The Greater Augusta Healthcare Network met to hear about the impact of Medicaid expansion in Georgia under the Affordable Care Act. Georgia is among about half the states, including most of the Southeast, that have refused Medicaid expansion; Gov. Nathan Deal said it is too expensive.
An analysis by Dr. William Custer of Georgia State University would argue otherwise, said Timothy Sweeney, the director of healthy policy for the Georgia Budget & Policy Institute, who presented it to the group. Georgia is 50th in Medicaid spending per enrollee and, at 1.8 million, has the fifth-highest population of uninsured and the fourth-highest number of uninsured children, outranking New York in the number of kids without coverage, he said.
The 13-county region surrounding Augusta actually has the lowest rate of uninsured children in the state but has 66,000 uninsured overall, about half of whom would be eligible for coverage under Medicaid expansion. Under current state rules, the only adults who can get Medicaid are parents of eligible children who make less than half of the federal poverty level, or around $9,000 a year for a family of three, Sweeney said.
“That’s it,” he said. “That’s our adult coverage unless you are disabled, unless you’re elderly in a nursing home.”
While Deal’s office has said Medicaid expansion will cost more than $4 billion over 10 years, the analysis pegs that at $2.1 billion a year. For every dollar the state spends on Medicaid expansion, it would get $14.46 in federal funds, according to the analysis.
“It’s really a pretty fantastic state investment,” Sweeney said. For the Augusta area, that would mean $180 million more each year in health care spending with an economic impact of $340 million each year, he said.
The Custer analysis projected that Medicaid expansion would create 56,000 jobs statewide, 3,073 in the Augusta area, with about half in health care and half from the economic impact, Sweeney said.
“Those new people go out to lunch and rent apartments and buy cars,” he said.
With increased sales tax, income tax and premium taxes figured in, the annual cost to the state would really be around $35 million a year, about .2 percent of the current fiscal year budget, Sweeney said.
“It’s a relatively small impact on state spending,” he said.
Without Medicaid expansion, 3.7 million people nationwide and about 400,000 in Georgia will fall into a coverage gap where they don’t qualify for Medicaid and because they fall below the poverty line won’t qualify for subsidies in the Health Insurance Marketplaces, Sweeney said.
That prohibition was put in place in the health reform law presumably to keep states from dumping their Medicaid populations into exchanges back when the federal government could penalize states for not expanding Medicaid. The U.S. Supreme Court decision upholding the law took away that provision, making expansion voluntary, and about half the states said no.
Arkansas, one of the few Southern states expanding Medicaid, is doing so through a waiver that allows those eligible for coverage to use the exchanges to get insurance, an option advocates hope will persuade neighboring states
to reconsider, Sweeney said.