Georgia Republicans reject Democrats' final push for Medicaid expansion

Georgia state Sen. David Lucas, D-Macon, presents a bill to expand Medicaid health insurance on Thursday, March 21, 2024 at the Georgia Capitol in Atlanta. The Senate Regulated Industries and Utilities Committee rejected the bill on a 7-7 tie vote (AP Photo/Jeff Amy)

Georgia Republicans shot down a last-ditch attempt by Democrats to expand Medicaid on Thursday in a state Senate committee, frustrating Democrats who say GOP leaders broke a promise to advance the bill.

The Senate Regulated Industries and Utilities Committee rejected the plan on a tie 7-7 vote, after two Republicans and five Democrats voted to advance a plan. The bill called for the state to buy private health insurance for lower income adults who aren’t covered. Private insurance could result in higher payments to medical providers than under Georgia’s existing Medicaid plan.

The measure was presented by Democratic Sen. David Lucas of Macon, who argued Republicans and Democrats should grab federal bonus money that would pay for the first two years of extending coverage.

“We can’t kick the can down the road any more. $1.2 billion is in D.C., waiting for Georgia to expand. But how long will it be there?” Lucas asked the committee.

Republican Sen. Ben Watson, a Savannah physician, argued that Gov. Brian Kemp’s Pathways plan, which offers coverage to adults earning up to the poverty line, might still work. To be eligible, people must document 80 monthly hours of work, study, rehabilitation or volunteering. But only about 3,500 people have signed up since the plan took effect in July, far fewer than the 100,000 that the Kemp administration projected.

“I think we need to give this a little more time,” Watson told the committee. “I think we need to let it mature a little bit.”

Watson isn’t normally a member of the panel, but was added specially for the meeting by Republican leaders, providing the deciding “no” vote. Other Republicans said they were concerned about the price tag, which Lucas estimated at $580 million a year, as well as other details.

Hopes for Medicaid expansion multiplied this year after Republican House Speaker Jon Burns of Newington said he wanted to explore the idea. But legislation never advanced in the House, with Burns instead opting for a study committee to meet over the next year.

The governor hasn’t outright said he would veto a broader expansion, but has repeatedly said he was focused on Pathways. It covers adults earning up to the poverty line — $15,060 for an individual. Lucas’ plan would have covered people up to 138% of the poverty line, or $20,782.

Kemp’s decision to sue the federal government to try to extend the program’s life was widely seen as a sign that he opposed an expansion of health care coverage. Pathways would expire in 2025, but Kemp sued to extend it to 2028. The bill proposed Thursday said the new plan, which would have required special federal approval, said the new plan wouldn’t have started until Pathways ended.

After North Carolina began offering Medicaid to uninsured adults on Dec. 1, there are 10 remaining states that don’t cover people with incomes up to 138% of the federal poverty line. More than 430,000 uninsured Georgia adults could gain coverage if Medicaid is broadened, health research group KFF has projected.

As in North Carolina, Georgia Democrats have tried to link Medicaid expansion with discussions over reducing the requirements for health care permits, known as certificates of need. Some Democrats voted for a Senate version of the bill, which would reduce permit requirements more than the House had proposed. But Democratic Minority Leader Gloria Butler of Stone Mountain said that support was conditioned on Medicaid expansion talks.

Butler said after the meeting that she believed Republicans had promised to advance the bill out of the committee and vote it out of the Senate in the last two days of the 2024 session in exchange for Democratic support to lessen certificate of need rules.

“I said we would not vote for CON if we didn’t get Medicaid expansion,” Butler said.

Senate Regulated Industries Committee Chair Bill Cowsert, though, said he only promised a vote in committee, and suggested Republicans might be more willing to change policy next year if more people don’t sign up for Pathways.

“My feeling is we need to support our governor and his approach and let’s give it a chance to work,” said Cowsert, an Athens Republican. “If it fails, then we’ll be back in here next year talking about other alternatives.”