Democratic candidates for governor are largely unified in their promise to fully expand Medicaid, which has been a longstanding Democratic priority, but that could be complicated as new federal law policy is implemented. the_burtons/Getty Images
Healthcare affordability remains a top concern for Georgia voters as they navigate a crowded ballot this primary election season, but as statewide Democratic candidates rally behind Medicaid expansion, campaign promises could be complicated by federal legislation passed last year.
According to a KFF poll, 72% of Democrats, 63% of independents and 47% of Republicans said the cost of healthcare will have a major impact on which party’s candidate they vote for later this year.
And Georgia voters are talking about it. At an early voting location in Rockdale County, voter after voter pointed to the rising cost of living as their top concern, with some saying rising insurance costs and high copays are squeezing their pocketbooks. Others said they are delaying healthcare appointments and necessary medication so that they can pay household bills or afford food.
“I’m 70 years old, and I have prescriptions that I can’t afford every month,” said retired Rockdale County resident Carolyn Mosely, who said she’s had to forgo buying prescriptions meant to prevent blood clots in the past month despite having “a little side hustle on the side” selling jewelry.
GET THE MORNING HEADLINES.
More than a half million Georgians have also recently dropped their insurance coverage after enhanced pandemic-era subsidies expired at the end of last year, causing premiums to jump for federally subsidized Affordable Care Act plans.
To address the affordability concerns around healthcare, Democratic candidates for governor are largely unified in their promise to fully expand Medicaid, which has been a longstanding Democratic priority.
Former Atlanta Mayor Keisha Lance Bottoms released a multi-page document detailing her plan to address healthcare concerns, which includes scrapping Georgia’s partial expansion program created under Republican Gov. Brian Kemp and fully expanding Medicaid. Former state Sen. Jason Esteves has simplified his messaging to a focus on Georgians’ “health, wealth and opportunities,” but Medicaid expansion is still a top campaign promise. Former DeKalb CEO Mike Thurmond has also prioritized Medicaid expansion, having said Georgia “has left $7 billion on the table because we did not expand Medicaid.” Former Lt. Gov. Geoff Duncan, who served as a Republican but is now running as a Democrat, also now points to expansion as a solution.
Republican candidates, meanwhile, largely sidestep healthcare discussions, and when they do speak to it, they often attack the Affordable Care Act, also known as Obamacare, or say that Georgia can tailor a program that better serves the state. Attorney General Chris Carr, for example, said in April that a “one size fits all” plan puts barriers on what the private sector can do to help provide health insurance. Lt. Gov. Burt Jones pointed to a recent legislative push to roll back restrictions on healthcare business regulations as an attempt to “expand access to healthcare.” Secretary of State Brad Raffensperger argues that “a big government solution will not work for healthcare.” And wealthy healthcare executive Rick Jackson told The Atlanta Journal-Constitution that he is opposed to Medicaid expansion.
Expanding Medicaid would be complicated enough for a potential Democratic governor in a divided government with a Republican-controlled Legislature, but it is even more so now that federal policy from H.R. 1, also known as the One Big Beautiful Bill Act, goes into effect in 2027.
Georgia’s current Pathways to Coverage program, often described as a partial expansion of Medicaid, requires eligible adults to prove they are working or doing another qualifying activity like job training or community service. And, beginning in January 2027, federal law will subject other states nationwide to federal work requirements for Medicaid enrollees.
Leah Chan, director of health justice at the left-leaning Georgia Budget and Policy Institute, said that will mean that “40 other states are going to be implementing a Pathways-style work requirement,” but Georgia will still pay significantly more than those states.
If Georgia were to fully expand Medicaid to 138% of the federal poverty level, which is about $45,540 for a family of four, the federal government would pay 90% of the program’s costs, leaving the state to cover the remaining 10%. Under the current partial program, the federal government pays a 66% match, leaving Georgia to pay about 34 cents on the dollar for Medicaid benefits.
“It just sort of defies logic that we are leaving those federal dollars on the table at a time when we know we’ve got gaps in our state budget that need to be filled because of a pullback in federal funds in other areas,” Chan said, adding that expanding Medicaid would be “a simple change” that moved the eligibility from 100% to 138% of the federal poverty level.
Despite keeping the 90% federal match for states that expanded Medicaid, the new federal law includes new disincentives that could complicate efforts to expand Medicaid in a divided state government. Jennifer Tolbert, a Medicaid and state health policy expert at KFF, a national health policy research organization, said new disincentives are intended to discourage holdout states like Georgia from fully expanding.
“There’s a scenario in which the state could end up losing money because of the restrictions on those other financing mechanisms, even as it gained additional federal dollars by adopting the Medicaid expansion,” Tolbert said.
While the economic benefits under the new federal provisions may be uncertain, there may also not be a substantial increase in coverage if the state expands Medicaid. Tolbert said that since Georgia is already doing something similar to what will be required under federal law, she is unsure that “Medicaid expansion will change the coverage picture that much” in the state.
And whether or not Georgia expands Medicaid, Chris Denson, director of policy and research at the Georgia Public Policy Foundation, a conservative think tank, said that Medicaid expansion would not address the limited number of physicians who accept new Medicaid patients. He also argued that fully expanding Medicaid would likely worsen access to healthcare services by moving some Georgians currently covered by private insurance to Medicaid.
“Those (people) will be kicked off their private health insurance plans, where they have greater opportunity to see a physician, then be put on a Medicaid plan, which only 60% of Georgia physicians are accepting new Medicaid patients right now,” Denson said.
Laura Colbert, executive director for Georgians for a Healthy Future, a patient advocacy group, said that even with the incoming federal changes, expanding Medicaid would still be beneficial for increasing access to care, and it would be “one of the most fiscally responsible actions” the state can take.
“It also supports our health system and creates jobs and produces economic activity, like tax revenue and the like, and so it’s just a phenomenally effective policy solution if you’re looking to help people’s day-to-day lives get easier and boost the economy,” Colbert said.
YOU MAKE OUR WORK POSSIBLE.
