One of the biggest carrots in the Affordable Care Act of 2010 was the promise that the federal government would pay 100 percent of the cost of a state extending its Medicaid program for three years.

A group of mostly Democratic US senators – including Georgia’s newly elected Raphael Warnock and Jon Ossoff – are pushing for laws that would provide the same incentive for states, including Georgia, that have not expanded Medicaid.


The States Achieve Medicaid Expansion (SAME) Act of 2021 would allow states that expanded Medicaid after 2014 or that expand Medicaid in the future to receive the same full federal funding as states that previously expanded Medicaid.

The 100 percent match is much better than the roughly 67 percent Federal match that will fall under Governor Brian Kemp’s plan to extend Medicaid eligibility to lower-income adults. The expansion would also cover roughly ten times the number of Georgians Medicaid is expected to receive under the Kemp plan, due to begin in July.

A Kemp spokeswoman said Friday the government was not commenting on the upcoming laws.

A similar bill was introduced in the U.S. Senate in 2019. Congress is now under Democratic control, albeit tightly, and with Democrat Joe Biden in the White House, such legislation has a better chance of being passed.

Biden has already hired the Department of Health and Human Services to re-examine Medicaid’s work requirements, making it more difficult for individuals to obtain coverage under the program. The Georgia Medicaid plan has stringent eligibility requirements that can include work, education, and volunteering.

“Health care is a human right and for too long many Georgians have been denied access to affordable health care through Medicaid,” Warnock said in a statement Friday. “I have long believed that expanding Medicaid in Georgia was an important step towards making affordable health care a reality for everyone. In 2017, I was even arrested in the U.S. Capitol for speaking out in favor of Medicaid’s expansion. ”

38 states have adopted the Medicaid extension. The Republican leadership of Georgia has consistently argued that the cost of this move was too high. Under state law, any full expansion in Georgia would have to be passed by the General Assembly, which is still controlled by the GOP.

“The expansion of Medicaid would save the lives of Georgians, make health care more affordable for Georgian families and prevent the closure of Georgian clinics and hospitals,” Ossoff said in a statement. “This bill would ensure Georgia gets the same funding as other states that expanded Medicaid years ago, and create an even bigger incentive for our state government to do what should have been done a decade ago, and Medicaid for families to expand in Georgia. “


The ACA directed federal funding to states that have expanded their existing Medicaid programs to cover all individuals up to 138 percent of federal poverty. The federal government paid the full cost of the expansion for three years and reduced the match rate for the sixth year of expansion and the following years to 90 percent.

Even without expansion, Medicaid roles in Georgia have swelled as many residents lost jobs and health insurance coverage during the pandemic. In Georgia, Medicaid patients rose 338,000 between March and December 2020, bringing the total number of child, adult and family recipients to over 2 million.

In addition to Ossoff and Warnock, there are Mark Warner and Tim Kaine from Virginia, Tom Carper and Chris Coons from Delaware, Debbie Stabenow and Gary Peters from Michigan, Bob Casey from Pennsylvania and Tammy Baldwin from Wisconsin. They are joined by Sen. Angus King, a Maine Independent.

Critics fear that policy changes could now burden Georgia with costly conditions for boarding the full expansion train years after other states joined the Obama-era health program, Capitol Beat News Service reported on Friday.

“I don’t know if the federal government will ever return to a time of budget austerity,” Chris Denson, director of politics and research for the nonprofit Georgia Public Policy Foundation, said last week, according to the news service. “But there is always the possibility that the government will lower this matching rate.”

Long-time supporters of Medicaid expansion, however, have been enthusiastic about the legislation.

Laura Colbert, executive director of the Georgians for a Healthy Future consumer group, said in a statement: “There are few things that would benefit Georgians and the Georgia communities more than extending Medicaid coverage to adults and families in difficulty. Health insurance would open up the health system to hundreds of thousands of poor Georgians, strengthen rural hospitals and community health centers, and boost our state’s economy. “

President Obama signs the ACA.

Another proponent of the expansion, Georgia Budget and Policy Institute CEO and President Taifa Smith Butler, said the SAME Act “comes at a time when the need for access to health care is more pressing and when it goes into effect Eliminated no excuse for Georgia leaders to completely refuse Medicaid enhancement. The same law increases the amount of federal funding that would flow into our state and is a wise choice that will help us put the Georgians first. “

The move would help adults in what is often referred to as the “shortfall in coverage”. Their income is low, but they earn too much to be eligible for Medicaid under applicable regulations and not enough to qualify for tax breaks on health insurance policies sold on the ACA exchanges. That means they have to buy full-price policies that many cannot afford.

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