The issue of Medicaid expansion drew its first full-scale 2014 General Assembly hearing Wednesday. As expected, the arguments reflected the passions surrounding the Affordable Care Act, also known as Obamacare.

A House Judiciary subcommittee voted to pass HB 990, which would require the Legislature to approve any expansion of Medicaid here, rather than leaving the decision up to the governor alone. At least for the foreseeable future, this would appear to put another obstacle in the path of expansion in Georgia.

Later, a second GOP-sponsored proposal on Obamacare also won the panel’s approval.

The main sponsor of the expansion bill, Rep. Jan Jones (R-Milton), House speaker pro tempore, said the Medicaid program already costs the state $3 billion a year, and that expansion would add to that tab. “It’s vitally important that [expansion] require a vote of the Legislature.”

Another proponent, Rep. Jason Spencer (R-Woodbine), said Medicaid should switch to more state control under a “block grant’’ in order to prevent patients from “gaming the system.’’

But Cathryn Marchman of Mercy Care, a safety-net health center in Atlanta that treats thousands of uninsured patients, took exception to that language. She told the panel, “Trying to get medical care is not gaming the system.’’

Mercy Care patients include the homeless, people with mental illness and those with multiple chronic health conditions, she said.

More than 80 percent of the Mercy Care patients are below 100 percent of the federal poverty level, and thus would qualify for Medicaid under an expansion, Marchman said.

Georgia is not the only state wrestling with the expansion issue. The Affordable Care Act envisions Medicaid expansion as an important part of changing the U.S. health care system. But the 2012 Supreme Court ruling on the ACA made clear that states could not be compelled to go along. With expansion now optional, roughly half the states have said “yes” to it and half have said “no.”

Under Gov. Nathan Deal, Georgia is in the “no” column, He opposes expansion, citing the cost to the state, and his fellow Republicans who control the Legislature have backed him fully on the issue.

On the issue of how much expansion would cost, the opposing sides gave very different estimates.

Jones told the panel that Medicaid expansion would cost the state $400 million a year, on top of the $3 billion it already spends on the program. Obamacare will lead to “fewer jobs, and fewer hours worked,’’ she added.

Yet Tim Sweeney of the Georgia Budget and Policy Institute, a proponent of the ACA, told the House panel that the state’s net expansion cost would be roughly $35 million a year, when factoring in new revenues created by the move.

That doesn’t include the federal dollars that would supplant state spending in programs such as adult mental health, Sweeney told GHN.

Patient advocates told lawmakers that the state should look to help low-income adults gain coverage. While the health insurance exchange has provided subsidies for people above the federal poverty level, those below that threshold are left without such help if a state doesn’t expand Medicaid.

An estimated 400,000 to 500,000 Georgians are “totally and completely left out’’ of health care reform in Georgia, said Linda Lowe of Families First.

Speakers for conservative groups voiced support for HB 990, including Joel Foster of Americans for Prosperity, who cited the “ballooning costs’’ of the current Medicaid program. “Medicaid needs an overhaul; it does not need an expansion,’’ Foster said.

Carolyn Cosby of Georgians for Healthcare Freedom also supported the legislation, saying, “Expansion of Medicaid is not working. It’s not working because it’s not good health care.’’

Georgia Democrats have criticized the expansion bill as an election-year ploy by the GOP majority.

Senate Minority leader Steve Henson (D-Tucker) said Gov. Deal and the bill’s sponsors are trying to kick the ball out of their court in an election year, WABE reported this week.

Deal spokesman Brian Robinson, though, said expansion “has tremendous budgetary implications,” WABE reported. “It only makes sense that the Legislature, given by our Constitution the power to set the budget, have a say in something so important to the budget.”

Anger over advocacy

The Judiciary subcommittee also approved HB 707, sponsored by Spencer, which would prohibit any unit of the state from spending state funds to advocate for Medicaid expansion.

In addition, the legislation would prohibit the state from operating a health insurance exchange. The federal government now operates the exchange in Georgia, as it does in a number of other states.

Also, 707 would bar  any entity of the University System of Georgia from creating or operating a so-called navigator program. A University of Georgia unit is currently running such a program. Navigators assist people seeking to obtain coverage through a health insurance exchange.

State employees under 707 would be barred from advocating for Medicaid expansion except on their own personal time. That provision sparked a testy exchange between Spencer and Rep. Roger Bruce (D-Atlanta).

That prohibition defies “the whole concept of freedom of speech,” declared Bruce.

Spencer responded that employees can advocate “on [their] own time.’’