Don’t fall for the Arkansas model of Medicaid expansion

In ancient Greek mythology, Pandora opened a box just a little bit to see what was there and unleashed terrible evils she never expected. Expanding Medicaid under Obamacare — no matter what name or form the expansion takes — would be opening a Pandora’s box that Georgians would forever regret.

Unfortunately, a once key player in the opposition to Medicaid expansion in Georgia believes we “have to open that box and look just a little bit and see what’s available.”

While I have great respect and admiration for the legacy-building work of State Senate Health and Human Service Chairwoman Renee Unterman (R-Buford), for her championing of policies to advance justice for child sexual abuse and human trafficking victims, I am concerned about her recent change of heart on Medicaid expansion.

Rep. Spencer
Rep. Spencer

It appears that this prominent state senator will be forming alliances with the Georgia Chamber of Commerce to push for a Medicaid expansion model similar to the one implemented in Arkansas, called the “Private Option.” Instead of working for taxpayers, this program, now known as “Arkansas Works,” has done the opposite.

Supporters of this model believe that a Section 1115 Medicaid Waiver, the kind Arkansas received, will give Georgia the ability to expand Medicaid under its own terms, not under those of Obamacare. That is just not true, and the disastrous experiment in Arkansas is proof.

In Arkansas, the state’s experiment with a customized, “not-your-average” Medicaid expansion program has been a terrible boondoggle. It has left Arkansas taxpayers on the hook for nearly $800 million in cost overruns, while pushing the truly needy to the back of the line and leaving the future of the state budget in doubt.

The problem lies in who is covered by Medicaid expansion.

Traditional Medicaid covers the disabled, single mothers and the poorest of our neighbors. These are fellow Georgians who truly need our help, people who don’t have any other options.

Medicaid expansion would cover a different group of individuals: able-bodied, working-age, childless adults. In short, these are Georgians who are fully capable of getting a job that would provide them with private health insurance, but who would instead go onto the state’s Medicaid rolls and become the responsibility of taxpayers.

Proponents of Medicaid expansion claim that it involves federal money that could supplant state spending. The chief proponents of Medicaid expansion say, “If you draw down federal dollars, you can free up some of those state dollars,” which implies that Georgians could save money at the expense of Washington, D.C.


The Arkansas “Private Option” proves that is not the case.

When a state expands Medicaid, it agrees to cover those newly enrolled people, with the support of the federal government. Unfortunately, that federal financial support is set to dwindle over time, and because it is a large line item in the federal budget, U.S. House Speaker Paul Ryan has said that it may become a key target for cuts. The cuts would put Georgia on the hook for covering even more of the Medicaid costs for this new enrollment base.

Furthermore, proponents state that “at some point you have to look at sustainability.” Well, a massive expansion of the state’s welfare program will put “sustainability” in a whole new light.

States that have jumped onto the Obamacare Medicaid expansion bandwagon have felt the financial strain of their growing Medicaid rolls. Costs are more than was expected and enrollment is higher than was estimated, which puts these states’ other programs at risk.

As a state’s costs rise, it has to make up the money elsewhere in its budget. In Georgia, that means programs like education, transportation and public safety could be on the chopping block if the state elects to expand Medicaid, either in the standard way or through a “Private Option” model.

Taxpayers in Georgia already foot a bill of more than $3 billion every year to cover health services through Medicaid, plus an additional $2 billion for services for the aging, for the developmentally disabled, and for programs involving addictive diseases, behavioral, mental and public health. Georgia taxpayers fund 60 percent of all births in the state through our current Medicaid program.


Our Medicaid costs have already grown by 40 percent over the past decade. With increased enrollment through Medicaid expansion, those figures would only get worse.

As a health care provider myself, I see the needs of Georgians firsthand. These are people who aren’t ready for rougher roads, fewer first responders in their communities, and poorer-performing schools just so we can provide health insurance to people who could already get it through the private sector.

As the tale of Pandora’s box has come to signify a source of endless complications, any form of Medicaid expansion would establish a legacy of human dependency and trouble for the state’s fiscal health. Instead, let’s establish a legacy of freedom and innovation in Georgia by rejecting this model of Medicaid expansion.
State Rep. Jason Spencer (R-Woodbine) represents District 180, which includes Camden, Charlton and Ware counties. He was elected to the Georgia House in 2010, and currently serves as secretary of the Special Rules Committee. He also serves on the Game Fish & Parks, Human Relations & Aging, Science and Technology, and Juvenile Justice committees. Rep. Spencer is a Board Certified Physician Assistant (PA-C) and practices primary and urgent care medicine in southeast Georgia.