Good afternoon, and welcome to our AJC Live360 discussion on Georgia's decision not to expand Medicaid under the Affordable Care Act. We've just published a two-part report on that decision -- the first part focusing on the people who fall into the Medicaid "gap" and the second on the policy implications of the governor's decision. Staff writer Misty Williams, who has been covering Obamacare for the AJC for four years, wrote both articles and is here with us today to take your questions.
Let's start, Misty, with a quick explanation of the program itself. A lot of people confuse Medicaid and Medicare.
So what is Medicaid?
Medicaid provides health coverage to the poor and is jointly funded by the state and federal government. It covers 1.7 million low-income children, pregnant women, the elderly and disabled.
It’s costs are big. Medicaid is routinely one of the largest expenses to the state budget. It costs about $8.5 billion a year. The state pays $2.8 billion and the federal government pays the rest.
Medicaid was established in 1965, along with Medicare, the government health program for Americans 65 and older.
What is Medicaid expansion all about?
Expansion is a key part of the Affordable Care Act's goal of extending health coverage to millions of uninsured Americans. Here in Georgia it would have given Medicaid coverage to 650,000 low-income residents, most of them childless adults.
Expansion would cost the state about $2.5 billion over 10 years but bring in $33 billion in new federal funding. The feds pay 90 percent of the cost of caring for these new Medicaid beneficiaries.
However, the Supreme Court ruled in 2012 that the feds couldn't force states to expand. As of right now, 25 states have expanded, Georgia and 18 others have opted not to. Some are still discussing it. States can opt to expand at any time in the future.
Those who are against expanding say the federal government is already saddled with too much debt and can't be trusted to fund Medicaid expansion forever, in which case, Georgia would be on the hook for billions of dollars.
Expansion supporters, however, say that the federal government have always funded Medicaid and there's no reason to believe it's going to stop now. Plus, they say it's foolish to turn away more than $30 billion in new funding that would boost Georgia's economy.
Why do supporters of expansion say it's such a good deal for Georgia?
Good question. A study by Bill Custer, a health care experts at Georgia State University, showed that expansion would create 70,000 new jobs and generate $8.2 billion in statewide economic impact each year.
It would also bring in more than $1.8 billion in new sales, income and other tax revenue, according to Tim Sweeney, a health policy analyst at the Georgia Budget & Policy Institute.
What is the Medicaid gap?
Well, there are about 410,000 very poor Georgians who make too much to be eligible for Georgia Medicaid but too little to qualify for federal tax credits to buy private insurance on the Health Care Marketplace. So they have no health coverage options at all. The feds assumed these folks would be covered by the Medicaid expansion, which was originally supposed to be mandatory, so the Affordable Care Act doesn't extend the tax credit option to them. It was never anticipated that expansion would be optional and states like Georgia would reject it.
The people in the gap make less than 100 percent of the federal poverty level. That's just under $20,000 a year for a family of three.
So, is there any option for care for those 410,000 people?
Georgia does have charity care clinics but they are overwhelmed and many people can't afford to wait for hours to see a doctor because they fear losing their jobs. Some go to emergency rooms because hospitals must treat people whether or not they can pay. Georgia hospitals provide $1.5 billion in free care to the poor every year. We all pay the cost of that in the form of higher hospital bills, higher insurance premiums and higher taxes.
More on who's in the gap. More than half live in working families. 60 percent are people of color. A little more than half are women.
This concludes today's live discussion. Thanks, everyone, for joining us today.