Jay Bookman

Opinion columnist and blogger with The Atlanta Journal-Constitution, specializing in foreign relations, environmental and technology-related issues

The irrefutable logic of Medicaid expansion for Ga.


They can no longer deny that the state’s health-care delivery system is in crisis, particularly in rural areas that are already underserved by hospitals and physicians. They acknowledge that public hospitals in urban areas are struggling as well, trying to serve the hundreds of thousands of Georgians with no access to health insurance. And at least some in the party are willing to admit that GOP efforts to patch together a solution have largely failed.

Sure, out of sheer cussedness at this point, the state still refuses to accept billions of dollars in federal health-care assistance readily available through Obamacare. Even as other Republican-led states find a means to accept the assistance, Georgia has not, and the impact has been substantial. According to the Kaiser Family Foundation, Georgia has the second-highest rate of uninsured in the country, at 18 percent of the nonelderly population. Many of those are working Georgians, people who work in the increasing number of lower-paid jobs but have no feasible means of affording coverage.

Some of those uninsured are getting some degree of health care anyway, and by doing so are adding to the system’s financial strain. Some are not getting that health care, and are either dying or living in perpetual sickness and pain. And much of it is completely unnecessary.

In an interview earlier this month with Denis O’Hayer of WABE radio, the chair of the state Senate Health and Human Services Committee acknowledged the situation.

“You may say, ‘Well, I don’t care about those people, they’re not my next-door neighbor, I don’t relate to them, I have my insurance,” Sen. Renee Unterman, R-Buford, said. “Well, unfortunately, it does relate to you, because you’re paying for those people, You’re paying for them in increased insurance premiums and you’re paying for them with increased taxes.”

A previous opponent of Obamacare and Medicaid expansion in Georgia, Unterman now argues that the state needs to find a politically and financially feasible way of ending its short-sighted boycott of the program.

“How long can you actually sit there and say, ‘No, no, no, we don’t want something,’ and continue to pump hundreds of millions of dollars into sustaining a system that’s not very good anyway,” she asked.

Like Unterman, Gov. Nathan Deal has also expressed a willingness to at least consider Medicaid expansion in the state. However, thanks to a 2014 law passed to reiterate Georgia’s defiance of the federal offer, he no longer has the necessary authority on his own. Any expansion will require legislative agreement, and that is far from guaranteed.

To an important degree, the outcome will depend on this fall’s national elections. Since 2010, Republicans have repeatedly promised their base that they would repeal Obamacare, and they have repeatedly failed. They have also repeatedly promised to produce their own feasible alternative to Obamacare, and they have failed repeatedly at that as well.

If Hillary Clinton wins the White House, as now appears likely, whatever lingering hope the GOP might still have at repealing Obamacare will disappear forever. If Clinton’s margin of victory is substantial and the Democrats succeed in retaking the U.S. Senate and making inroads into the House, even the most stubborn of GOP holdouts may finally concede to reality.


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About the Author

Jay Bookman writes about government and politics, with an occasional foray into other aspects of life as time, space and opportunity allow.