Posted: 6:26 pm Wednesday, June 11th, 2014

Lifting the lid on the debate over Medicaid expansion 

By Jim Galloway

Early this week, a small panel assigned the task of saving rural health care in Georgia gathered to take a first crack at the problem.

Four rural hospitals have closed since 2012, eight since 2000. The finances of another dozen or so balance on a razor’s edge, the panel was told.

A bit of Malthusian arithmetic for you: Jimmy Lewis, CEO of HomeTown Health, a Georgia collection of health care facilities, says a community of 40,000 is required for the independent operation of a hospital.

Rural Georgia has 1.8 million people – enough for 45 hospitals. “We’re down to 55,” Lewis said afterwards. Only ten to go.

The solutions discussed were notable for what wasn’t considered – an expansion of Medicaid coverage offered under the Affordable Care Act, as many hospitals would like to see.

One reason: The panel was appointed by Gov. Nathan Deal, who views an extension of federally subsidized health coverage for the uninsured as a fiscal trap that state governments ultimately won’t be able afford.

Another reason: HB 990, passed this spring by the Republican-dominated Legislature and signed by the governor, gives state lawmakers final approval when it comes to Medicaid expansion. “The Legislature took it off the table,’’ said a somber state Sen. David Lucas, D-Macon, a panel member.

But did it? As the panel deliberated on Monday, Deal’s Democratic challenger, state Sen. Jason Carter of Atlanta, stalked the health care halls of Montezuma, Ga., site of a recently closed hospital.

There, Carter not only declared Medicaid expansion to be very much on the table, but a fiscal necessity. “It’s our money and Nathan Deal wants Washington to keep it. That doesn’t make sense to anyone, certainly not here,” the state senator said.

The Democrat has an uphill argument. Republicans, as their 30-second ads attest, think it is enough simply to link Carter’s name to “Obamacare” – antipathy toward the president is presumed to be that strong in Georgia. Carter, on the other hand, requires his audiences to do the math.

“Every single day, our governor takes $9 million in our taxpayer money, our tax dollars that we pay to the federal government, $9 million a day, that he sends off to other states, to give health care to those people – and denies it to 600,000 people in Georgia,” Carter recently argued to a group of supporters in Savannah.

But if Medicaid expansion remains in the grips of a Legislature in which Republicans outnumber Democrats by 2-to-1, or close to it, then Carter’s calculations become moot. Right?

Which brings us to the loophole. As signed into law, HB 990 requires the General Assembly to approve any expansion of Medicaid “through an increase in the income threshold.”

Other states have cut different deals with the federal government. Arkansas, for instance, uses the federal subsidy to purchase private health care insurance – not Medicaid coverage — for those who can’t afford it.

At this writer’s request, state Senate Democratic Leader Steve Henson of Tucker consulted with one of the many lawyers who draw up bills for passage in the Capitol. “She did think there are ways you could expand Medicaid through an Arkansas-type plan without legislative approval,” Henson said.

So a go-it-alone strategy for a Democratic governor might be feasible when it comes to expanding health care in Georgia. But “could” and “should” aren’t always the same thing.

“The letter of the law gives the General Assembly a say over expanding Medicaid,” said Brian Robinson, a spokesman for the governor. But he, too, appeared to acknowledge the possibility that HB 990 may not be the airtight lid that many have said it is.

“Any workaround that would expand an entitlement connected to the Affordable Care Act without legislative approval would violate, at the very least, the spirit of the law,” Robinson said.

Carter himself walked the same delicate ground in this statement issued by his campaign on Wednesday: “Jason will work with the General Assembly and anyone else who wants to stop sending $9 million a day of Georgia taxpayer dollars to Washington.”

Alan Essig is the executive director of the Georgia Budget & Policy Institute, which provides much of the data used by Democrats in their debates.

Expanding health care through the ACA, regardless of how it’s done, would amount to such a major policy shift that the General Assembly would have to give its approval in some fashion, Essig theorized.

Any governor would have certain tools. “The governor can veto other things. The governor can hold things hostage,” Essig said. “There’s a political aspect to this that will have to play out. It’s not going to be easy, that’s for damn sure. But it’s not impossible.”

Even should Carter break the Democratic drought and win the Governor’s Mansion, the expansion of Medicaid would become one of several issues subject to the same dynamic, Essig said.

