Is Georgia Next? Following Louisiana, Expansion Could Sweep the South

Since the passage of the Affordable Care Act in 2010, states across the South have united against Medicaid expansion — until Louisiana broke ranks in January. Led by Gov. John Bel Edwards, the state expanded the federal healthcare program to stave off its fiscal crisis and provide quality healthcare to hundreds of thousands of its citizens.

Since the June 1 enrollment kickoff, the Pelican State has enrolled more than 250,000 Louisianans, many of them through its novel approach of automatically screening food-stamp recipients for eligibility. By taking the Obama administration’s offer to pay 100 percent of expansion costs through 2016, Louisiana is poised to benefit from $184 million in new federal funds.

It’s a win-win for the state — healthier residents and a larger budget — that’s piqued the interest, if not the buy-in, of multiple Georgia GOP legislators.


Georgia’s GOP Stands Divided


After Louisiana’s embrace of expansion, the cracks have begun to show in Georgia’s political firewall.

Critics like Gov. Nathan Deal and the Georgia Republican Party say cost is the issue. At its recent convention, the Georgia GOP passed a resolution against Medicaid expansion, calling members to support “responsible state budgeting” and to “aggressively oppose” attempts to expand Medicaid. The program would drain $200 million from the 2017 state budget, Deal maintains, with an estimated cost of $4 billion over 10 years.

Without third-party studies to support Deal’s claims, though, some Republicans like State Sen. Renee Unterman aren’t convinced.

“We have to open that box and look just a little bit and see what’s available,” she said in a radio interview. “Hopefully, if you draw down federal dollars, you can free up some of those state dollars. Right now, we’re just pumping out state dollars to stay in the midst of the crisis.”

Unterman cites Arkansas’ waiver program, a customization of Medicaid expansion palatable to many moderate Republicans, as a strategy to reduce state healthcare spending while sharing costs equitably. Such a program, which Unterman says her colleagues have responded positively to, is likely to be debated at the state’s next legislative session.


Why Georgia is Poised to Follow Louisiana’s Lead


In a number of ways, Georgia is economically and politically similar to Louisiana. Here’s why Georgia can benefit from looking to Louisiana as a model for Medicaid expansion:

  • Rural hospitals need relief having lost funding that the federal government intended to make up for by funding Medicaid expansion.
  • 853,000 people remain uninsured who could receive benefits under expansion
  • Boost the economy

Rural Hospitals

Although Medicaid expansion is still new to Louisiana, the nonpartisan Louisiana Budget Project expects expansion will save the state $677 million on hospital charity care in the next decade. Jared Stark, CEO of University Hospital and Clinics in Lafayette, Louisiana, projects expansion to cut his 116-bed hospital’s bad debts by approximately $6 million per year.

Those savings must be enticing music to the ears of Georgia’s rural hospitals. Its rural hospitals are struggling, and five have closed outright since 2013, pushing the state to 46th in the nation for access to emergency care. To stem the closures, the state’s 7,000-member medical association has endorsed expansion, alongside Republican State Sen. Chuck Hufstetler and other GOP colleagues.

Low-income residents need affordable care.

Louisiana sits squarely at the bottom of America’s Health Rankings, thanks to high rates of obesity, hypertension, diabetes and mortality. Its 30 federally qualified healthcare centers (FQHCs) are stuffed to capacity, having provided 1.1 million patient visits in 2014. Ninety-three percent of those patients lived below 200 percent of the federal poverty line (FPL), and 37 percent were uninsured. Overall, 13 percent of Louisiana was uninsured prior to expansion — a figure that drops by the day.

If Louisiana’s uninsured figure is striking, Georgia’s number — 16 percent — is appalling. The state’s refusal to expand Medicaid has kept health insurance out of the hands of 853,000 Georgians with incomes below 138 percent of the FPL — 52 percent of whom are employed. Georgia’s 2015 budget included a Section 1115 waiver as a Medicaid “experiment” to help residents buy private insurance, but expansion was, sadly, off the table.

Its economy needs a boost.

Louisiana is solidly in the red, and not just in terms of political ideology: It’s deficit projections this fiscal year recently grew from $600 million to $800 million. Expansion will help, though, adding $184 million — about a quarter of the total shortfall — to the state’s coffers.

Georgia, which has a balanced budget amendment, is not running a deficit, but its economy could still use a boost. Its population is aging, hospitals are in a financial crunch, and the state’s healthcare debt is growing. As Sen. Unterman remarked, Medicaid expansion could plug the gap. Moreover, experts claim that if Georgia had expanded in 2014 when the option first became available, it could have added 70,000 new jobs and $8.2 billion to the economy through 2023.

Lessons from Louisiana

As the Pelican State provides its residents with affordable care, Louisiana’s health ranking and hospital outcomes will show the merits of expansion. With similarly high rates of uninsured “working poor” and access problems, Georgians are undoubtedly watching with envy.

Looking back years from now, history may remember Louisiana Gov. Bel Edwards as the southern bellwether of Medicaid expansion.