ATLANTA -- Republican leadership in the Georgia House is stating its case: Medicaid expansion is such a pricey idea that any decision to do so cant be left to the executive branch alone.
Right now, the governor, via the Department of Community Health board, can make more people Medicaid-eligible by raising the income cap that a person can earn and still qualify.
But House Bill 990 says no way -- not unless Georgias legislators say so first.
We felt, and the governor felt, like this should be a joint effort ... to make such a step with taxpayer money, said GOP House Majority Leader Larry ONeal of Bonaire. Hes one of the sponsors of the bill, which will be assigned to a committee this week.
Medicaid is a health coverage program for low-income people of any age. Its funded jointly by federal and state governments. In Georgia, Medicaid could get somewhere between 500,000 and 620,000 new customers if it were expanded to cover people at or below 138 percent of the federal poverty level, or about $27,000 for a family of three.
Not that Gov. Nathan Deal has shown any sign of pushing for a Medicaid expansion. He has frequently said its too expensive, probably $4.5 billion over the next 10 years.
Its not a matter of being cruel or insensitive. Its a matter of being able to pay for it, said ONeal. It has been a rising expense, and we have to budget prospectively.
This year, some bump in Medicaid sign-ups is expected anyway, said ONeal, as people who have been eligible but just never signed up now have to get some insurance or pay a penalty under the federal Affordable Care Act.
About 16 percent of Georgias low-income Medicaid-eligible population is not signed up. To pay for those who are, Deal is recommending about $3.8 billion in spending next fiscal year, up from $3.2 billion spent in 2012.
Even if it is not enacted, the new House measure is a clear statement against expansion in an election year for all 236 lawmakers and the governor. And it may represent a bit of closing ranks amid frustration with health care costs, complexities and criticism.
Still, not everyone is happy with whats happening on the Medicaid front in Georgia.
Right now, The Medical Center of Central Georgia recoups about 82 percent of the costs it incurs to treat Medicaid patients.
Yet, we would very much want to see Medicaid expanded in Georgia, H. Bryan Forlines said in a written statement. Hes assistant vice president for government relations and reimbursement at Central Georgia Health System, the Medical Centers parent company.
Though hospitals lose money on Medicaid patients, they lose even more on patients who have no insurance at all and little means to pay.
As part of health care reform, the hospital industry agreed to major reductions in payments they were receiving to treat the uninsured with the understanding many of those patients would become eligible for Medicaid, Forlines said.
Over 10 years, the Medical Center expects those uncompensated care payment reductions to cost about $113 million. If Medicaid had been expanded, they expected to recoup about $109 million.
We understand the governors position, but those payment reductions are happening whether the state expands Medicaid or not, Forlines said.
Flawed and unsustainable
The states biggest doctors association is also unhappy with Medicaid in Georgia in several ways.
Medicaid reimbursement rates are not increasing even to match inflation, Medical Association of Georgia President William Silver said in a written statement, and administrative burdens are growing.
The Medicaid program in the state is flawed and unsustainable and, change notwithstanding, thats going to be the case whether the state expands the program by hundreds of thousands of new patients or not, Silver wrote.
If theres a Medicaid expansion, though, its not clear which doctors might take such patients. According to the medical association, Georgias low reimbursement leads to fewer providers accepting Medicaid patients.
A 2013 state Senate study committee report on Medicaid said that the program has evolved into a mess that is unnecessarily complicated, encumbered by a large bureaucracy (and) ... as currently structured is not affordable and sustainable in Georgia.
The report blames several things. Among them: federal government inflexibility; Georgias administration of the program; fraud, waste and abuse; and a lack of attention to wellness.
And some people argue that expanding Medicaid is not nearly as pricey as Deal has said.
Its clear that expansion is good for Georgia, said Timothy Sweeney, director of health policy for the Georgia Budget and Policy Institute, an Atlanta-based nonprofit.
Some $40.5 billion additional federal Medicaid funds would flow to Georgia from 2014 through 2023 if the program were expanded to families at 138 percent of the poverty line or lower, according to the Healthcare Georgia Foundation, a grant-making body that advocates expanded health care availability and quality.
That could also create thousands of jobs, the report said.
Against that, Sweeney put the expansion-specific cost to Georgia at some $2 billion over 10 years.
We cant afford not to expand, said Sweeney, in part because without expansion, Georgia will have one of the largest uninsured populations in the country.
Total state revenues in the last few years have totaled from $18 billion to $20 billion.
Silver said the medical association would support legislation that would enable the state to use federal funds to expand the Medicaid program to help Georgians who are at or below 138 percent of the federal poverty level obtain private insurance.