“The state of Georgia has never had a governor from one party, and a united General Assembly from another,” he said. “They’ve never had to do that kind of negotiation before. But other states have to deal with that in an on-going basis, and things get done.”

In other words, Essig concluded that when it comes to health care, “HB 990 is not the end-all, be-all of the discussion. It’s the beginning of the discussion.”

127 comments
EP1
EP1

With cuts to education and the rejection of Medicaid expansion, I guess that means we prefer an uneducated and sick population that can carry weapons wherever they desire. I'm pretty sure that is a way to keep business from wanting to move to Georgia. I guess that article about Georgia being number one for business that the governor is touting is wrong. What on earth are our state legislators thinking?!?!? Obviously, and unfortunately, they are not.

HeatherBurns
HeatherBurns

Why don't you start telling people the truth. How much will the people of the state lose when all of those previously eligible for Medicaid and not enrolled, enroll in order to comply with the individual mandate, thereby leaving the people stuck with 30-45% of the increased costs (It only covers 90% for NEWLY eligible)? And given the enormous debt of the Federal government now, what guarantees are there, for the people, of any state for that matter, that the Federal government will not reduce their share of the payments in the future, once again leaving hard working Americans to foot the bill? And since the program is only "fully" funded, for NEWLY eligible adults, until 2017, "fully" funded for CHIPS to the end of this year (with only the OPTION of extension to 2019), when it will have to be re-legislated, again, I will ask, what will be the true cost? Exactly how many people, right now, are eligible, and not enrolled? Surely you can,at the very least, give an honest answer to that question.  The people have a right to know exactly how much more of their hard earned money they are going to be forced to give up because of the economic ineptitude of bleeding heart progressives. 

The Governor has the right of this.  

GaBlue
GaBlue

Our legislature passed HB990 because they are worried that their buddy, the most corrupt Governor in the United States, will lose his bid for reelection, and we'll get a Democratic Governor who -- unlike most of them -- actually gives a rat's fuzzy whether people can get the access to healthcare they need to survive.


I asked one of my legislators about this bill directly. He danced around with a bunch of rhetorical nonsense. I pressed him for an answer: What is the real purpose of this bill?  He man'splained to me that the Governor "does not have that authority," and tried to move on.


I asked the obvious question, "If the Governor doesn't have that authority, then why is this legislation necessary?" 


A: Stammer stammer stammer, change the subject.

lithoniaguy
lithoniaguy

THE REPULICAN HEALTHCARE PLAN: ......DEATH!

lithoniaguy
lithoniaguy

I wish you white reporters would just tell the truth bout the reason the racist birther gop is not expanding Medicaid. ITS BECAUSE OF THEIR HATRED OF HAVING A BLACK PRESIDENT. But most reporters be they liberal, moderate, or rightwing are white. And all the media is ran by whites too which means they will sweep the truth under the rug just like Galloway is doing.

lithoniaguy
lithoniaguy

Sorry rural Georgia but the fact that the racist gop hates the black president means the repubs would rather u die than expand Medicaid. Just like the racist gop would have let Bergdahl die because of their hatred of  the black president.

hamiltonAZ
hamiltonAZ

There was a time in this state when our people cared enough about other people in this state that their representatives passed a law that permitted communities to establish local "hospital authorities". These authorities would work to establish a local hospital and own it for the people. The authority would act as a transfer account for funds between the state and the hospitals.

It was clear from the outset that rural hospitals would depend in large part on state support, but the people of Georgia thought that it was a decent, worthy endeavor. The laws permitted local, non-profit hospitals to be exempt from paying property, sales, or income tax.

In exchange for the exemption, the hospitals were expected to give back to their community in other ways - health screenings, financial assistance, universally available emergency rooms, and participation in Medicare/Medicaid.


The Medicaid position taken by the legislature and the governor today is an affront to the decency shown by their predecessors.

StraightNoChaser
StraightNoChaser

I do believe this is a case of cutting of your nose to spite your face....Rural Georgians are the ones who voted for the piece of work that now occupies the governors mansion.  I hate to say we told you so but here it goes anyway....We told you so!

Jefferson1776
Jefferson1776

Ga will need the money,  more folks are signing up for the existing program that qualify due to awareness.  Take the money.

