Legislator: Medicaid expansion may get a look

A Republican state senator said Thursday that he believes the General Assembly will hold hearings this year on the idea of Medicaid expansion in Georgia.

Sen. Chuck Hufstetler
Sen. Chuck Hufstetler

“I think there’s a number of Republican [legislators] who are looking for a solution,’’ said Sen. Chuck Hufstetler (R-Rome), after speaking on a legislative panel at an event sponsored by the consumer group Georgians for a Healthy Future.

The conventional wisdom has held that Medicaid expansion would not be a topic of discussion in the Republican-dominated Legislature, which convened this week. The issue barely came up in the 2014 elections.

Gov. Nathan Deal, a Republican, has been a vocal opponent of expansion, saying it would cost the state too much money. And last year, the General Assembly added an additional roadblock to such a move in the future. It passed a bill requiring legislative approval, not simply a decision by the governor, for Georgia to expand Medicaid.

About half the states have expanded Medicaid under the Affordable Care Act, including some led by Republican governors. If enacted in Georgia, it would extend coverage to an estimated 500,000 low-income people.

A way to rescue hospitals?

Another state senator and panel member, Dr. Dean Burke (R-Bainbridge), told the Atlanta audience Thursday that the chances of expansion occurring in Georgia have increased.

He said, “I would say the chances [were] zero” after the end of the 2014 legislative session. He put the chance now at a 5 on a 1-to-10 scale.

Sen. Dean Burke
Sen. Dean Burke

“There’s a chance,’’ Burke told GHN after the event, but he was noncommittal about whether he would support an expansion plan. “The devil’s in the details,” he said.

He also said he wasn’t sure about a potential time frame for such a plan to take shape in the Georgia General Assembly.

Much of the support for expansion focuses on its potential impact on the hospital industry. An expanded Medicaid program would cover more people who are now uninsured, so hospitals would get more reimbursement for treating them.

Georgia’s hospitals face unprecedented financial pressures, and five have closed since 2013.

Burke, who is chief medical officer of Bainbridge Memorial Hospital in South Georgia, said, “Like many hospitals in the state, we’re struggling to stay in the black.”

Hufstetler, a physician assistant, was the lone Republican senator who supported Medicaid expansion last year.

“I would have voted against the Affordable Care Act in Washington,’’ Hufstetler told the audience Thursday. But he added that with the ACA now in place, the state needs to look at what it offers.

“These are the working poor,’’ Hufstetler said of people who would be covered by Medicaid expansion. “We’ve got to find a way to help our working poor.”

Different ways to do it

Other states have implemented various versions of Medicaid expansion, and Hufstetler said Georgia has the advantage of analyzing and comparing those variations.

He pointed to a Medicaid expansion plan in Tennessee, where Republican Gov. Bill Haslam has developed a conservative alternative to standard expansion. The Volunteer State plan would require premiums and co-pays.

The Tennessee Hospital Association has agreed to pay expansion costs beyond what the federal government covers. Haslam has described his proposal as a two-year pilot program that would need reauthorization.

Still, another Republican on the Georgia panel, state Rep. Bruce Broadrick (R-Dalton), said he was concerned about creating a system ‘’that’s so dependent on federal dollars.”

And last week, House Speaker David Ralston (R-Blue Ridge) seemed to pour cold water on further talk of expansion. He told reporters, “I haven’t heard any widespread regret in Georgia on our decision not to expand Medicaid.”

Two Democrats on the panel Thursday expressed their support for expansion.

State Rep. Patty Bentley (D-Reynolds) noted that many of her rural constituents fall into a coverage gap – with too little income to qualify for subsidies in the health insurance exchange. Expanding Medicaid “would be a great benefit to constituents,’’ she said.

Rep. Pat Gardner
Rep. Pat Gardner

State Rep. Pat Gardner (D-Atlanta) said expansion would save state dollars spent on mental health and prisoner health care, replacing it with federal funding.

“I continue to have confidence that the leadership in this state will come around,’’ Gardner said, adding that she hopes the Georgia Hospital Association will take a strong stand in support of expansion.

Hospitals in Kentucky and Arkansas – two Southern states that have expanded Medicaid – have seen a financial boost, officials from those states told the audience Thursday.

Emily Parento of the Kentucky Office of Health Policy said that since that state expanded Medicaid, it has seen an increase of 5,300 health care jobs.

Parento added that hospitals in the Bluegrass State have experienced a $450 million increase in Medicaid revenue in only nine months, along with a 78 percent drop in charity care and a 51 percent drop in self-paying patients. Meanwhile, there has been ‘’a dramatic increase’’ in people using preventive health services such as screenings, she said.

Marquita Little of the Arkansas Advocates for Children and Families said her state’s hospitals have experienced a 54 percent decline in uncompensated care costs in the first six months of expansion.