That’s the question Georgia’s governor and legislators face as they decide whether to expand Medicaid coverage for Georgians.
It’s a decision that was left at Georgia’s doorstep by the U.S. Supreme Court. Last summer, the court upheld the Affordable Care Act, the 2010 health care law. But it tossed out the requirement that states expand Medicaid, giving states the freedom to decide whether to expand Medicaid within their borders.
Georgians may decide that they won’t expand Medicaid. But we have no control over what other states do, and the deal is one that most states won’t be able to refuse. Under terms set out in the Affordable Care Act, states that expand Medicaid will do so at no cost for the years 2014-16. The federal government will pick up 100 percent of the cost of expansion. Long-term, the federal government will continue to pay 90 percent of costs.
In the first three years alone, 2014-2016, it’s estimated that Medicaid expansion would pump $8 billion into Georgia. That money will go directly to doctors, hospitals, clinics and other health care providers.
That’s serious money. Where else will the state find more than $30 billion in new money for Georgia medicine over the next 10 years?
Many know that Medicaid already covers pregnant mothers and children living in poverty, but many Georgians don’t realize that it doesn’t cover the working poor or other childless adults living at or below poverty.
Thirty billion dollars will go a long way toward helping the nearly 2 million Georgians, or 19 percent of our population, who went without health care coverage in 2010-11. Medicaid expansion would cover roughly more than 600,000 of those people. Most are adults who fall into the “working poor” population. They earn no more than $15,000 a year, which is too little to buy health insurance.
People who don’t have health insurance visit doctors infrequently if at all. They go without filling prescriptions. They miss work. Their conditions worsen. By the time they show up at the emergency room of a hospital, where they can’t be turned away, they may be critically or catastrophically sick. The resulting “uncompensated care” at hospital emergency rooms and clinics in Georgia runs $726 million a year.
The uninsured suffer, but we all pay. Some of the cost of uncompensated care is borne by the hospitals, clinics and health professionals that provide the care. The rest is borne by insurers, who pass it along to their customers in the form of higher premiums. In fact, roughly half of uncompensated care — or roughly $363 million a year in Georgia — finds its way into our insurance premiums. (That’s one reason the cost of your health care coverage rises every year.) In other words, we already pay for that untreated care.
Those opposed to expanding Medicaid argue that the state’s portion of that cost — about $250 million a year — is too much. But too much compared to what? The Kaiser Family Foundations estimated in a recent report that the cost to Georgia to expand Medicaid will equal about 1.4 percent of the state budget. For that investment, Georgia can generate more than $30 billion in direct payments to health providers.
As with much else, it’s not whether the state has the money. It’s about the choices that the state must make with the money it does have. Is it wise to deny health care to Georgia’s working poor and turn down money other states will be happy to collect in our place? Is it wise policy to deny that much money from Georgia’s medical for the state’s medical community?
States provide tax breaks because they fear losing businesses. Georgia wants and needs to be competitive. Just last year the state extended for manufacturers an exemption for the sales tax paid on energy used in manufacturing. But manufacturing isn’t the only arenas where Georgia faces competition. Georgia already ranks 44th among 50 states in overall health coverage.
Hospitals, doctors and other health professionals must make decisions about where to set up new buildings or practices, whether to expand a community presence or practice, or even sometimes whether to leave a market and move elsewhere. Isn’t medicine critical to Georgia’s economy, too?
Those are the stakes: health insurance and medical care for more than 600,000 of our fellow residents who don’t currently have access to non-emergency health care and more than $30 billion over the next 10 years in additional revenue for medical professionals and institutions in Georgia.
Can we afford to expand Medicaid in Georgia? It’s getting harder and harder to see how we can afford not to.
Greg Tanner is state director of AARP Georgia. The organization’s website is at states.aarp.org/category/Georgia.