Republican majorities block efforts to expand Medicaid in Georgia and Kansas

ATLANTA – Plans to expand Medicaid coverage to over half a million more people in Georgia and Kansas were defeated by Republican-led committees in the states’ legislatures Thursday.

There are currently only 10 states that don’t cover people with incomes up to 138% of the federal poverty line, after North Carolina began offering Medicaid to uninsured adults last December.

In Georgia, Democratic Sen. David Lucas of Macon argued that lawmakers from both parties 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 anymore. $1.2 billion is in D.C., waiting for Georgia to expand. But how long will it be there?” Lucas asked the committee.

More than 430,000 uninsured Georgia adults and 150,000 Kansans could gain coverage if Medicaid is broadened, health research group KFF has projected.

Kansas’ Democratic Gov. Laura Kelly had expected federal funds and bonus dollars to cover the $715 million cost of expanding Medicaid, wipe out the state’s costs and even cover an additional $62 million in other social services spending.

But Republicans, skeptical of the governor’s projections and medical providers’ ability to take on thousands of new Medicaid patients, wouldn’t move the bill out of the health committee to the full House. The only yes votes on the 17-member committee came from its five Democrats.

Democrats in Georgia claimed Republican leaders in the state’s GOP-controlled legislature had gone back on their promise to advance the Medicaid expansion bill in the Senate. The bill called for the state to buy private health insurance for uncovered, lower income adults. Private insurance could result in higher payments to medical providers than under Georgia’s existing Medicaid plan.

The Georgia Senate’s Regulated Industries and Utilities Committee rejected the plan on a 7-7 vote; two Republicans and five Democrats voted to advance it.

Republicans’ rejection of Medicaid expansion has its roots in their opposition to Democratic President Barack Obama’s signature Affordable Care Act, which has the federal government covering 90% of the cost. Some conservatives also are wary of what they see as a major expansion of government.

“I do look at this as Medicaid expansion being socialized medicine and, you know, the United States of America is not a socialist country,” said Kansas Rep. Carrie Barth.

In Georgia, one key issue is Republican Gov. Brian Kemp’s existing Pathways plan, which offers coverage to adults earning up to the poverty line. 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,” Republican Sen. Ben Watson, a Savannah physician, told the state Senate committee. “I think we need to let it mature a little bit.”

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

Hopes for Medicaid expansion in Georgia multiplied this year after Republican House Speaker Jon Burns said he wanted to explore the idea. Legislation never advanced and Burns instead opted for a study committee to meet over the next year.

Georgia’s 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.

The governor’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 proposed new plan, which would have required special federal approval, wouldn’t have started until Pathways ended.

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. However, Democratic Minority Leader Gloria Butler of Stone Mountain said that support was conditioned on Medicaid expansion talks.

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Hanna reported from Topeka, Kansas.