Eustis
Eustis

td1234 asks:

"Lower taxes or Medicaid?"

"More businesses being motivated to move to Georgia or Medicaid"

I ask:

Where will businesses locate when there is no hospital nearby?

Eustis
Eustis

Has anyone ever said we can't afford it about anything other than medicaid expansion?

JackClemens
JackClemens

"One reason: The panel was appointed by Gov. Nathan Deal, who SAYS HE views an extension of federally subsidized health coverage for the uninsured as a fiscal trap that state governments ultimately won’t be able afford."


Fixed it for you. His real reason is the GOP anti-Obama agenda.

StraightNoChaser
StraightNoChaser

@HeatherBurns Nice spin because that's exactly what the GOP has been good at doing to block healthcare.  You guys love to talk about cost but you never include what the states will save by sharply reducing the number of people without health insurance, the law will result in a decline in state and local costs for hospital care for the uninsured.  According to the urban institute In 2008, state and local governments shouldered $10.6 billion, or nearly 20 percent, of the cost of caring for uninsured people in hospitals.  By reducing the number of uninsured people, the law also will push down state costs in providing mental health services to the uninsured.  State and local governments provided 47 percent of the funding for state mental health agencies, amounting to $14.7 billion, in 2006.  Your governor that you are so fond of knows this his plan for the mental health is to dump them on the street because the CEO for the hospital I work for gave him notice last year that unless the states comes up with money to take care of its mentally ill this is exactlty what will be happening.  Guess what they will be coming to a neighborhood near you.  So when you tell a story tell the whole story not part of the story.

Kamchak
Kamchak

@GaBlue 

Our legislature passed HB990 because they are worried that their buddy, the most corrupt Governor in the United States, will lose his bid for reelection, and we'll get a Democratic Governor who -- unlike most of them -- actually gives a rat's fuzzy whether people can get the access to healthcare they need to survive.

Yeah, pretty much.

DS
DS

@GaBlue, that's interesting. I'm glad you got the chance to ask.

It seems to me the legislature would have to be involved in Medicaid expansion anyway, even without this bill, to approve funding legislation. What am I missing? I wonder how legislators feel about that.

Anyway, it would be painful for everyone, legislators too, if we see more hospitals close unnecessarily just because of Nathan Deal and his cranky ideology.

td1234
td1234

@GaBlue Nope, they passed it to take the issue off the table for the Governor's election.


All the progressives sound like idiots wanting to elect Carter to expand Medicaid when he can not do it if he was elected. 



HeatherBurns
HeatherBurns

@lithoniaguy ... and 79% of American voters (legal, that is) are WHITE.  How did Obama get elected if we are all racist "birthers"?

The GOP doesn't want it passed because they actually understand economics.  All of the people eligible for Medicaid right now, who are not signed up, will cost the state up to 45% of the plan.  The expansion only covers 90% of the plan for the NEWLY eligible. 

So when "Gov. Nathan Deal, who views an extension of federally subsidized health coverage, for the uninsured, as a fiscal trap that state governments ultimately won’t be able afford," he is absolutely correct; and serving his constituents (that's you) very well, in this matter.

lithoniaguy
lithoniaguy

@hamiltonAZ its called "FEAR OF THE BLACK PRESIDENT!" They would rather people die just to spite the president. As a black man that's plain to see.

The_Centrist
The_Centrist

@StraightNoChaser - Nothing close to a majority of voters in rural Georgia are demanding an expansion of Medicaid.  That would be mostly ITP Atlanta urban liberals.

The_Centrist
The_Centrist

@Eustis - Businesses have already shunned areas where there is a dirth of qualified labor.  These rural areas have higher than average high school dropouts who mostly work on farms and in support businesses for farms, and there is not enough potential educated workers to support larger start up industries.  By definition rural areas also lack required utilities, rail, and air transportation.  Whether the local hospitals are financially unsound without added government support does not factor into such start-up business decisions.

honested
honested

@Eustis 

The entire business siting argument is just another wrong-wing strawman anyway.

Spread the net job shift back to the beginning of the republican regime and, at the current rate, we should be back to the employment levels of 2001..........in about 2025!

