kemp and other Georgia Republicans instead proposed a Pathway to Coverage plan.[5] This waiver was initially approved by the Trump administration in 2019 but was later denied by the Biden administration.[6] However, in 2022, a federal district judge issued a decision that led to the reinstallation of the program. The plan requires that able-bodied Georgia residents prove 80 hours of work, community service, vocational rehabilitation, or school work a month in order to maintain coverage. The plan initially hoped to have 100,000 Georgia residents enrolled by the end of the first year; however, this has not seen fruition.[Ibid]

State democrats have voiced concerns and disapproval of the plan, claiming that it is too restrictive to help all who need it and too slow to implement for those it will aid. While the plan hoped to enroll 100,000 residents in its first year, by October, it had only covered 1,300 low income adults.[7] This has been a major point of contention for Georgia policymakers. Experts are concerned that those who cannot afford health care currently will not be able to engage in the activities needed to qualify for Medicaid, thus creating an ongoing cycle that excludes large groups of low-income residents.[Ibid] Additionally, it is estimated that it will take sixteen years to cover 90,000 people, a measly fraction of the population that is in need today.[Ibid] The slow enrollment continues to prove far less successful than the full expansion adopted by 49 other states, leading to an ongoing public health crisis in Georgia that disproportionately impacts minority groups. 

The solution to this issue is straightforward and has already been established by 49 other states. Georgia must adopt the full Medicaid expansion, including the Affordable Care Act’s (ACA) Medicaid expansion. Adopting this package will not only extend necessary health care to a significantly larger portion of Georgia’s population than the Pathway to Coverage waiver will ever be able to even at its peak, but it will do so more efficiently and at a more affordable cost. The ACA’s Medicaid expansion has not only provided coverage to adults with incomes up to 138% of the Federal Poverty Level ($20,120 for an individual in 2023), but it has also provided states with an enhanced federal matching rate (FMAP) for their expansion populations.[8] 21 million people across the United States have received medical coverage since their states adopted the Medicaid expansion. Across the country, states have seen tremendous results in expanding their healthcare services.[Ibid] The most efficient and humane solution to solve such an outdated issue, that is, the lack of medical coverage for Georgia residents, is to adopt the expansion.