With a dozen states rejecting an offer of extra federal money if they expand Medicaid, Georgia's two Democratic U.S. senators are now pushing for a federal workaround.
Sens. Jon Ossoff and Raphael Warnock on Wednesday wrote a letter saying they want the federal government to find a way to provide health insurance coverage to people in Georgia and 11 other states that haven't agreed to expand the Medicaid program.
"The federal government, which already funded coverage for these individuals through the Affordable Care Act, has a responsibility to step in and help these citizens who have been left behind by their state leadership," Ossoff and Warnock wrote. "We cannot continue to allow Americans with low incomes to suffer any longer just because they live in a state that has been overcome by political obstruction."
Democrats had tried to motivate the 12 remaining holdouts by offering extra money to states that adopt Medicaid expansion through coronavirus relief. The federal government offered to boost its share of costs in the regular Medicaid program for two years if the states would expand Medicaid to cover more of the poorest Americans. Many able-bodied adults with low incomes are not currently covered, although those making more than 138% of the federal poverty level are eligible for federal health insurance subsidies paid to private insurers through an online marketplace.
In the letter to Democratic Senate Majority Leader Chuck Schumer and Republican Senate Minority Leader Mitch McConnell, Georgia's senators said they were working on legislation to create a federal workaround or "pursue other strategies" to provide coverage in holdout states. The two said they want the legislation attached either to President Joe Biden's infrastructure proposal or his proposal to provide additional education and family support benefits.
They said any alternative should not require insurance premiums and should require people who are insured to cover a low share of costs, like the traditional Medicaid program. Warnock and Ossoff didn't outline how they would make up for the state share of the costs over the long term, though.
Judy Solomon, a senior fellow on health policy at the liberal-leaning Center on Budget and Policy Priorities, said one approach could be to use the federal marketplace and subsidize private insurers, creating plans with no premiums and smaller copayments. Another approach would be for the federal government to set up Medicaid-only plans in states that didn't expand the program.
Solomon said there are "a lot of details" to work out, but that "people who were supposed to get coverage in 2014 shouldn't have to wait any longer."
Medicaid expansion is the keystone of Democratic policy demands in most states that have kept narrower eligibility. A federal workaround would give Warnock a major achievement as he seeks election to a full six-year term in 2022.
An analysis by the Kaiser Family Foundation found the additional federal money offered under the coronavirus relief incentives would send Georgia about $1.4 billion over two years, and the state's share of expanding coverage would be about $640 million. Georgia would end up $700 million ahead. More than 450,000 people in the state could become eligible for coverage.
But Republican leaders in Georgia and other states have ignored the enticement. Instead, Gov. Brian Kemp has been pursuing a more limited expansion that would impose work or education requirement to receive the benefits. The plan seeks to add an estimated 50,000 poor and uninsured Georgia residents to the Medicaid rolls in its first two years, with Republicans saying it's a more narrowly tailored, fiscally responsible alternative to a full expansion.
President Joe Biden's administration froze former President Donald Trump's approval of Kemp's plan, although Georgia lawmakers provided money for it anyway in the budget beginning July 1.
A spokesperson for Kemp didn't immediately respond to a request for comment.
The Georgia House voted 98-68 in March to reject full expansion, with majority Republicans rejecting the Democratic gambit.
Other states have been equally resistant. Republican lawmakers in Wisconsin on Tuesday opened and then closed within moments a special session that had been called by the Democratic governor seeking Medicaid expansion.