Wascatlady
Wascatlady

@Eustis There are many, many things we "can" afford other than medicaid expansion.  For example, we can afford a dollar for dollar tax money reroute to private schools for "scholarships,"  many of which just so happen to be awarded to family members of those rerouting their tax dollars.

honested
honested

@JackClemens 

Leadership must always take a back seat to retribution in 'modern' Georgia.

The-Centrist
The-Centrist

Absolutely correct.

Perhaps the fever will break in two years, although I wonder if the GOP anti-Clinton agenda will be just as fervent and just as irrational.

GaBlue
GaBlue

@DS


Thanks. I make a point to ask questions of my legislators. I wish more people would. It's amazing what they try to pass off as information, and how little they want to comment on the actual bills themselves. Like I said, this GOP State Senator kept dancing around what is -- always -- a valid question: "WHAT IS THE PURPOSE OF THIS BILL?"  And as usual for this particular little poser, his answer made no *bleep* *bleep* sense at all.

honested
honested

@td1234 @GaBlue 

Elect a Governor who would follow the will of Georgians?

Never!

We must have a Governor that will follow the will of outside political agitators!!

StraightNoChaser
StraightNoChaser

@td1234 One more time the right has chosen to use the United States Constitution as toilet paper...Apparently this is a regular occurance when it does not serve their pupose of using it as a punch line for a right wing pep rally and putting it away afterwards. 

GaBlue
GaBlue

@td1234,


Thank you for confirming what I knew. They voted to take the authority away from the Governor because they did not want the people of Georgia to be able to vote their own best interests on this issue -- which would have been against their buddy, the uber-corrupt Shady Deal. 

Corruption is the Georgia GOP's bread and butter. Honoring their fake Christianity to help the poor and the sick does not line their fake Christian pockets, so.... "NO MEDICAID FOR YOU, PEASANT SCUM!"

lithoniaguy
lithoniaguy

@The_Centrist @StraightNoChaser yeah they like dying rather than admit they need help from a NWORD president...BUT THEY LOVE THE BULLDOGS though. a team of mostly black players that give these racists a false pride built on the athletic shoulders of people they actually hate.

The_Centrist
The_Centrist

If Medicaid expansion was a hot button issue with voters, the legislators would either do it or be in jeopardy of losing their jobs.  Same goes for the Governor.  Deal will be re-elected by a landslide margin and the House and Senate will again be overwhelmingly Republican without Medicaid expansion.

Kamchak
Kamchak

@The_Centrist 

Nothing close to a majority of voters in rural Georgia are demanding an expansion of Medicaid.

Got proof?

DS
DS

@The_Centrist, one might think so, but polling cross tabs actually show fairly consistent support for Medicaid expansion across Georgia.

For example, the SurveyUSA cross tabs show support numbers of 61% in Metro Atlanta, 57% in North Georgia, and 58% in South Georgia.

With more town hall type meetings and local reporting, I wouldn't be surprised to see the rural numbers overtake Metro Atlanta, especially in South Georgia, which faces the greatest risk.

StraightNoChaser
StraightNoChaser

@The_Centrist Either this is an outright lie "Four rural hospitals have closed since 2012, eight since 2000. The finances of another dozen or so balance on a razor’s edge, the panel was told." or Atlanta urban is now Atlanta rural.  Do you even know the difference between urban and rural? 

 What good are lower taxes and a bank account full of money if you are sick and can't get to a nearby hospital?  Your health is your wealth without it money has no value. 

Kamchak
Kamchak

@The_Centrist 

Businesses have already shunned areas where there is a dirth[sic] of qualified labor.

By definition, what is a dirth?

DontTread
DontTread

@The_Centrist @Eustis  "By definition rural areas also lack required utilities, rail, and air transportation."


By whose definition?  When I drive in rural areas, I see power lines, railroad tracks, and airfields.  Go look at Google Earth sometime...

Ralph-43
Ralph-43

@Wascatlady @Eustis  We were also able to afford a parking lot at the new football stadium so those box-seat holders will not need to take MARTA. 

StraightNoChaser
StraightNoChaser

@The-Centrist  No need to wonder the GOP attack dogs who are attacking the president are from the President Clinton era... Rush Limbaugh and Newt Gingrich have been at it a long time.  Newt Gingrich attacked President Clinton on Monica Lewinsky while he was banging his staffer on his sick wife and had to resign in shame as speaker of the house before his own sex scandal broke.  Sean Hannity is the new kid on the block he was busy hanging out with Hal Turner at the time.  Want to know who Hal Turner is?  Google him.  Enough said.

