“Louisiana rolls out Medicaid expansion; can it be a model for Georgia?”

By Tom Crawford

On June 1, Louisiana became the first southern state bordering the Gulf of Mexico to launch a Medicaid expansion program funded through the Affordable Care Act.

That happened because of the upset victory last fall of Democrat John Bel Edwards in the governor’s race.

Where outgoing governor Bobby Jindal denounced Obamacare and refused to expand Medicaid coverage, Edwards ran against Republican David Vitter partly on a pledge to bring healthcare coverage to more low-income Louisiana residents.

In a little more than two weeks, more than 200,000 people have already signed up for Medicaid coverage and Edwards’ goal is to attract at least 375,000 enrollees to the program.

Louisiana’s rollout campaign is being closely watched by people in other states where Medicaid expansion so far has been a non-starter, including Georgia.

“They have experienced great success and appear to be well on their way to meeting their July 1 enrollment goals,” said Beth Stephens, the access program director for the consumer organization, Georgia Watch. “It’s wonderful to see a nearby southern state experience this level of enrollment success in such a short time.”

Amanda Ptashkin of Community Catalyst, a healthcare advocacy organization, said many of the enrollees have signed up through federal waiver programs that were already in operation at several locations around the state.

Edwards’ administration also devised a way to work around the Republican-controlled legislature’s refusal to appropriate funding for administrative expenses related to Medicaid expansion. They had Louisianans apply for Medicaid coverage at the same time they applied for food stamps under the Supplemental Nutrition Assistance Program (SNAP).

“I really do believe it (coordinating with SNAP signups) would work here,” Ptashkin said. “I think the lessons learned in Louisiana certainly will resonate with the southern states.”

Whether the Louisiana model is followed or not, there is more talk in Georgia these days about the possibility of some form of Medicaid expansion that wouldn’t be directly connected to the Affordable Care Act. The state instead would customize its own version through the use of federal 1115 waivers.

Gov. Nathan Deal and the Republican leadership of the General Assembly have flatly refused to accept the federal funding that has been available to the state for Medicaid expansion since 2014. That refusal has cost Georgia an estimated $9 billion over the past three years.

State Sen. Renee Unterman (R-Buford), who chairs the health and human services committee, has been talking publicly about the need for Georgia to bend a little so that it can get some of that money.

“You have to reexamine where you are because the times change, you can’t stay stagnant,” Unterman said in a public radio interview on WABE. “Everything’s on the table and we need to be open-minded.”

She suggested that Georgia follow the example of Arkansas, which implemented a version of Medicaid expansion that required recipients to pay some of the costs involved.

“The consumer would have to have some skin in the game,” Unterman said. “You don’t want to give these people a handout, but if they contribute to what they’re trying to purchase or get, they have some skin in the game. . . . It wouldn’t be a high premium, they’d just have to pay a minimum amount.”

In that interview, Unterman also acknowledged that the Affordable Care Act, which she has opposed for the last five years, is not likely to be repealed.

“I believe some form of it is here to stay, and that’s why I am willing to look at a waiver,” she said. “We’re not going to go back to fee-for-service. The infrastructure has already changed. You can’t flip back time.”

One factor that might nudge Georgia officials towards accepting federal funds is the precarious financial state of many hospitals, particularly those in rural areas that treat a large number of indigent patients who can’t pay their bills.

Since 2013, at least five hospitals have shut their doors and the latest one, North Georgia Medical Center in Ellijay, was one of two hospitals in the district of House Speaker David Ralston (R-Blue Ridge), one of the most powerful figures in state government.

Ralston declined to talk about the issue. “We are still more than six months before the 2017 session, and the speaker will be happy to chat in the future should developments warrant,” said Ralston’s spokesman, Kaleb McMichen.

© 2016 by The Georgia Report

SOURCE: The Georgia Report

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