Will jobs beat ideology to spur Medicaid expansion in the South?

Joanne Kenen

About Joanne Kenen

Joanne Kenen, (@JoanneKenen) the health editor at Politico, is AHCJ’s topic leader on health reform and curates related material at healthjournalism.org. She welcomes questions and suggestions on health reform resources and tip sheets at joanne@healthjournalism.org. Follow her on Facebook.

Photo: FacebookJust-closed Hutcheson Medical Center in Fort Oglethorpe, Ga.

Photo: FacebookJust-closed Hutcheson Medical Center in Fort Oglethorpe, Ga.

We’ve written extensively about Medicaid expansion and the impact on hospitals that have many low-income uninsured patients that would be eligible for coverage.

Now, there are some signs – admittedly preliminary – that the dollar and cents needs of rural hospitals in Georgia may trump the political imperative to keep saying no to the Affordable Care Act’s Medicaid option.

And with the final stage of the employer mandate going into effect in January, Medicaid may offer some options for low-wage workers and their employers that are not well understood.

The hint of change in Georgia comes as Louisiana’s new Democratic-governor elect has vowed to expand Medicaid, and as Alabama’s governor and a task force begin to look at the option. The wall of resistance may be beginning to crumble in the South.

In a column for The Atlanta Journal-Constitution, Jim Galloway writes that the closure of a fifth rural hospital in Georgia (which took place Dec. 4 in a highly Republican district) is helping change the equation. He writes:

“But this time, the critical arguments will be made not by Democrats, but by Republicans who will contend that, like it or not, the Affordable Care Act is a fact on the ground that is not going away. Human life isn’t the only thing at stake, they will argue. So is the economic life of the state. Jobs, jobs, jobs.”

Gov. Nathan Deal of Georgia hasn’t announced a policy change – and change is not really very likely until after the 2016 presidential election. But the ground is being prepared.

Two former high level aides, both of whom were deeply involved in Deal’s health policy and the resistance to the ACA, now are talking about expansion in a whole new light, Galloway reported after having an informative breakfast with the two. Both are now working with the Chamber of Commerce on a pro-expansion effort. A state with an inadequate health care infrastructure can’t be economically competitive – and voters who can’t get decent health care aren’t going to be very happy voters.

In the business community the push is on to find a “Georgia-specific solution that fits within the federal framework,” Galloway writes. In other words, he says, “a relationship with Obamacare that is both financially sustainable and politically digestible by a state GOP that has vilified the program for the last five years.”

So if you are in a non-expansion state, now’s a good time to check in with local business groups like the chamber of commerce about their position vis-à-vis Medicaid – and what they plan to do about it. Many state legislatures will be convening again a month or so.

And while we’re on the topic of Medicaid expansion – there’s another aspect of interest to businesses that is not very well understood. The next phase of the employer mandate goes into effect in January. More workers in big businesses have to be covered, and businesses with 50 to 99 workers now have to comply. But for low wage workers, Medicaid or Medicaid expansion is an option that’s not well understood. In other words, if working people are eligible for Medicaid they can take it, even if they have a job that offers coverage. (Higher income workers, however, can’t go into the exchange with a subsidy if they have job-related coverage that meets the legal definition of “affordable.”)

For workers in a restaurant or a retail establishment, Medicaid may be a much better financial deal than the employer plan, which may have costly premiums and a big deductible. And it helps the employer too. The worker on Medicaid is still part of the head count affected by the employer mandate. But the employer doesn’t have to pay for that worker’s coverage.  It would be interesting to talk to mid-size, low-wage businesses in your communities to see if they understand this and whether they are helping their employers look into Medicaid as an option. And, if they are in a non-expansion state, do they want their state government take another look at it.

Leave a Reply

This site uses Akismet to reduce spam. Learn how your comment data is processed.