Amy Bielawski hopes for what seemed unlikely a year ago.

It was then that the Trump administration approved Governor Brian Kemp’s Medicaid waiver plan for Georgia.

The plan would have put some people on the state’s Medicaid list, but it would also have set new eligibility requirements for the program – such as employment or schooling. Bielawski, an uninsured Tucker resident, wasn’t sure she could meet any of these requirements.

She wanted Georgia to do a standard, full Medicaid upgrade under the Affordable Care Act (ACA), which Republican leaders who control the government have long disliked as being too costly.

But in January of that year, Democrat Joe Biden became president. He’s a big supporter of the ACA, unlike his predecessor, Republican Donald Trump, who unsuccessfully fought to scrap him.

Biden’s government has messed up health arithmetic at the national level, and that could reverberate here in Georgia. For one thing, the incentives for a state to expand Medicaid have become much more enticing.

The 56-year-old Bielawski is currently in a so-called “coverage gap”. Your income isn’t high enough to get discounts on health insurance purchased on the ACA exchange, but it’s too high to be eligible for Medicaid.

The expansion of Medicaid to include more low-income adults in the program would mean steady access to health care for Bielawski.

In the past few weeks, federal health officials have told the new Georgia government that they will not meet the requirements for Medicaid eligibility under the upcoming Kemp plan. The government cited the hurdles created by the pandemic.

The Kemp administration plans to appeal the government’s decision. Kemp’s Republicans in the General Assembly, such as House Speaker David Ralston, support him in this. “I am confident that they will look positively at what we are trying to do, which is simply to tailor a Georgian solution to Georgia’s needs,” Ralston told reporters last week.

But now the COVID relief package Biden just signed has dangled tempting carrots for the 12 states, including Georgia, that haven’t fully expanded Medicaid.

The eleven others are mostly Republican-controlled and are mostly located in the south and west: Wyoming, Texas, South Dakota, Wisconsin, Mississippi, Tennessee, Alabama, North Carolina, South Carolina, Kansas, and Florida.

States that expand the program at this point would receive an additional 5 percentage point increase in their regular Medicaid matching rate for two years. During that time, considering the cost of implementing the expansion, Georgia would raise $ 700 million under the new incentives, according to the Kaiser Family Foundation.

The Kemp waiver plan now outlined is much less ambitious. According to consumer advocacy group Georgians for a Healthy Future, it would cost $ 75 million in the first year and only cover 31,000 low-income adults. A standard extension would allow Medicaid to service 480,000 to 600,000 people in the state, said Laura Colbert, the group’s executive director.

“Medicaid’s expansion has always been the moral and cost-effective choice for Georgia,” she said. The new incentive package, she said, “only reinforces that choice.”

Ball in Kemp’s yard

Kemp, who has been very critical of the COVID relief package, has spoken out strongly against Medicaid’s expansion.

And the Georgia Department of Health, which operates Medicaid, continues to plan for the current waiver plan to go into effect in July.

But since the government is unlikely to execute on its limited Medicaid waiver plan, Kemp would only be faced with a handful of options. He could drop his waiver idea altogether or pursue it without the additional admission requirements – which would be much more expensive than his original proposal.

Or he could think about expansion.

Brian Robinson, a Republican strategist who runs the consulting firm Robinson Republic, said expansion policies and the ACA, sometimes called Obamacare, have changed.

“The Biden administration will allow no alternative other than the full expansion of Medicaid,” said Robinson. And he added, “I think people have given up on the idea of ​​lifting Obamacare.” So it’s a reality to deal with.

Some Republican-led states expanded Medicaid after letting voters decide on the issue, Robinson noted. “Utah passed with big margins.”

Republicans in Georgia can draw up a referendum or opinion poll on the ballot, he said. “We have scheduled a special redistribution session. We could do it then. ”

Opinion polls over the past few years have shown that a majority of Georgians are in favor of Medicaid’s expansion when asked about it. An electoral question on this idea could gauge the real interest of Georgia voters.

“I know Governor Kemp wants to do something,” said Robinson. From a political perspective, he added, the pursuit of expansion would remove one of the main issues that Democratic gubernatorial candidate Stacey Abrams spoke about in 2018.

Kemp will “not suffer politically,” Robinson said.

According to experts, only one of the twelve states may be required to adopt the Medicaid extension and trigger similar steps in other states.

As it has been for several years, Georgia is run by Republicans at the state level. But the Democrats have made gains recently, such as the election of two new US Senators last year. And Democrats support the expansion.

“Now it is up to our heads of state to use these resources, expand Medicaid, and ensure that no one in this state has no access to medical care because they cannot afford it,” said US Senator Jon Ossoff (D-Ga .) Week at a virtual town hall meeting, according to AJC. “Because health care is a human right. If that wasn’t clear before, this COVID-19 pandemic has made it incredibly clear. “

Amy Bielawski can’t wait for Georgia to move to increase insurance coverage. Right now she’s saying, “I don’t think they care about people like me falling through the cracks.”

This story comes to GPB through a reporting partnership with Georgia Health News.