Georgia’s Republican Gov. Brian Kemp fought off Democratic challenger Stacey Abrams in 2022 in part on Medicaid expansion. The state is one of the remaining 10 holdouts refusing to adopt the expansion under the Affordable Care Act, leaving at least 400,000 people uninsured. Medicaid expansion was a key part of Abrams’ campaign, undercut by Kemp’s promise that he would continue pushing his plan for expansion called Georgia Pathways to Coverage. It helped get him reelected, but it won’t help the hundreds of thousands of uninsured people in Georgia. It’s not intended to. It’s a classic bait-and-switch, promising help and then yanking it away in the fine print—in this case, work requirements that will result in higher costs for Georgia taxpayers and fewer people with coverage. And it starts in a few days, at the beginning of July.
It’s particularly cruel that the empty promise of Medicaid coverage for poor people in Georgia is coming as thousands are being dropped from the rolls with the end of the COVID-19 pandemic declaration. That declaration allowed for continuous enrollment; states weren’t allowed to disenroll people as long as the public health emergency lasted. Now between 245,000 to 454,000 non-elderly adults and children could be dropped, and Kemp’s Pathways to Coverage will only help a fraction of them.
That’s because everyone in the gap—adults up to age 64 who earn too much to qualify for traditional Medicaid and too little to qualify for coverage on the ACA exchange—will have to fulfill the work requirement, attend college, volunteer for a registered nonprofit, or participate in on-the-job training for 80 hours per month. That leaves out the people who are responsible for providing care to others and can’t leave the home.
Belinda Sherley, 42, is the sole caregiver for her disabled husband. The two live on the $914 per month from his disability payments, and SNAP food assistance. She has her own serious health issues, and has never had insurance as an adult. She knows about Kemp’s plan, “But I’m not going to be able to work,” she said. Even taking online classes isn’t possible because her rural home doesn’t have reliable internet coverage. “That’s what’s so frustrating,” she said. “I need help and can’t get the help I need.”
She and thousands like her are shut out while the plan is promising to be a boondoggle, costing the state millions to implement and losing out on something like $1.3 billion over the next two years that could come from the federal government if the state simply expanded. The state itself estimates that only about 100,000 people will end up qualifying for coverage. The Georgia Budget and Policy Institute estimates that covering those 100,000 will cost taxpayers $10 million more a year than covering the 482,000 uninsured people under simple Medicaid expansion.
Work requirements under the Medicaid program require a federal waiver, so theoretically the Biden administration could stop Kemp from implementing it. The problem is that Kemp initiated the plan under the Trump administration, which opened up a waiver process. President Joe Biden’s Centers for Medicare and Medicaid Services rescinded the work requirements waiver in 2021, and the state sued.
U.S. District Judge Lisa Godbey Wood, a George W. Bush appointee, sided with the state, and the administration decided not to appeal. That’s a controversial decision, but the appeal would have been a dangerous gamble with the conservative-packed appeals court and ultimately the Trump-packed Supreme Court. The administration apparently decided allowing Georgia to pursue this bad plan was preferable to giving the Supreme Court a chance to rule.
Georgia already has some of the strictest, cruelest Medicaid restrictions. A family of three has to earn less than $8,000 a year to qualify for traditional Medicaid. Childless adults aren’t eligible, period. The reality remains that the huge majority of people who would qualify for regular Medicaid are already working. They’re in low-paid jobs that may or may not provide them the required 80 hours per month, and certainly don’t provide health insurance.
Atlanta physician Reed Pitre, who works in Atlanta at the charity clinic Mercy Care, explained just how cruel this new program is, and how hard it will be for people to meet the monthly requirement of wading through bureaucratic red tape. “People who are poor ... we’re lucky if they have a smartphone. So the idea that they have to have an email address, have access to technology—these are presumptions,” he said. “These are routine parts of our lives now. But most of our [Mercy Care] people don’t even have a cell phone.”