Georgia Democrats slam Kemp’s kibosh on full Medicaid expansion

The Democrats also challenged statistics that Kemp laid out to defend his position, saying that they were false.

Kemp is holding off on fully expanding Medicaid to all Georgia adults in order to work for the success of his own Medicaid program, called Georgia Pathways to Coverage.

Estimates vary, but perhaps 290,000 Georgia adults remain uninsured because Georgia has not expanded Medicaid under the Affordable Care Act — also known as Obamacare — to cover all its poor. Instead, Kemp devised a tailored solution that he forecasted would insure 90,000 Georgians. However, only 4,000 have enrolled since the program launched last July.

Kemp has said his Pathways program will encourage people to work and move up in life. In order for people to enroll, they must prove they’re working or doing certain activities, such as volunteering for a registered nonprofit. But not all types of work count. For example, working to care full-time for a disabled relative does not count. People who are too disabled to work but haven’t been federally declared disabled also don’t qualify.

Because of the restrictions on who qualifies, the Democrats said Thursday the Pathways program was “anti-family,” and was preserving Kemp’s political image at the expense of Georgians.

In a response, Kemp ignored the broadsides from Democrats. He instead focused on the press and the data.

“After the AJC was faced with undeniable data showing the incredible progress our state has made in providing Georgians with greater access to affordable, quality healthcare coverage, it is no surprise that they would bend over backwards to give credit to the (Biden) administration responsible for trying to block the state’s work every step of the way,” Kemp spokesman Garrison Douglas said in a written statement.

“The fact is that through a conservative, innovative, Georgia-centric approach, more Georgians have received quality private insurance than traditional Medicaid expansion would’ve covered.”

The statement did not address the perhaps 290,000 people earning below the federal poverty level who are not eligible for those private plans.

In laying out his position last month, Kemp said that by not expanding Medicaid, “we signed up 713,000 people, the majority of those being on private sector insurance.” In that comment Kemp appears to be taking credit for the federally subsidized ACA coverage available to some poor people in Georgia.

During the pandemic, subsidies enacted under the Biden administration made premiums free to people just above the federal poverty level. Enrollment surged. Those people, who make from 100% of the federal poverty level to 138% of the federal poverty, or about $15,000 to $20,000 a year, signed up for ACA plans in droves in Georgia, to the tune of more than 700,000. They were able to sign up in every state that has not expanded Medicaid, which is currently Georgia and nine other states.

The main reason for the ACA program’s popularity in 2024 is the free premiums, said Leah Chan, director of health justice at the Georgia Budget and Policy Institute, a nonprofit that favors full Medicaid expansion. Experts agree that new, heavy advertising of ACA plans this year by the Kemp administration also probably helped. Kemp also has had for years a state subsidy program for ACA plans that has greatly benefited rural residents, especially those with middle to higher incomes.

“But,” the Kemp spokesman continued, “when you add up what we have done through Pathways, plus our Access program ... we signed up 713,000 people, the majority of those being on private sector insurance. What we have done with a conservative solution has already covered 713,000 people, even with Biden trying to block the Pathways program.”

The Biden administration blocked Georgia’s proposal for Pathways in its early years, saying in part that the pandemic and a massive Medicaid shift in eligibility after the pandemic made it untenable. Kemp sued to get it enacted.

Kemp also said that if the state did expand Medicaid, those more than 700,000 people now covered by ACA plans would be forced to drop their private plans for Medicaid, which offers weaker coverage.

That would happen if the state enacted traditional Medicaid expansion like that advocated by former gubernatorial candidate Stacey Abrams. However, the version of expansion that Georgia legislators were studying most closely would not do that. That version would take the Medicaid money and put it into private ACA plans. Those people’s coverage would remain the same.

Sen. Michelle Au, a Democrat from Johns Creek who is also a physician, said Kemp’s rejection of Medicaid expansion after the legislative session ended was a “thumb in the eye” to those who had worked in good faith during the session, including Republicans. The efforts resulted in Kemp approving a study commission on the issue.

“I honestly don’t know what this commission is supposed to do now,” Au said. “Because we’re basically admitting that this was all talk.”

By the numbers

Gov. Brian Kemp recently defended his health insurance policies by saying, “When you add up what we have done through Pathways, plus our Access program ... we signed up 713,000 people.” Here’s the breakdown.

709,000

The number of people in Georgia that the federal ACA Marketplace signed up for 2024 health coverage who make more than 100% of the federal poverty level and less than 138% of the federal poverty level.

4,000

The number of people in Georgia who make less than 100% of the poverty level that Georgia has signed up for Pathways to Coverage, Gov. Brian Kemp’s limited Medicaid expansion.

713,000

The number Kemp cited adds those two numbers together: 709,000 plus 4,000.

290,000

The number of people in Georgia who could be covered by full Medicaid expansion but are now uninsured. They make less than the federal poverty level.

Sources: The office of Gov. Brian Kemp and the Georgia Budget and Policy Institute.