Credit: Ben Gray

Credit: Ben Gray

“That landmark legislation opened the door for my administration to pursue innovative, Georgia-centric policies to tackle our unique health needs head-on,” Kemp said I’m proud to say that we rejected the top-down, one-size-fits-all approach some promote, and instead chose to treat Georgians as individuals with different strengths, challenges and health care circumstances.”

Kemp took office in 2019 vowing to remake health care for “hardworking Georgians.” One of his initiatives was a limited expansion of Medicaid, the government health insurance program for poor children and some poor adults including some who are elderly or federally declared as disabled.

Unlike 40 other states, Georgia does not automatically give health insurance to poor adults. Kemp instead devised a unique program to offer Medicaid to those who meet certain requirements, such as working for an employer 80 hours a month, attending certain amounts of college, or other activities. Activities such as caring for one’s own children full-time does not count.

Kemp aides currently calculate that about 240,000 poor Georgia adults could be eligible for the program if they meet the activity requirements. But as Pathways closed its first full year of enrollments this summer, only about 4,300 people had signed up.

The $10.7 million ad campaign Kemp announced Monday would continue advertising the state has been doing already for Pathways. The state spent more than $990,000 in the first months of 2024 on ads that reached 7.5 million people, according to state documents, but the new campaign will be a significant increase from that.

Kemp and the Trump administration spent nearly two years designing Pathways. But after the Trump administration approved the plan in late 2020, the Biden administration took office and challenged it, leading to nearly two more years of delays.

Kemp and Department of Community Health Commissioner Russel Carlson made the case Monday morning that the Biden administration’s decisions to delay Pathways’ rollout ended up hamstringing the program. Pathways launched last year just as all states tackled a massive job of reviewing millions of Medicaid case files. Georgia Medicaid staff were already overwhelmed with the work, and potentially eligible poor Georgians were overwhelmed with other messages about Medicaid.

Now things are different, said Carlson. “That’s why we’re encouraged with this media campaign — we feel like Georgia Pathways, for the first time, will be granted open seas, if you will,” Carlson said at the event. “We’re able to go out and educate everyone ... and get these (applications) processed in a timely fashion, and educate people on their options along the way.”

The governor’s big health law

Kemp held the roundtable discussion Monday with Carlson and Insurance Commissioner John King not just to mark the watershed moment of the full rollout of The Patients First Act, but to make the case that that law is responsible for successes in health care in Georgia in recent years. Those successes include stabilizing Georgia’s ACA marketplace, and soaring enrollment in ACA plans, including some 700,000 low-income Georgians who now have near-free ACA plans.

The ACA, proposed by President Barack Obama and passed in 2010, offers private health insurance to people above the poverty level, with hefty federal subsidies that make the private plans affordable.

Because the state did not expand Medicaid to all poor adults, the federal government allows low-income adults earning just above the poverty level to sign up for private plans on the ACA, sometimes still called Obamacare.

Researchers such as those at the nonprofit KFF say that enhanced subsidies under the Biden administration, which expire in 2025, are mostly responsible for the massive increase. Those subsidies made the plans robust and nearly free for those 700,000 Georgians. The researchers agree that Kemp’s advertising through Georgia Access was helpful in spreading the word.

Asked about that by an AJC reporter, Kemp said, “I don’t know what experts you’re talking to, and of course, that’s what the Biden administration is going to say. But I would remind you, I campaigned on this issue,” Kemp said. “We started doing this before Joe Biden ever became president.”

Georgia’s Pathways to Coverage is just one of three major initiatives in the state’s Patients First Act.

The Patients First Act in 2022 rolled out “reinsurance” for the first time here — a huge state subsidy that helped make policies for upper-income ACA policyholders cheaper — which Kemp claims is responsible for stabilizing the marketplace. Researchers at Duke University have suggested that reinsurance unwittingly harmed lower-income ACA policyholders, and drove thousands out of the marketplace.

The final accomplishment of the Patients First Act came last week as Washington approved a state-based exchange for Georgia to take over management of the ACA in the state, which covers 1.3 million Georgia health insurance policyholders.

When open enrollment begins Nov. 1, residents of Georgia will be blocked from the federally operated website healthcare.gov and referred instead to the state-based website, georgiaaccess.gov, called Georgia Access.