The Georgia Chamber of Commerce has proposed three plans, collectively termed the “Georgia Way,” to increase the number of residents receiving taxpayer-funded health insurance, paid for with a combination of state and federal funds under the Affordable Care Act (ACA).
“Alternative 1” would expand Georgia’s Medicaid program to include all people with incomes less than 100 percent of the federal poverty level (FPL) who do not currently qualify for Medicaid, the Chamber’s study states.
Alternatives 2 and 3 would make between 600,000 and 700,000 able-bodied people with incomes less than 138 percent of FPL, which in 2016 is $16,242, newly eligible for Medicaid.
The third alternative resembles a form of Medicaid expansion known as the “private option,” adopted by Arkansas in 2013. Iowa tried a similar model and abandoned it in 2015. Medicaid expansion by private option gives newly eligible enrollees state and federal funds to purchase commercial insurance, or qualified health plans (QHPs), on a state’s Obamacare exchange.
Alternative 3 would make taxpayer-funded QHPs available to Georgians with incomes of 100 percent to 138 percent of FPL, including individuals who currently have employer-sponsored health insurance (ESI).
All three plans list intentions to minimize enrollment of those with ESI, require some enrollees to pay small copays and premiums, and promote personal responsibility by creating health savings accounts for enrollees.
Any Georgia Way proposal would be subject to approval by the federal Centers for Medicare and Medicaid Services. A panel of Arkansas and Georgia lawmakers will meet in December to discuss the Chamber’s study, released in August, in preparation for the 2017 legislative session. (See article on p. 15.)
Georgia Way Off
Dr. Hal Scherz, secretary of the board at the Docs4PatientCare Foundation and vice president of finance at Georgia Urology in Atlanta, says the Chamber’s proposals double down on a broken system.
“Any expansion to Medicaid that does more of the same is a spectacular error of judgment and simply an attempt to pander to special interests and a segment of their constituency that wants the state to take care of their health care needs,” Scherz said.
Lawmakers could avoid the runaway costs characteristic of traditional and expanded Medicaid by moving recipients to a direct-pay model, Scherz says.
“The best way to cap costs and to make them more predictable is by giving each Medicaid recipient a direct primary care doctor,” Scherz said. “This would take a tremendous amount of political courage, to say no to the powerful special interests such as the insurance companies.”
Plans using commercial insurance, as Alternative 3 would do, continue to grow more expensive as insurers drop out of the government insurance exchanges, Scherz says.
“Premiums are going up on average 10–15 percent [per year] across the country and by as much as 60 percent in some areas,” Scherz said.
Georgia state Rep. Jason Spencer (R-Woodbine), a board-certified physician assistant, says Medicaid expansion proponents consistently underestimate the program’s cost and number of enrollees.
“States that have expanded Medicaid under Obamacare have seen their Medicaid rolls increased dramatically beyond stated projections,” Spencer said. “The cost of health care continues to rise under expansion, and access to care remains limited.”
‘Enslavement,’ Not ‘Conservatism’
The Chamber’s study describes the ideal Georgia Way plan as presenting the “most conservative, most sustainable pathway under U.S. law to close the coverage gap.”
One of the Chamber’s guiding principles when crafting the plan was to “take advantage of all federal dollars available,” the study states.
Spencer says the Chamber’s proposals undermine their self-described “conservatism.”
“The alternatives for Medicaid expansion endorsed and provided by the Georgia Chamber of Commerce to the General Assembly for consideration are not conservative options at all,” Spencer said. “They are going to cost the taxpayers a serious amount of money while placing more stress on our education, transportation, and public safety budgets, if adopted.”
The Georgia Way would ensnare individuals in dependency while preventing the truly needy from prospering, Spencer says.
“Expanding this ineffective entitlement program under Obamacare to able-bodied adults will only entrap our people into a form of enslavement, burden our taxpayers, and divert funding of the neediest and medically frail in our state from the care they need,” Spencer said.
Brandon Best ([email protected]) writes from Cedarville, Ohio.
Matthew Glans, “Medicaid Expansion Costs Continue to Grow,” Research & Commentary, The Heartland Institute, August 30, 2016.
Michael T. Hamilton, “Post-Op Policy Debrief: ‘Nontraditional’ Medicaid Expansion,” Health Care News, The Heartland Institute, April 2016.