Georgia's Republican Gov. Brian Kemp unveiled a proposal Wednesday that would authorize his office to pursue Medicaid waivers to give the state more flexibility in using federal health care funding.
But some Democrats worry that the legislation would give Kemp, who railed against Medicaid expansion during his recent election campaign, nearly free rein in designing and implementing the program.
The proposed Patients First Act, introduced Wednesday, aims to increase access to health care and its affordability, especially for low-income Georgians. A federal waiver, as opposed to a full Medicaid expansion backed by Democrats, would give Georgia the option to adopt a more conservative plan.
Kemp said the legislation should help lower private sector health care costs.
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"That's what's killing hardworking Georgians out there. We need people to innovate a health care system that's not working," he said.
Kemp said he realizes the bill gives him significant influence in shaping how Medicaid will operate in Georgia, but pledged to work closely with the legislature.
"I take great responsibility with that but I'm not trying to be the lone ranger on this," Kemp said. "We're all in this together."
Georgia is one of 14 states that have not yet fully expanded Medicaid as prescribed under the 2010 Affordable Care Act, also known as Obamacare.
The expansion was initially intended to be nationwide, but a 2012 ruling by the Supreme Court effectively made it optional for states. Most of the states that have not taken up expansion are Republican controlled.
Georgia's previous Republican Gov. Nathan Deal opposed Medicaid expansion on the grounds that if federal funding ceased, the state would be left to fully pay the costs.
Under the original call to expand Medicaid under the 2010 act, anyone who fell slightly above the poverty line qualified for benefits.
The Patients First Act would cap that eligibility at the poverty line, limiting the number of people who would receive benefits.
Other aspects of the waivers remain unclear. Earlier this session, Kemp set aside $1 million in his budget proposal for a consultant to analyze Georgia's options.
The governor and lieutenant governor both distanced themselves from supporting Medicaid expansion.
"At the end of the day, it's not about Medicaid expansion," said Lt. Gov. Geoff Duncan. "It's about us trying to get free markets and private insurance to cover as many Georgians as we possibly can."
Democrats worry the proposal gives Kemp too much discretion over Georgia's Medicaid program without any requirement to consult the legislature.
"His bill is nothing more than converting the power back to the governor's office to do Medicaid expansion," said Senate Minority Leader Steve Henson, a Stone Mountain Democrat. "Certainly, to do that, he has to give us more understanding of what he's interested in doing."
Henson has authored a bill pushing for full Medicaid expansion in the Senate. "We would hate to see anything watered down that isn't as effective," he said. A mirror version has been introduced in the House as well.
Sen. Kay Kirkpatrick, one of the two GOP women in the Senate, said it's unfortunate that more Democrats are not on board with the proposal.
"What we've got to do first is get authorization from the legislature to work on the waivers because right now you can do all the research on it that you want but you can't do anything without authorization," Kirkpatrick said.
"I know this is a big step. But a big step is needed," Kemp said. "We're at a crisis in health care, not only in our state, but in our country."