With numbers like that, it’s easy to see why it’s an issue that is also a top of mind for leaders and campaigns alike in races that could determine control of the Senate — and, quite possibly, the future of health care in America.

“This is why these Senate runoffs are so vital,” said Democrat Jon Ossoff, who faces U.S. Sen. David Perdue in one of the races.

Gov. Brian Kemp recently announced a federal waiver to Medicaid rules that will make Medicaid available for an additional 50,000 low-income Georgians. The same waiver, however, will also block access for all Georgians to purchase insurance through the federal health exchange, sending them to private insurance brokers or insurance companies instead.

Separately, Perdue, Ossoff and the two candidates in Georgia’s other Senate race — Republican U.S. Sen. Kelly Loeffler and the Rev. Raphael Warnock — have put forward their own proposals to improve both access to and affordability of health care coverage in the state.

Perdue vs. Ossoff

The issue most central in to Perdue’s campaign is that of coverage for people with preexisting conditions who were routinely denied coverage before Congress passed the Affordable Care Act in 2010.

But since Senate Republicans, including Perdue, have railed against the ACA, he has also signed on to the Protect Act, a bill sponsored by Sen. Thom Tillis of North Carolina that would prevent health insurance companies from denying coverage to people with preexisting conditions.

Critics of the Protect Act point to a loophole in the bill that could allow companies to deny coverage if the company can show it does not have the “financial reserves” to offer coverage.

But Perdue says covering people is a top priority. An ad early in his campaign featured his younger sister Debbie, a cancer survivor, and the senator saying: “Health insurance should always cover preexisting conditions for anyone. Period.”

A Perdue spokeswoman also told the AJC that the senator has worked to lower the cost of prescription drugs and add new protections to COVID-19 relief legislation that the Senate recently voted for.

Unlike Perdue’s market-based approach, Ossoff’s primary plan would add a public option to the private insurance coverage already available through the Affordable Care Act. A public option, Ossoff says, would give a lower-cost alternative to anyone without access through their employers or Medicare and Medicaid

Ossoff, whose wife is an OB-GYN, has also put forward a detailed set of additional health proposals in a seven-page plan available on his website.

In response to Ossoff’s plans, Perdue routinely accuses the Democrat of wanting “socialized medicine,” a charge that Ossoff flatly rejects.

“That’s a lie and he knows it,” Ossoff told the AJC. “I want to add a public option to the exchange while protecting every Georgian’s right to choose between public and private insurance. Georgians need more choices. They need more affordable choices.”

Loeffler vs. Warnock

With the one-on-one battle in the second Senate race just getting started, details for Loeffler’s and Warnock’s health care positions have been slower to emerge.

Loeffler voted in favor of the Protect Act in the Senate, and in an interview with the AJC, the Republican outlined her principles for expanding health insurance in Georgia.

“Republicans want to do it through private markets, not through government mandates and socialized medicine,” she said. “We are very focused on expanding the options and the affordability, but not expanding taxpayer obligations for health care. This burden will fall on those who can least afford it.”

Warnock has neither a voting record to review such as those of Perdue and Loeffler, nor a detailed health care plan like Ossoff’s.

His website details his past efforts to expand Medicaid in Georgia, and his spokeswoman said he would work to defend and expand the Affordable Care Act in the Senate.

In an interview, Warnock said his time as a pastor has helped set the health care priorities he would pursue in the Senate. “When I talk about health care, it’s not theoretical, it’s deeply personal,” he said. “I’ve spent most of my time walking alongside people during some of their most difficult days."

Critics for all

Trying to predict the ways each plan would affect people’s lives specifically is difficult. Health care and insurance markets are so complex, a change to one area can trigger multiple changes elsewhere.

Bob Moffit, a health insurance expert with the right-leaning Heritage Foundation, has studied the idea of adding a public option to the health insurance market for more than a decade.

Instead of lowering costs, he predicted, costs would increase since the federal government would have the power to set prices for medical services below market rates.

“The consequences of that will be that a lot of your private health insurance plans would not be able to compete with the public option,” Moffit said. “The result will be that the private plans will be driven out of the market.”

The Protect Act has its critics, too, including Harry Heiman, an associate professor in the School of Public Health Policy at Georgia State University.

Not only does the legislation leave loopholes for insurers, Heiman said the Protect Act does not address some of the most important parts of the ACA, including restrictions on lifetime and annual cost caps and the provision that allows adults up to 26 years old to stay on their parents' health insurance.

“Just like any other complex piece of legislation related to a very complex health care system," Heiman said, "to pull out that one piece without looking at how it’s integrated across all the other pieces doesn’t really work.”