Standstill on Medicaid growth leaves poor Georgians with out protection

That stalemate leaves perhaps 400,000 Georgians like Stewart, 41, stuck in the middle. She cannot afford private insurance and is not eligible for government assistance, so she cannot afford visits to an endocrinologist to monitor her thyroid abnormality.

“It’s not fair,” she said.

Kemp’s proposal – technically a proposed waiver of the existing Medicaid rules – had the enthusiastic support of former President Donald Trump’s administration and was due to take effect next month. State officials estimate that it could have served more than 20,000 people in the first year and perhaps 50,000 in the second year.

An estimated 350,000 other Georgians, like Stewart, would not have complied with the plan’s proposals and would have remained uninsured.

But linking work or other activities to health insurance has been repeatedly rejected by federal courts as inconsistent with Medicaid’s goal of providing health care. One of the earliest steps taken by the Biden government was to revoke Georgia’s waiver approval and mark its status as “pending”.

Ryan Loke, an adviser to Kemp who works on Medicaid and other health issues, said Georgia and the federal government are still debating the state’s waiver.

State officials, Loke said, “expect Georgians trapped in this coverage gap to have access to coverage because of our innovative approach.”

Hurdles to cover

For four years, Stewart has not qualified for subsidized health care either under Georgia’s current system or Kemp’s proposed waiver. The last time she had insurance coverage was when she qualified for Medicaid as a minor mother. You have grown now.

Since then, Stewart has often helped relatives who could not support themselves but not for an official salary. According to Kemp’s proposed work requirement, this would not be considered “employment”.

To be eligible for any other “qualifying activity”, Stewart would have had to leave her relatives alone to do something else, such as working for a recognized nonprofit for at least 80 hours a month.

Otherwise, their only option would have been subsidized insurance through the Affordable Care Act. But these subsidies are only offered to people who earn at least as much as the federal poverty line, or $ 12,880. Stewart never made that much in a year.

Stewart lives in Chatsworth, a small town in Murray County about 85 miles northwest of Atlanta. Last year she tried driving for DoorDash, the food delivery service, but spent more on gasoline for her rural area than she could earn. She applied online for every job she could find. She applied for unemployment insurance but said she had not received a response to more than 20 requests to appeal her rejection of account registration by the state Labor Department.

The bureaucratic hurdles to getting government aid show why Stewart would like Georgia to open Medicaid to the poor.

When it comes to establishing special entitlement categories, lawyers for the poor – who are trained to qualify people as disabled – say it’s a nightmare for those in need of immediate help. It will take several months for them to qualify. Few qualify. For example, if surgery could relieve their disability, that person will usually not be registered as disabled even if they cannot afford the surgery.

$ 700 million incentive

Even if he wanted to fully expand Medicaid, according to Kemp’s advisor, he would need legislative approval. But the Republicans, who control the House and Senate, have never deviated from their opposition to the idea. They say Congress could stop these payments at any time and force the state to pay the full cost itself, while it sounds good to bring in billions of federal dollars to expand Medicaid eligibility.

But 10 years after the Affordable Care Act was passed, “lowering this matching rate has not been discussed,” said Rachel Garfield, vice president of the Kaiser Family Foundation, a nonprofit research organization focused on healthcare.

Kyle Wingfield, president of the libertarian Georgia Public Policy Foundation, agreed to a point.

“You are doing what you promise,” said Wingfield. “But the trend in federal spending has only become untenable.”

Last October, Governor Brian Kemp celebrated with Seema Verma, then administrator of the Federal Medicare and Medicaid Services Centers, after agreeing to a limited expansion of Medicaid services in Georgia. That year, President Joe Biden’s administration revoked the approval. (Hyosub Shin / [email protected])



The federal government currently bears around two thirds of Georgia’s regular Medicaid expenses. A full expansion of Medicaid would increase state coverage to 90% for new beneficiaries.

In addition, the Biden administration offers another incentive: The federal government would increase its contribution for those who are already on the Medicaid lists by 5 percentage points for two years. That would result in more than $ 700 million in net income for Georgia by 2023, according to Kaiser.

A full expansion of Medicaid would also benefit hospitals and doctors who have treated many uninsured for free. For example, at the Mercy Care charity clinic, up to 80% of patients are uninsured and many are homeless, said Tom Andrews, CEO of the organization.

“If you can’t take care of your health, you can’t get jobs,” said Andrews, who originally supported Kemp’s limited Medicaid expansion proposal. “The basis for access to health care is the basis for really being able to live a whole life.”

With government solutions stalled, Stewart tries to attend to her own health needs and train herself for a home office job that could include insurance benefits.

She thinks she’ll need the cover. For the past 30 days, she has had symptoms that her former endocrinologist warned her about. Growths in your thyroid are suddenly out of whack. She went from size 4 to size 10 in a month due to rapid weight gain. Your moods fluctuate badly.

She is afraid it could be cancer. But she cannot afford the endocrinologist without insurance. She is left with a somber look.

“There are people out there who put a price tag on our lives.”

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