The_Centrist
The_Centrist

This is a screen name stealing, liberal hypocrite sock puppet.  While it shows his/her lack of integrity and ethics, it also shows how far at least this one leftist will go with such "debate" tactics and those who won't condemn them.

td1234
td1234

@GaBlue I thought our Constitution was clear. It is the legislature that appropriates and spends money and it is the governors duty to run the government. 


Where did I get the concept wrong? 

Kamchak
Kamchak

@The_Centrist 

 If Medicaid expansion was a hot button issue with voters, the legislators would either do it or be in jeopardy of losing their jobs.  Same goes for the Governor.  Deal will be re-elected by a landslide margin and the House and Senate will again be overwhelmingly Republican without Medicaid expansion.

Deflecturbation

You used a lot of pixels when you could've just posted no, you had no proof.

StraightNoChaser
StraightNoChaser

@The_Centrist If you say so, I do believe Eric Cantor got served by relying on polling. 

td1234
td1234

@StraightNoChaser And it is all Obamacares fault because they cut the grants to these Hospitals because they thought they could force all states to expand Medicaid. The SCOTUS said that was unconstitutional and Obama did nothing to remedy the problem.

The_Centrist
The_Centrist

@DontTread - Not to the scale that businesses require.  Look at the KIA investment in West Point.  Large interstate leading to LaGrange and Hartsfield to the north and Auburn and Columbus to the south.  

Those wide rural areas between I-85, I-75, I-95 and I-20 lack the population and infrastructure required by start-up businesses.

Charles50
Charles50

@StraightNoChaser and to add to Hannity's resume, to me he doesn't have an original thought in his brain.  He appears to simply parrot everything Rush Limbaugh says.  That's all he did even when he was here in Atlanta.  The only difference is he a little younger and better looking than Limbaugh.  I'm guessing that's the only reason he's still on the air.

Bearhand
Bearhand

@The_Centrist Wasn't there originally a screen-name of TheCentrist and you had to settle for The_Centrist?

hamiltonAZ
hamiltonAZ

One poll has Georgia 54 to 38 in favor. Recent one has 59% favoring expansion, 32% opposed, 9% stoned and don't know.


Guess here is there's quiet support that won't show up in polling. Public disagreement from the party line on any issue, risks being labeled RINO.

The_Centrist
The_Centrist

@StraightNoChaser - Primary elections with low turnout make it too hard to pinpoint likely voters.  General election polls are more accurate.  And Cantor lost from the right, not the left (too bad - more moderation is needed instead of deeper divisions).  There are NO political pundits who study polls, campaign funds, trends, and voting patterns who predict a single Democrat to win state-wide office in Georgia in 2014.  Only partisans dreaming here.  Any want to predict either the GA House or Senate will flip to the Democratic side this year?

StraightNoChaser
StraightNoChaser

@td1234 If what you say is true a good governor would have been able to access the damage and not sign HB990 which in the end hurts his own constituents. Pathetic is what I call your post, you can't use the Obamacare excuse anymore it's obvious that Deal is not the smartest guy in the room.  I wonder if rural Georgians will hold there nose and still vote for Nathan Deal.....Ooops my bad they already cut their nose off to spite their face. 

StraightNoChaser
StraightNoChaser

@Charles50  Make no mistake about it the GOP knew exactly what they were doing when Sean Hannity was placed in its talk show circuit.  He has one purpose and one purpose only because of his ties with Hal Turner and that is to indoctrinate other people like him and Hal Turner.  It has nothing to do with his looks, he's their daily dog whistle.

td1234
td1234

@lithoniaguy Nope, it is Obama's fault for not respecting the 10th Amendment and thumbing his nose at the SCOTUS. 


Just because you want it to be so does not mean that we have a dictator in this country. 

lithoniaguy
lithoniaguy

@td1234 @lithoniaguy thanks for agreeing with me. and why do every con think theyre as constitutional expert? I guess listening to a addict like Limbaugh makes u an "expert". and just admit u hate it because a black man is in the white house...but at least u have PUTIN...