House Bill 990 started out the day as what its sponsor called a “straightforward, one-paragraph proposal’’ — requiring legislative approval of any expansion of the Georgia Medicaid program.

But after a committee hearing Wednesday, the bill has acquired a lot of added material: It now has the original Senate-passed foster care reform legislation attached to it.

Sen. Renee Unterman (R-Buford), with a committee substitute, added the foster care language to 990 in a surprise move that reflects the late-session tug-of-war between the state Senate and House over certain key legislation, including the gun-carry bill.

The General Assembly is due to adjourn for the year next Thursday.

Unterman said a House committee Tuesday had stripped “most of the good parts’’ from Senate Bill 350, which she sponsored.
The Senate version calls for privatization of much of the child welfare system, turning over foster care, adoption and case management services to private companies.

WABE reported that the House version maintains that structure, with one major change: A pilot program would be set up in three districts for monitoring over a two-year period in order to make changes before a system-wide rollout.

The Senate version of foster care “is going on a lot of bills,’’ Unterman said.

The Health and Human Services Committee on Wednesday heard testimony from sponsor Rep. Jan Jones (R-Milton) on the Medicaid expansion bill, but took no vote.

Unterman said a hearing was scheduled for early Thursday that would again consider 990, which is widely expected to pass the Republican-dominated General Assembly.

While Medicaid expansion is called for under the federal Affordable Care Act, the U.S. Supreme Court ruled in 2012 that states don’t have to do it. Georgia is one of several states that have turned down expansion.

Jones, the House speaker pro tempore, told the panel that the expansion bill’s intent is to create another bulwark against expansion – “to protect Georgia for the long term from the significant consequences of such a decision on its budget, its citizens and the state economy.”

She called Medicaid expansion “old-style welfare.’’

Georgia is currently one of only eight states that don’t require legislative approval before expansion can go forward, Jones said. She also noted that Gov. Nathan Deal opposes Medicaid expansion.

An estimated 400,000 to 500,000 Georgia residents living under the federal poverty line could receive Medicaid coverage under expansion.

Democratic Sen. Lester Jackson of Savannah asked Jones what she would do for such uninsured people if they don’t get Medicaid coverage.

Sen. Nan Orrock (D-Atlanta) noted that Georgia has a high rate of uninsured people, roughly 20 percent of its population. She also brought up an economic argument, noting a Georgia State University study estimating that expansion would create up to 70,000 jobs in the state.

Jones acknowledged that expansion would benefit some people. But she insisted that overall it would be unaffordable for Georgia. It would mean cutting some essential state services or passing a tax increase, she said.

Putting more people under Medicaid would be an incentive for them to remain in lower-paying jobs so they could keep that coverage, Jones added.

“I think our first priority is to the most vulnerable’’ – those already getting Medicaid, she said.