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Georgia can learn something from Louisiana
Tom Crawford

This may be the first time I’ve ever written these words, but here goes: Georgia could learn a lesson from Louisiana.

On June 1, Louisiana became the first Deep South state to launch a Medicaid expansion program funded through the Affordable Care Act.

That happened because of the upset victory last fall of Democrat John Bel Edwards in the governor’s race.

Where outgoing governor Bobby Jindal denounced Obamacare and refused to expand Medicaid coverage, Edwards pledged to bring health-care access to more low-income residents of the Pelican State.

In less than three weeks since the expansion was launched, more than 200,000 people signed up for Medicaid coverage; Edwards’ goal is to attract at least 375,000 enrollees.

Louisiana’s rollout is being closely watched by people in other states where Medicaid expansion has been a non-starter, including Georgia.

Amanda Ptashkin of Community Catalyst, a health-care advocacy organization, said many of the Louisiana enrollees signed up through limited expansion programs that were already in effect in several cities.

Edwards’ administration also devised a way to work around the Legislature’s refusal to appropriate money for the administrative costs of expanding Medicaid. Louisianans apply for Medicaid coverage at the same time they apply for food stamps under the Supplemental Nutrition Assistance Program.

“I really do believe it (coordinating with SNAP signups) would work here,” Ptashkin said.  “I think the lessons learned in Louisiana certainly will resonate with the Southern states.”

Whether the Louisiana model is followed or not, there is more talk in Georgia these days about the possibility of Medicaid expansion, even if it isn’t directly connected to the Affordable Care Act. The state could customize its own version through the use of federal waivers, as other states have done.

Gov. Nathan Deal and the Republican leadership of the General Assembly have refused to accept the federal funding that has been available for Medicaid expansion since 2014. That refusal has cost Georgia nearly $9 billion and kept an estimated 650,000 residents from potentially getting health-care coverage.

State Sen. Renee Unterman, R-Buford, who chairs the senate’s Health And Human Services Committee, has been talking about the need for Georgia to bend a little so it can get some of that money.

“You have to re-examine where you are because the times change. You can’t stay stagnant,” Unterman said in a public radio interview. “Everything’s on the table, and we need to be open-minded.”

She suggested that Georgia could follow the example of Arkansas, which implemented a version of Medicaid expansion that required recipients to pay small premiums for their coverage.

“The consumer would have to have some skin in the game,” Unterman said. “You don’t want to give these people a handout, but if they contribute to what they’re trying to purchase or get, they have some skin in the game.”

Unterman also acknowledged that the Affordable Care Act, which she has opposed for the last five years, is not likely to be repealed.

“I believe some form of it is here to stay, and that’s why I am willing to look at a (federal) waiver,” she said. “The infrastructure has already changed. You can’t flip back time.”

One good reason for Georgia officials to consider accepting these federal funds is the precarious financial condition of many hospitals, particularly those in rural areas that treat a large number of indigent patients who can’t pay their bills.

Since 2013, at least five rural hospitals have shut down because of financial shortfalls. The latest one, North Georgia Medical Center in Ellijay, was in the district of House Speaker David Ralston, R-Blue Ridge, one of the most powerful figures in state government.

If the state had agreed to Medicaid expansion three years ago, that federal money would have flowed to the hospitals and might have helped keep them in operation.

Ralston declined to talk about the Medicaid situation.

“We are still more than six months before the 2017 session, and the speaker will be happy to chat in the future should developments warrant,” said his spokesman.  

While Ralston waits, thousands of Georgians continue to lack health-care coverage, and more hospitals are in danger of closing. It’s way past time that the political leadership started talking about this issue.

Crawford is editor of The Georgia Report, an Internet news service at that reports on state government and politics. He can be reached at

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