As a retired health care executive and former state employee, I appreciated the GHN interview with Gov. Nathan Deal. So much so that I...

As a retired health care executive and former state employee, I appreciated the GHN interview with Gov. Nathan Deal. So much so that I would like to comment on a few of the remarks he made.

Jack Bernard

Jack Bernard

He indicates that Medicaid expansion would add 620,000 people to our Medicaid rolls, implying it would clearly be a disaster for the state. Georgia’s uninsured rate, by the way, has been estimated at up to 22 percent, one of the highest in America.

The figures Deal cites regarding the cost of expansion are skewed. Expansion will create 70,000 jobs (mostly private sector). Deal fails to mention the objective Georgia State University study that made this projection. He further ignores the taxes that will be collected by the state, cities and counties as a result of this increased economic activity.

In fact, the Georgia Budget and Planning Institute has stated that, when these factors are taken into account, the net cost of expansion would be only $25 million a year, a very small amount when considering Georgia’s multibillion-dollar state budget.

The governor also states that he disagrees with the one-size-fits-all approach taken by the ACA (Obamacare). He fails to even acknowledge that there are many states with GOP governors or legislatures that have asked for programmatic waivers regarding Medicaid expansion, which have been approved. In other words, these states changed the approach to implementation of the Medicaid provision substantially, tailoring it to meet their exact needs . . . including in some cases converting their state’s Medicaid into a private insurance program.

In the interview Gov. Deal speaks about the importance of K-12 education. How ironic in that he and the state Department of Community Health rolled out a new State Health Benefit Plan that dramatically transferred the cost of teacher/state employee health care insurance from the state into the laps of our poorly paid teachers/state employees. The original plan had the state paying no co-pays, dumping the burden on educators. Amid complaints by the teacher group TRAGIC, the governor reversed course and made a revision. The plan has started making co-payments. However, the deductibles in the plan are still much too high. In fact, for the Bronze plan, the annual deductible for a family is $10,000. The maximum out-of-pocket expense is $24,000.

Regarding the ACA, the American Hospital Association and its lobbyists went along with cuts to hospitals on indigent care funding because it was assumed that many of their existing low-income patients would be on Medicaid when it was expanded, cutting hospitals’ uncompensated care load.

In Georgia, unlike some other states, this offset did not occur, due to Deal’s failure to expand Medicaid.

It makes little financial sense to have Medicaid expansion money, paid for by Georgians via their federal taxes, going to other states to take care of their medically indigent people.


Jack Bernard was the first director of Health Planning for the state of Georgia. He also served as a senior level executive with numerous national health care firms, including Humana, NME (now Tenet), Premier, and MedAssets.

Bernard served on the Jasper County Board of Commissioners from 2005 to 2012. He has been on numerous committees and boards, including the Jasper County Board of Health, and chaired the state Tax and Property Tax Committees of the Association of County Commissioners of Georgia.




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