In my long political career, no threat to Georgia lives has been greater than the current COVID-19 virus, and never have public policy decisions and leadership been more critical to saving lives. Given the current numbers of deaths and hospitalizations, Georgia must deliver healthcare in the absence of having taken advantage of Medicaid expansion under the Affordable Care Act (ACA). Failure to take advantage of the federal ACA Medicaid dollars is the single biggest public policy mistake the state’s leadership has made during my time at the Capitol. To help the most Georgians at this time, what opportunities are available to expand Georgia’s healthcare delivery systems, extend coverage to more Georgia citizens, and save lives?
Since enactment of the ACA 10 years ago this month, Georgia has forfeited some $21 billion federal dollars and will forfeit billions more over the next 10 years by not expanding Medicaid to the state’s approximately 600,000 uninsured, low-income, and working-poor citizens. Under the Kemp administration, the state only recently requested a partial expansion of Medicaid affecting 50,000 Georgians (whose incomes meet 100% of the federal poverty level rather than the 138% required by the ACA). Not only have we left money on the table, the real cost has been in Georgia lives and tax dollars. We know expanded Medicaid has led to better medical outcomes elsewhere. And our federal tax dollars support the Medicaid expansion used by 37 other states. Without Medicaid expansion and the lost federal money, Georgia’s current public health crisis is more severe.
Now all states, including Georgia, are beginning to compete for federal dollars to expand healthcare coverage under the recently passed federal packages. In late March, the State Department of Community Health (DCH) submitted several requests to the Centers for Medicare and Medicaid Services (CMS) for flexibility to manage Georgia’s Medicaid and PeachCare for Kids programs. One such waiver was approved in part on April 2nd and includes flexibility for prior authorizations, appeal timelines, out-of-state providers, and alternative settings to deliver healthcare. If approved, other pending requests would benefit current Medicaid and PeachCare enrollees by waiving premiums and co-payments, providing for increased telehealth, and expanding home- and community-based services. DCH should pursue these waivers with as much pressure as possible to achieve relief. But in such an unusual crisis, we cannot delay taking other actions crucial to saving Georgia lives.
Even assuming the pending waivers are granted, how can we maximize other opportunities to bring life-saving dollars to Georgia as quickly as possible? I propose the following: apply now to expand Medicaid under the ACA; broaden and streamline eligibility requirements for Medicaid under existing federal laws; and pressure Congress to enact immediate legislation that will complete the emergency packages.
First and foremost, Georgia must expand Medicaid under the ACA beyond the current pending waiver application. The recent federal Coronavirus Aid, Relief, and Economic Security (CARES) Act does not fully address those who are uninsured, about 14% of Georgia’s population. Without expanded Medicaid, how will those most in need get healthcare in this crisis? The Kaiser Family Foundation currently estimates the cost of treatment for coronavirus at $20,000. The uninsured are likely to postpone or avoid critical treatment out of fear of the cost. As news outlets are reporting, many of these are the uninsured working poor who are part of delivering essential services and thus more likely to be exposed and avoid hospitalization, thus spreading the disease to others.
Second, with increased demand on Medicaid during this crisis, Georgia should fully implement the Families First Coronavirus Act and draw all potential funding for our existing Medicaid program. The nonpartisan Center on Budget and Policy Priorities recommends ceasing redeterminations, stopping the use of periodic income checks, and ceasing implementations of restrictive waivers. The Center also suggests streamlining mechanisms for new enrollees such as maximizing use of presumptive eligibility.
Third, Georgia’s Congressional delegation should push for additional federal legislation designed to fill gaps that will provide additional life-saving healthcare options for Georgia’s most vulnerable. If the Trump administration does not reopen Obamacare enrollment, large numbers of Georgians will remain or become uninsured at the very moment when healthcare can mean life or death. The National Council of State Legislatures has published an analysis of the CARES Act, estimating that Georgia is entitled to receive $4 billion to address healthcare impacts of the virus under the stimulus package. However, there are gaps that need to be addressed, many of which are in the Taking Responsibility for Workers and Families Act introduced in the U.S. House of Representatives. These include increasing the federal contribution to expanded Medicare from 90% to 100% until the economy improves, expanding Medicaid eligibility, and making it easier for people who lose employer-provided insurance to get other insurance.
Not only are the short-term consequences of our prior decision to refuse expanded Medicaid affecting us in this emergency, the long-term consequences will continue to mount if we do not act. With low tax rates and the economy in a precarious and uncertain position, Georgia can no longer afford to leave federal dollars on the table. On behalf of my constituents and every Georgian, I ask Gov. Brian Kemp, House Speaker David Ralston, and Lt. Gov. Geoff Duncan to use every existing and newly available lever to increase medical coverage to save lives, including taking expanded Medicaid federal dollars. And, please do so immediately.
The Atlanta Journal-Constitution contributing writer, State Rep. Mary Margaret Oliver, D-Decatur, represents District 82.