A small, surprising step toward a big change in health coverage?

The bill may not get very far this year, with time running out in the General Assembly session and without the fiscal impact yet studied.

But a Senate health committee broke new ground Wednesday by holding a legislative hearing on a proposal, Senate Bill 368, that would create a Medicaid expansion alternative in Georgia.

The panel’s discussion of the plan represents what experts say is the first time that a bill to pursue expansion or an expansion-like alternative has actually gained a hearing at the General Assembly since the Affordable Care Act was passed by Congress in 2010.

The hearing on the bill, before the Senate Health and Human Services Committee, came as a surprise to many in the health care industry.

No vote was taken Wednesday on the legislation, which is based on Arkansas’ expansion alternative. It’s sponsored by state Sen. Michael “Doc” Rhett (D-Marietta).

Senate Bill 368 doesn’t mention the term Medicaid expansion, and its author deliberately avoided the phrase in connection to his plan.

Sen. Rhett
Sen. Michael Rhett

Instead, the bill calls for the state to run a “premium assistance’’ program for people who earn 138 percent of the federal poverty level or less. These individuals would gain private health plan coverage through the current health insurance exchange, and would be responsible for paying up to 5 percent of their income toward the cost.

The proposal hinges on the federal government agreeing to pay the same level of funding that it does under regular Medicaid expansion.

More than 30 states have pursued expansion, or a variation of it, under the ACA. Georgia’s Republican political leadership has so far stood against such a move, saying it would be too costly to the state.

As a result, though, more than 300,000 Georgians are in the so-called “coverage gap.’’ These people earn too much to qualify for Medicaid under current eligibility rules but not enough to earn subsidies in the health insurance exchange, created by the ACA.

That coverage gap ‘’was one of the reasons I was intrigued by [the bill],’’ said Sen. Renee Unterman (R-Buford), chair of the Senate Health and Human Services Committee.

Rhett said he came to embrace the idea after a trip through Middle Georgia where he noticed that hospitals were a long distance away from a GPS signal.

He told the committee that his proposal could help struggling rural hospitals and economies, and also “provide health care for people who may not be able to afford it.”

Rhett said he based his legislation on Arkansas’ “private option’’ plan.

Through a federal “waiver,’’ Arkansas is using federal funds to purchase private insurance for low-income residents — unlike ordinary Medicaid expansion, which has been done in most states.

Arkansas is among the states that have had the largest reductions in their uninsured rates under the ACA, according to several national surveys. The state has used federal money to buy coverage for more than 200,000 low-income individuals.

Rhett’s plan would create a legislative oversight committee and begin as a pilot program under the Department of Community Health, which runs Medicaid.

At least two health plans would provide coverage in each county, “to make sure no one has a monopoly,” Rhett said.

“This is an opportunity for people to have good health care,” he said, adding that he has requested a fiscal note detailing the costs to the state for such a plan. “I pretty much wanted to start the dialogue,” said Rhett, an educator and a retired Air Force master sergeant.

The consumer advocacy group Georgians for a Healthy Future voiced support for the measure.


Ethan James of the Georgia Hospital Association told the committee that something must be done to address “a crisis of the uninsured in Georgia.”

Yet James also said his organization was committed to the current process of developing an independent study of health care access, sponsored by the Georgia Chamber of Commerce. “We don’t want to rush to get this wrong,” he said.

After the hearing, Sen. Chuck Hufstetler (R-Rome) told GHN that other states had produced “a lot of innovative things’’ in their broadening insurance access with federal funding.

He said he liked the idea of individuals paying a portion of the cost – “having skin in the game,’’ he said. Prevention and wellness programs can produce real savings, Hufstetler said.

Tim Sweeney of the Georgia Budget and Policy Institute said that the bill would “use the marketplace of plans that are out there’’ for expanding coverage. “We are supportive of efforts to do this.”

“Arkansas is a middle ground,’’ he told GHN. “Provider groups have been more supportive because it builds off the private insurance world.”

Matt Hicks of Grady Health System said, “I think hearing Senator Rhett’s bill reflects an authentic concern among senators about how to ensure access to health care for the uninsured in Georgia. It is encouraging to see the Senate begin to deliberate publicly what is the best way for Georgia to transform its health care system and provide access to care for those in the coverage gap.”

A spokeswoman for Gov. Nathan Deal, asked about Senate Bill 368, said Wednesday that the governor does not comment on pending legislation. Deal has long opposed Medicaid expansion.