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One year later, an opioid epidemic could change Georgia's Medicaid debate

Wednesday will mark the first anniversary of Donald Trump’s election as president of the United States. By no coincidence, it will also be the first anniversary of the last time an expansion of Medicaid was a political possibility in Georgia.

In the fall of 2016, anticipating eight years of Democrat Hillary Clinton in the White House, a task force organized by the Georgia Chamber of Commerce put together a cafeteria-style package that offered three Republican-friendly ways that health insurance coverage could be extended to poor Georgians under the auspices of the Affordable Care Act.

With Trump’s unexpected victory, the chamber initiative was quickly shelved, and we began waiting for a GOP-controlled Congress to repeal and replace Obamacare and install a new health care order. We are still waiting.

Given this current state of limbo, arguments are building in our Republican-controlled state Capitol for a renewed effort to draw more federal Medicaid dollars into Georgia – and perhaps save a rural hospital or two.

The motivating logic: Barack Obama is no longer in the White House. And Georgia is neck-deep in an opioid epidemic that is draining away both lives and money.

“You can’t control what happens in D.C. But you can control what happens in the state,” said Renee Unterman, R-Buford, who chairs the state Senate Health and Human Services Committee. “The dollars are floating away.”

Fans of Obamacare wouldn’t call what Unterman is pitching an expansion of Medicaid. That would involve the offer of Medicaid coverage to all adults, from age 18 to 65, with incomes of 133 percent of the federal poverty line.

And that is fine with Unterman. Because as sacred as Medicaid expansion is to many Democrats – that’s how poisonous the phrase remains among Republicans.

Medicaid expansion “is when you open the barn door and allow everyone in, and balloon the program,” Unterman said. “But if you have targeted programs that specifically have good outcomes, and you can prove those outcomes — I don’t have a problem with that.”

Seeking a “Medicaid waiver” has become the proper Republican term.

Unterman has two narrow targets: Young people with behavioral problems, and those who are dealing with opioid addiction. Often they’re one and the same.

“It’s not opening up the door for a million people. It’s opening up the door for a hundred thousand high-flyers who you know you’re spending a lot of money on,” the health committee chairman said. “Let’s bring the cost down. Let’s give them a better quality of life. To me, it’s just compassion.

“We all wanted repeal and replace. We’re all disappointed we didn’t get repeal and replace. But now it’s time to move on,” Unterman said.

Unterman is a member of a health care reform task force backed by Lt. Gov. Casey Cagle, a Republican candidate for governor. A new Medicaid program and funding for the treatment of opioid addiction in Georgia is one of several possible recommendations that could come later this month.

Any such request for new Medicaid dollars would have to be made through a term-limited Gov. Nathan Deal. In 2014, the General Assembly insisted on legislation that requires its approval for any expansion of Medicaid in Georgia. Unterman thinks that could be as simple as a vote in favor of a state budget that incorporates the waiver. Others are likely to disagree.

President Trump gave Georgia Republicans some cover last week, when he declared the opioid epidemic to be a national health emergency that is claiming nearly 100 lives a day. But that declaration came with no additional funding.

The state Capitol has already been dealing with the costs of the epidemic. On Wednesday, a ribbon-cutting ceremony celebrated the $6.68 million expansion of the GBI morgue in Decatur, which had been overwhelmed by the OD’d dead.

A quarter of all overdose deaths this year have been attributed to fentanyl, a powerful synthetic opioid. An airborne flake can kill — which means law enforcement investigators must don the same expensive hazmat suits that they would for the Ebola virus.

Unterman and I are of an age. I can’t say the same, but she is a confessed former flower child of the ‘70s. “I smoked marijuana. I made bad decisions, but my bad decisions didn’t kill me,” she said. “Now, one pill with one synthetic derivative on top of that pill can kill you. There’s no turning back.”

Doses of naloxone, an effective antidote to fentanyl, can cost more than $15 per. Multiple doses can be required to resuscitate some overdose victims. That’s one of the costs that Unterman hopes Medicaid might be able to cover.

The question is whether the urgency of the situation can overcome our polarized politics. That Obama no longer figures in Obamacare makes the lift somewhat easier, Unterman said. That Tom Price, a former Georgia congressman, is no longer secretary of the U.S. Department of Health and Human Services makes the task somewhat harder.

“You’ve got the far left. They’re just obsessed with Medicaid expansion. And then you’ve got the far right that is just as obsessed about hating everything that happened,” Unterman said. “If you can’t find the middle ground with mothers and fathers that are losing their children, then you don’t need to be here, in my opinion.”

Click here to listen to an interview with state Sen. Renee Unterman with Denis O'Hayer of WABE (90.1FM) on the opioid epidemic.

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About the Author

Jim Galloway is a three-decade veteran of The Atlanta Journal-Constitution who writes the Political Insider blog and column.