Case Study 4-2

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1 Should Georgia expand Medicaid? Bethel Tewabe University of Iowa HHP:4040: Health Services Dr. Gayle Walter 02/11/2023

2 Should Georgia Expand Medicaid? The topic of Medicaid expansion has been a controversial one since the Affordable Care Act went into place. The majority of states have opted into the expansion while 12 have not, Georgia being one of them. Here within the state of Georgia, there are many reasons why the expansion of Medicaid has not been implemented yet. The first and largest is the rising cost of doing so. The initial promised federal assistance was 100% reimbursement according to Georgia Center For Opportunity. Since its establishment, it has since decreased steadily to about 90% reimbursement which has caused expansion-participating states to shell out 95.2% more of state funds between the years 2010 and 2018. If this trend were to continue, long-term costs are predicted to be vast. Another negative to the expansion of Medicaid would be the idea that those covered under Medicaid would become “trapped”, or would have no reason, in the welfare system. Randolph questions, if a person is given exactly what is needed while doing the bare minimum, say a minimum wage job, what is there to encourage them to strive for better, or strive to get out of welfare? This directly leads to the political ideologies of this state. Georgia is a predominantly republican state where the belief around welfare and government assistance is that it makes individuals lazy and dependent on the government and discourages self-reliance and responsibility. Three major tangible pros of the expansion of Medicaid in other states were that doing so would assist low-income families, and individuals, with their financial well-being as well as improve overall and long-term health. Improving the long-term health of many individuals within a community would overall benefit the community as a whole because the quality of life would increase, financial stress and medical expense stress would decrease and productivity

3 levels would increase. The expansion of Medicaid also reduces hospitals’ uncompensated care. In the emergency room, a person receives care whether insured or not spa lot of this care and supplies and work are going uncompensated because individuals are unable to pay the ridiculous amount of money back. Expanding would greatly reduce this amount of money which in turn would save the state a lot of money. There would also be many spillover financial benefits in many other categories as well. According to the Common Wealth Fund, expansion-participating states saw savings in mental health and substance abuse health care and corrections. Costs of almost anything are on the rise, and these states spending on corrections increased by 4% compared to non-expansive states which increased by 10%. Currently, ¾ of adults in Georgia are living at or below the poverty line due to not meeting eligibility requirements and 452,600 non-elderly individuals, roughly 39% would be covered if Georgia were to expand. Over the next two years, the expansion would cost $336 million however Georgia would receive between $1.4-1.9 billion within those same two years for the expansion. The state legislature has denied the expansion in the past creating a whole new reform called Georgia Pathways. Georgia Pathways is essentially the same concept except it covers about 38% fewer people and requires a report of at least 80 hours of work each month and individuals making above the 50% FPL would have to pay premiums. Georgia receives no federal assistance with this partial-Medicaid expansion so it is very difficult for citizens within the state to understand this course of action. My recommendation would be to fully expand Medicaid. Not only would it assist many individuals, families, and children but it would benefit the economy and the state as well. There are large benefits to the expansion that has countless spillover benefits in many different aspects as well. Primarily within rural areas, where Georgia has seen nine hospitals close and 19 more

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4 are at risk. Furthermore, for the state of Georgia specifically, expanding Medicaid would create jobs, 64,000 to be exact. These jobs would be within healthcare, construction, retail finance insurance, and many more. I do believe the expansion is feasible within the state and the major thing holding back the decision to do so is the enforced republican ideologies and beliefs and how they focus on the possible disadvantages of the expansion, individuals becoming lazy, etc., instead of the real tangle and long term benefits it would bring all citizens and the state as a unit.

5 References Buchmueller, Thomas C. “The Benefits of Medicaid Expansion.” JAMA Health Forum , JAMA Network, 15 July 2020, https://jamanetwork.com/journals/jama-health-forum/fullarticle/2768596. Camp, Lauren. “Advisory: Republican Meeting: ‘Building on Welfare Reform's Success in Lifting Americans out of Poverty - Rather than Move Backward.’” House Committee on Ways and Means , Ways and Means, 15 July 2021, https://waysandmeans.house.gov/advisory-republican-meeting-building-on-welfare- reforms-success-in-lifting-americans-out-of-poverty-rather-than-move-backward/. Flugrath, Max. “Kemp Doubles down on Opposition to Medicaid Expansion as Another Georgia Hospital Closes.” Democratic Party of Georgia , Georgia Democrats, 6 Sept. 2022, https://www.georgiademocrat.org/kemp-doubles-down-on-opposition-to-medicaid- expansion-as-another-georgia-hospital-closes/. Gringlas | WABE, Sam. “Georgia Still Hasn't Expanded Medicaid. Politicians Offer Competing Narratives Why.” WABE , 18 Jan. 2022, https://www.wabe.org/georgia-still-hasnt- expanded-medicaid-politicians-offer-competing-narratives-why/. Harker, Laura. Medicaid Is Now an Even Better Deal for Georgia . Georgia Budget and Policy Institute, 18 Mar. 2021, https://gbpi.org/medicaid-is-now-an-even-better-deal-for-georgia/. Norruis, Louise. “ACA Medicaid Expansion in Georgia [Updated 2022 Guide].” Healthinsurance.org , Healthinsurance.org, 30 Jan. 2023, https://www.healthinsurance.org/medicaid/georgia/. Randolph, Erik. “Three Reasons Why Medicaid Expansion Is Bad for Georgia.” Georgia Center For Opportunity , Georgia Center For Oppurtunity, 1 Feb. 2021, https://foropportunity.org/three-reasons-why-medicaid-expansion-is-bad-for-georgia/. Ward, Bryce. “The Impact of Medicaid Expansion on States' Budgets.” Commonwealth Fund , CommonWealth Fund, 5 May 2020, https://www.commonwealthfund.org/publications/issue-briefs/2020/may/impact-medicaid- expansion-states-budgets. “Who Could Medicaid Reach with Expansion in Georgia - KFF.” Kaiser Family Foundation , KFF, 2020, https://files.kff.org/attachment/fact-sheet-medicaid-expansion-GA.

Case Study 4-2

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