Georgia Gov. Brian Kemp outlined his health care policy priorities for 2025 in his recent remarks at the Georgia State Capitol, with the Georgia General Assembly session in full swing, and in his State of the State address.
It was encouraging to see the governor commit to improving health care access and quality for Georgians across the state — goals that I deeply share as a fellow Republican. His proposal to enhance the Georgia Pathways to Coverage program by qualifying parents and legal guardians of young children ages 0-6 for health care coverage would support growing families and ensure that more hardworking parents can access care that will keep them healthy.
Expanding Pathways eligibility to new populations, as the governor has proposed, and as the Comprehensive Healthcare Coverage Commission (CHCC) recommended in its first-year report published in December, is a continued step in the right direction. But, even if these positive changes were enacted, hundreds of thousands of hardworking Georgians — farmers, veterans, part-time, hourly and gig workers, adults who are not yet Medicare eligible, and other caregivers — would still be left in the health care coverage gap.
As a Republican, I was disappointed to hear the governor say that extending coverage to the approximately 300,000 Georgians in the coverage gap through full Medicaid expansion to 138% of the federal poverty level (FPL) is not a fiscally responsible choice. Though we share many of the same values and objectives, on this point I have to respectfully disagree with the governor. And I know I’m not the only Republican who sees Medicaid expansion as a policy in line with conservative principles because 21 red states have already expanded. Full Medicaid expansion would cost the state significantly less per enrollee than Pathways, and is a clear win-win for Georgia’s health and economy. In fact, for the first time in Georgia, a bipartisan group of state senators introduced legislation last month to close the coverage gap, citing the economic and health benefits to rural Georgians as a key reason for their action.
It’s important to understand what our different insurance programs are doing and where Georgia could be doing better, as some of the numbers might be confusing. The Pathways program was originally estimated to cover roughly 30,000 Georgians at the end of its first year in July of 2024. Today around, 6,500 hardworking Georgians are enrolled, and the new estimate is that about 30,000 people will be enrolled by 2030. This is far fewer Georgians than would be covered under Medicaid eligibility to 138% FPL. Georgia Access, our state’s private insurance marketplace, is currently enrolling a record-breaking 1.5 million people, a huge achievement worth acknowledging. But, it is an apples-to-oranges comparison to include that full enrollment number when comparing these programs to the benefits of Medicaid expansion to 138% of FPL, as many people on Access earn more than the eligibility threshold for traditional Medicaid and Pathways.
Full Medicaid expansion would also be a more efficient way to increase access to health care coverage than the current Pathways program. Pathways has high administrative and consulting costs, and full Medicaid expansion would actually cost the state significantly less per person than if Pathways hits its full enrollment goal, which the program is far from doing. Medicaid expansion to 138% of FPL would also maximize our federal dollars, instead of having federal income taxes paid by Georgians subsidize health care in the 40 other states who have already expanded Medicaid. In 2023 alone, Georgia forfeited $3.6 billion in federal money by failing to close the coverage gap. Right now we are leaving federal money on the table, and expanding eligibility to 138% of FPL as 40 other states have already done would allow us to keep our federal tax dollars in Georgia where they belong, benefiting our citizens and our state’s economy.
Why should Georgia continue to pay full freight for a program that isn’t achieving what’s needed, when we could fully leverage and maximize our federal tax dollars, cover more Georgians, and stop subsidizing health care programs in other states?
Additionally, expanding eligibility to 138% of the FPL would spur job creation and increase incomes for hardworking Georgians across the state. A 2024 statewide and county-level economic impact study projects more than 150,000 new jobs would be added in Georgia during the first three years of expansion, and that closing the coverage gap would increase personal income in the state by $10.8 billion in those first three years. Many of those new jobs would specifically be located in rural areas across the state, bolstering our rural economy.
I agree with the governor that Georgia should take a conservative approach to managing our state’s budget, and I encourage him to look to other states who have fully expanded Medicaid as evidence for why closing the coverage gap supports that objective. States that have expanded Medicaid have actually seen a reduction in state spending on their traditional Medicaid programs. State budgets have also saved on mental health care and in other areas as a result of expansion.
Ultimately, the data clearly indicate that expanding Medicaid eligibility to 138% of FPL is a fiscally responsible policy. For the economy of our state and the health of our workforce, it’s time to close the coverage gap.
Natalie Crawford, a Republican, is a former two-term Habersham County Commissioner and executive director of Georgia First and BRIDGE Georgia.
Credit: Natalie Crawford
Credit: Natalie Crawford
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