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Legislators reflect sharp divide on Medicaid expansion
Medicaid panel
From left, Cindy Zeldin of Georgians for a Healthy Future, state Sens. Greg Kirk and Emanuel Jones, and Reps. Lee Hawkins and Debbie Buckner participate in a panel discussion on health issues. - photo by Georgia Health News photo

ATLANTA — A bipartisan panel of state lawmakers recently voiced agreement on at least a couple of health-care issues.

Support for a higher cigarette tax, and for the emerging trend of ambulance crews treating people in their homes rather than in ERs were two areas of general unanimity on the panel, at an event sponsored by the group Georgians for a Healthy Future.

But as expected, there was sharp division among the four legislators on the panel when it came to the issue of expanding the state’s Medicaid program.

The topic of expansion arose Jan. 14, a day after Gov. Nathan Deal, a Republican, reiterated his opposition to such a move, which is outlined under the Affordable Care Act.

Earlier this month, Louisiana became the 31st state to pursue expansion. But Deal said in his State of the State address Jan. 13 that Georgia has saved money already by not doing so. Had Medicaid coverage been expanded to more adults, it would have cost the state more than $200 million in the fiscal 2017 budget, he said.

“That number would only continue to grow exponentially,” he told a joint session of lawmakers.

Rep. Debbie Buckner, D-Junction City, a health educator, said in the panel discussion that while $209 million sounds like “a bad thing,’’ the state of Georgia “has left on the table’’ $6 billion in federal funding that would have come with adopting Medicaid expansion.

Sen. Emanuel Jones, D-Decatur, noted that without expansion, at least 300,000 Georgians are stuck in a coverage gap — making too much money to qualify for Medicaid under current rules, but not enough to obtain subsidies in the ACA health-insurance exchange.

“Many are young adults,” said Jones, an automobile dealer. “This gap is real. We can do better in this state.”

But Republican panelists Rep. Lee Hawkins of Gainesville and Sen. Greg Kirk of Americus, whose party controls state government, reflected the general GOP opposition to expanding Medicaid, which would add adults to the rolls.

Hawkins, a dentist, pointed out that Medicaid currently does not cover the cost of treating patients.

And Kirk, a consultant, said of expansion in the current political climate: “That dog won’t hunt.’’

Still, Kirk voiced interest in proposals that would request federal waivers to cover more uninsured Georgians.

“Let’s be strategic,’’ he said, “and cover as many people as we can.”

The Georgia Chamber of Commerce, along with other groups, is studying proposals that would improve Georgians’ access to care.

The Affordable Care Act “isn’t the right way’’ to solve health-care problems, said Hawkins. He noted that federal money that goes to hospitals serving large numbers of poor people is being cut under the ACA.

Buckner, though, said the “disproportionate share” money was going away because the health-reform law’s designers expected states to expand Medicaid to compensate for the funds lost.

“That’s our choice” as a state not to accept the deal, she said.

The U.S. Supreme Court, in its 2012 decision on the ACA, ruled that Medicaid expansion is strictly a state decision.

The panel united in praise of community paramedicine. Under such programs, paramedics function outside their usual roles of emergency response and transport, focusing instead on measures that can reduce inappropriate use of emergency services. Patients often are treated in their homes, rather than in emergency rooms.

Kirk said that in Crisp County, ambulances function “more like a critical-care unit.” And Buckner noted that this effort takes care of patients “right where they are.” She added, though, that there are some Wi-Fi “dead spots’’ in rural areas that must be addressed.

She and Kirk spoke of broadening medical providers’ scope of practice — essentially allowing medical personnel to offer new services — in order to bring additional health care to areas that have shortages. Buckner and Kirk also spoke of ideas to lower loan payments for medical providers to help them pay off their educational debts, along with incentives to practice in underserved areas.

Hawkins backed tax credits for charity clinics and legislation that would allow people with disabilities to have savings accounts of more than $2,000 and still qualify for benefits.

Jones and both Republicans spoke of the benefits of raising the state’s tax on cigarettes, currently one of the lowest in the country. Hawkins said he favored using the extra revenues from the levy to provide services to people with mental illness.

A higher cigarette tax “is a no-brainer to me,’’ Kirk said, but added that such a proposal does not have widespread support in the Legislature.

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