In an effort to better provide healthcare to Georgia's exploding population and as a way to balance the state's budget, conservative lawmakers are renewing temporary Medicaid payment increases and looking at expanding the program, according to a Republican state Senate leader.
Sen. Renee Unterman, chairwoman of the Senate's Health and Human Services Committee, said that while she's been critical of Medicaid expansion, she's seeing hospitals close and people waiting to see providers.
Unterman said there is enough support in the Senate for a conservative expansion model, similar to the one in place in Arkansas. Under that state's model, residents with incomes between 100% and 138% pay up to 2% of their income in monthly premiums.
The Georgia Chamber of Commerce is expected to present some expansion ideas to the General Assembly when it reconvenes in January 2017, she said.
State Rep. Sharon Cooper, the Republican chairwoman of the House's Health and Human Services Committee, said she and her colleagues will entertain the proposals, but added that she doesn't believe it will solve the access problem.
“The problem with expansion is, who is going to treat these people,” Cooper said. “We don't have the physicians, nurse practitioners or physician assistants to care for them in rural areas of the state.”
Access to care is scarce in rural parts of Georgia, where five hospitals have closed since 2012, according to state data.
Unterman and other lawmakers say that access to care issues are only increasing as the state's population explodes. A healthy job market has drawn more than a 20% population spike between 2000 and 2015. There are currently 10.2 million residents in the state, according to census data.
And as many as 400,000 people would be eligible for Medicaid expansion. An expansion could have drawn $33 billion in federal funding between 2013 to 2022, with nearly $13 billion of that going to hospitals, according to a 2014 Urban Institute report. The funding could have aided the 66% of rural hospitals that in 2014 ended the year with negative margins. In all, 41% of Georgia's hospitals ended 2014 with negative margins, according to the Georgia Hospital Association.
Oklahoma, likewise, is now looking at an expansion to help cover a $1.3 billion budget hole that's devastated the state's providers.
Even if expansion passed the House and Senate, Georgia's Republican governor, Nathan Deal, could veto the measure despite new GOP support. He recently vetoed a religious liberty bill and a gun carry bill that had wide support from his party.
Meanwhile, Cooper and Unterman hope continuing an ACA provision that raises Medicaid rates for primary-care doctors will improve access for the 1.7 million current beneficiaries of the program.
The provision expired at the end of 2014. States that wanted to continue would have to spend their own funds, and would receive only a limited federal match on what they spent. In all, 23 states have continued the ACA pay bump either fully or partially in 2016, according to the Kaiser Family Foundation.
Georgia continued in a limited way. Last fiscal year, Georgia paid 90% of 2014 Medicare rates for a set of primary-care billing codes, and in the upcoming fiscal year starting in July it will pay 100% of 2014 Medicare rates. Providers are expected to receive an additional $84 million this year as part of the bump.
And Georgia's pay bump policy actually goes further than the ACA because it includes OB-GYNs. The state was responding to a troubling trend of shuttering labor and delivery units. Thirty-five have closed their doors since 1994, said Pat Cota, executive director of the Georgia OBGyn Society.
She said that fewer than 75 of 180 hospitals in the state have labor and delivery units and more than 40 Georgia counties lack obstetrical providers.
Before the pay bump in the ACA, doctors in the state had not seen an increase in Medicaid reimbursement in more than a decade, said Fay Fulton, executive vice president at Georgia Academy of Family Physicians.
“Georgia is successfully moving the needle to a healthier future for our citizens by committing to stabilizing the primary-care physician workforce,” Fulton said.