This story was updated on Tuesday, Jan. 28, 2025, at 7:18 p.m.
Democrats in the state legislature are making another attempt this session to extend health insurance to more Georgians under Medicaid coverage — and this time, four Republicans have already signed on, despite Gov. Brian Kemp making clear he does not back full Medicaid expansion.
“We believe that this bipartisan legislation can get passed,” Senate Minority Leader Harold Jones told reporters at a Tuesday press conference.
Georgia is one of just 10 states that have not fully expanded Medicaid under the Affordable Care Act. The PeachCare Plus Act would expand Medicaid to cover hundreds of thousands of Georgians.
But unlike other states that have fully expanded Medicaid under the Affordable Care Act to cover low-income people who earn up to 138% of the federal poverty line of $25,820 for a family of three, Georgia’s bill would do something different.
Using a mix of state and federal funds, Georgia would enroll patients into plans purchased on the private insurance market. Arkansas is the only other state with a similar model, and it has drawn interest from some Georgia Republicans.
“This is the first bill by Republican cosponsors that would also fully close Georgia’s coverage gap,” says Laura Colbert, who directs the group Georgians for a Healthy Future.
While Colbert’s organization supports traditional Medicaid expansion, which she maintains would be cheaper for Georgia taxpayers, she says PeachCare Plus would cover many more people than Georgia Pathways.
Kemp remains committed to his own more limited program
Pathways is the state’s Medicaid program for adults earning up to 100% of the federal poverty level who document 80 hours per month of work, training, volunteering or other activities, and otherwise wouldn’t qualify for Medicaid in Georgia.
So far, Pathways sign ups have been sluggish. By the end of 2024, fewer than six thousand Georgians had enrolled in the program — far fewer than state officials’ initial projections.
“The hurdles to enroll and stay enrolled in the program are too large to be realistic. And frankly, the state has spent a lot of money on this program,” Colbert says. “I don’t want our state to be throwing good money after bad. And I think the bill that’s been proposed today would be a much better use of our public resources, frankly.”
Pathways has cost taxpayers more than $40 million in state and federal funds, with most of the money going toward program costs rather than health care, according to a recent report from nonpartisan health news, policy and research group KFF.
The governor has also called for further extending Pathways eligibility to low-income parents and legal guardians of children up to age 6. The proposed additional eligibility would need approval from the Trump administration. Without federal action, Pathways is set to expire Sept. 30, 2025.
“Increasing access to quality, affordable health care for every Georgian, regardless of zip code, has been, and will continue to be, a top priority for the Georgia House,” House Speaker Jon Burns said earlier this month.
Kemp says he is committed to growing Pathways and has reiterated that he will not support fully expanding Medicaid.
Democrats press ahead, despite opposition from Kemp
So why are General Assembly Democrats and some Republicans still pursuing the seemingly quixotic effort to expand Medicaid this session?
Jones, the Senate minority leader, says it was a watershed moment when a proposal similar to PeachCare Plus fell just short of advancing out of committee last year with some GOP support.
“We came so close last year and that gives you the momentum, and we didn’t want to lose that,” Jones says.
Georgia has the third-highest uninsured rate in the United States, according to the Georgia Health Initiative.
Natalie Crawford, executive director and founder of the group Georgia First, estimates the PeachCare Plus Act could cover nearly 300,000 uninsured Georgians.
And she says more state lawmakers are seeing the effects of Georgia’s insurance gaps on rural hospitals, which are struggling to stay afloat.
“We’ve seen nine hospitals permanently close in Georgia,” she says. “We have 18 more that are at risk. And, rural communities in particular are disproportionately affected by the lack of expansion because oftentimes — and I saw this firsthand in my own community when I was a county commissioner — that rural payer mix is a lot less diverse. It is oftentimes very high in Medicare, Medicaid, self-pay and indigent.”
Crawford is among those at the Capitol pushing this year for Georgia to take advantage of the millions of dollars in federal matching funds that come with full Medicaid expansion.
“We know that the 40 other states and the District of Columbia who have expanded Medicaid have seen huge economic gains, increased employment, and support for rural hospitals and providers,” she said in a statement. “The bottom line is that instead of paying full freight, we should be fully leveraging and maximizing the federal dollars available to us instead of helping subsidize care in other states.”
Officials with Kemp’s office have disputed that the benefits would outweigh the state’s costs for a full expansion.
Sen. Russ Goodman, like other GOP cosponsors of the new bill, represents a rural district. He says the one near his farm proved critical when his son nearly got electrocuted after lightning struck the house.
“If that rural hospital hadn’t been there, I don’t know that my son would be here today,” Goodman told WABE. “It’s something I think about often when we have these discussions.”
Goodman says he wants to have the debate about Medicaid expansion, even though he’s not sure he would ultimately vote yes on the bill he sponsored and despite the reality that the governor is not in favor.
“I probably agree with my wife 80% of the time and I sleep in bed with her,” Goodman says. “And I probably agree with Brian Kemp 95% of the time. I may very well vote against it on the floor; I just want to have the debate.”
Jones says the Democratic caucus, however, would not be interested in reaching an agreement on Medicaid expansion by cutting a deal on one of Kemp’s top priorities, tort reform.
“These are separate issues and I think they should be treated separately, and that’s how we are going to be approaching this at this particular point in time,” Jones says.
Democrats like House Minority Leader Carolyn Hugley hope they can convince enough Republicans to come along.
“Under the gold dome, a ‘no,’ might mean, ‘not now,’” Hugley says. “And windows are never really closed.”
But that window may not really swing open again until Kemp has left the building.
A previous version of this article made a minor transcription error in a quote from Laura Colbert. It has been corrected.