By Dr. Harry Heiman Last month, Gov. Brian Kemp revealed two new health care waiver proposals. While they were presented as Georgia-focused solutions to... Health reform plans would spend a lot for very little

By Dr. Harry Heiman

Last month, Gov. Brian Kemp revealed two new health care waiver proposals. While they were presented as Georgia-focused solutions to improve health care access and affordability, the current proposals fail to meaningfully address either problem.

Unfortunately, our state leadership is missing an opportunity to expand access to care, stabilize rural and safety-net hospitals, and leverage federal funding to not only improve health, but support economic development and new jobs.

It’s astonishing that our state paid Deloitte consultants almost $2 million for a plan that costs so much and accomplishes so little. This is especially disturbing, because Georgia’s health problems are real and the policy solutions well within our reach.

Georgia has urgent health and health care problems that need to be addressed.

They include the fact that 1.4 million Georgians, almost one in seven, including 217,000 children, have no health insurance, placing us third worst in the country. Georgia also has lagging in health outcomes, with high rates of diabetes and cardiovascular disease, high rates and profound disparities in both infant and maternal mortality, and the challenge of an opioid epidemic that in 2017 alone led to more than 1000 deaths in our state. While many states have used Medicaid expansion and the Affordable Care Act to expand health insurance coverage and affordability, improve health outcomes, and address their urgent health challenges, Georgia’s leadership has consistently failed to act.

Expanding Medicaid would provide access to affordable health coverage to more than 500,000 low-income Georgians, and would be paid for at least 90 percent by the federal government. This includes more than 400,000 people who currently fall into the coverage gap, with no affordable options because they make too little to qualify for subsidies in the health insurance marketplace.

Medicaid expansion has been shown to support health and financial stability in low-income families, improve health outcomes for parents and children, and improve access to both mental health and substance use treatment. And while rural and safety-net hospitals have stabilized in Medicaid expansion states, in non-expansion states like Georgia they continue to struggle and sometimes close.


The 1115 waiver proposed by the governor in place of Medicaid expansion would lead to new coverage for an estimated 25,000 to 50,000 people. It also would include a significant administrative burden for both participants and the state to document work status. While there is a compelling relationship between employment and health, the experience of Arkansas and other states clearly shows that making documentation of work status a prerequisite for health insurance coverage creates a barrier to both. Ironically, the cost to Georgia to increase coverage for a modest 50,000 people, as proposed in the waiver, is higher than the cost of Medicaid expansion, which would cover more than 500,000 people.

Kemp also proposes using a 1332 waiver to lower health insurance costs by developing a state reinsurance pool to offset the costs of claims in the individual insurance marketplace. This, by itself, is a good policy proposal. Yet the governor undermines this approach by also proposing to use subsidies to pay for policies that lack coverage for critical areas of care, like maternity care and mental health and substance use treatment. That the governor would propose subsidizing non-ACA-compliant policies at a time when Georgia leads the nation in maternal mortality and faces the continuing challenges of untreated mental health and substance use disorders is unfathomable.

Gov. Kemp promised to put Georgia in the lead in the national conversation about health care reform. He succeeded — everyone is talking and wondering why our state would want to spend so much to accomplish so little. Unfortunately, his waiver proposals appear designed for political talking points at the expense of meaningful policy action. The citizens of Georgia deserve better. Our dismal health outcomes demand that we do better.

Dr. Harry J. Heiman is a clinical associate professor in the Department of Health Policy and Behavioral Sciences at the Georgia State University School of Public Health. Prior to joining GSU, he served as Director of the Division of Health Policy at the Satcher Health Leadership Institute at Morehouse School of Medicine, where he was also  associate professor in the Department of Family Medicine. He also serves on the board of Georgians for a Healthy Future, a statewide consumer health advocacy organization.

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