Medicaid Expansion Becomes Election Issue in Rural Georgia

In the runup to November’s gubernatorial election in Georgia, Democrat Stacey Abrams has made Medicaid expansion an important part of her pitch to rural voters. Her opponent, Republican Brian Kemp, opposes expanding the program, instead favoring a tax credit for businesses and individuals who donate to struggling rural hospitals. Incumbent Republican governor Nathan Deal is term-limited and not running for re-election.

Under the Affordable Care Act, the federal government provides millions of dollars to states that choose to expand their Medicaid programs to individuals with incomes below 138 percent of the poverty line, or approximately $16,000 per year. Georgia was one of 19 states that did not expand Medicaid. If the state expanded Medicaid, 500,000 uninsured people would become eligible for the program – representing the third-largest potentially-eligible population among non-expansion states.

Ms. Abrams has estimated the eventual cost to Georgia of Medicaid expansion at approximately $300 million per year, which she argues would be partially offset by savings in other areas. “It is economically false, a falsehood over all, to say we can’t afford to expand Medicaid,” she said at a recent campaign event.

Mr. Kemp and other Republicans, however, dispute these claims, estimating that Medicaid expansion could cost more than $450 million annually and preferring to expand the state’s tax credit program from $60 million to $100 million dollars each year. Ms. Abrams, who has called the Republican plan “a Band-Aid,” downplays Medicaid’s cost to Georgia, emphasizing that the federal government would shoulder 90 percent of the burden of expansion.

Ms. Abrams’ political calculation reflects the increasing popularity of expansion, particularly in non-expansion states. According to an October poll from the Kaiser Family Foundation, a majority of people (56%) across the 17 Medicaid holdout states favor expanding the program, and a January 2018 Atlanta Journal-Constitution poll found that 75 percent of Georgia voters favor Medicaid expansion. Additionally, recent research suggests that low-income rural populations would particularly benefit from the program’s expansion.

Source: The New York Times, October 20, 2018.