Political Insider

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In search of more Medicaid dollars: 'Go for it, Senator Unterman'

Sunday’s column focused on a budding Republican effort in Georgia, led in part by state Sen. Renee Unterman, R-Buford, to draw down more Medicaid dollars – in order to combat the state’s opioid epidemic. It began thusly:

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.”

The column drew a response from Mike King, a former AJCer who’s now a health care journalist and author of the award-winning book, “A Spirit of Charity: Restoring the Bond Between America and Its Public Hospitals.” As follows:

It’s good to hear state Sen. Renee Unterman seems interested in pushing her General Assembly colleagues – finally – to cover more uninsured Georgians with Medicaid. That’s good news even if her fellow Republicans want to call it a “waiver” and not the dreaded Obamacare name for it “expansion.”

Some of us who have been advocating expansion under the Affordable Care Act are happy with any movement in that direction. Our only lament is that the state has taken so long and wasted so much time and money promoting the Republican Party’s “fake news” pledge to repeal and replace Obamacare once they gained complete control of Congress and the White House.

Still, it’s worth remembering, now that Unterman acknowledges that “the dollars are floating away,” how much the state has already been wasted by adopting the state Republican party line that Obamacare should be obstructed at every possible level.

In the first three years of its existence, when federal taxes were set aside to pay for Medicaid expansion, Georgia turned its back on about $10 billion (that’s billion with a “b”) that was appropriated for the state’s use. Taxpayers in Jersey, New York, California and elsewhere want to say thank you Georgia for helping with their state budgets.

By way of comparison, it’s also worth noting that Georgia has spent enormous amount of time lobbying the federal government – in both the Obama and Trump administrations – to make good on a one-time pledge to provide $640 million to dredge the Savannah River so the port of Savannah could be enlarged.

Take a moment and think about what that says about the state’s priorities: We beg for millions of as yet unbudgeted federal dollars for an economic development program like the port expansion so that the state can benefit from the jobs expansion creates. But we reject billions of federal dollars already appropriated to expand Medicaid for tens of thousands of Georgians, more than half of whom are working in low-wage jobs that do not come with insurance. And we know that lack of access to affordable care leads to increased disability and, when the safety net fails, death.

Keep in mind, as well, that this is money that could have gone to the state’s financially-strapped rural hospitals that take care of some of these very same uninsured Georgians, a crisis state government didn’t create, but clearly deepened by its political decisions. Moreover, that money could have gone to improved community mental health and substance abuse services for the at-risk Georgians who have died or are now addicted to pain-killing drugs, a public health epidemic like no other we have seen in recent years.

Unterman has correctly (even if belatedly) identified the need to assist rural hospitals and provide more services to opioid abusers as two of the reasons the state should now consider some limited expansion of Medicaid. Perhaps she will be able to persuade her colleagues that this little toe-in-the-water effort is worth the abuse they might take from the Georgia Republican party’s anti-Obamacare base. I sure hope so.

But she also worries that it might not be worth the effort if Democrats and health care advocates insist on full expansion. She thinks we are “obsessed” that Medicaid should be expanded the way it was envisioned in the 2010 law and the way some 31 other states have implemented it. (In those states that expanded, any individual earning less than 133 percent of the federal poverty level now qualifies for Medicaid.)

I can’t speak for all of those advocates, but let me just say you won’t get a demand for an all-or-nothing approach from this one. I’ve been waiting for a state Republican to break through the party’s obstructiveness on Medicaid expansion, or a waiver – to use your term – for years. Every little bit helps.

So, go for it, Senator Unterman. It can’t hurt. Because what we aren’t doing now in Georgia is literally killing some of us.

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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.