Gov. Brian Kemp has rolled out two proposals to improve access to health care for low-income residents. The first is a plan to reduce premiums for people buying health insurance under the Affordable Care Act, aka Obamacare. The second would provide options to enroll in Medicaid or government-funded employer coverage with requirements for work and premium payments. Both proposals are subject to approval by the federal government.

“We’ll shake up the status quo,” Kemp said of his proposals. “This is not a free handout. Hard-working Georgians who qualify will have skin in the game.” He said his plans provide “a path forward towards higher earnings, better opportunities and a healthier future.” Critics strongly disagree, pushing for major expansion of Medicaid, a longtime aim of Democrats.

Key provisions of Kemp’s first proposal call for state and federal governments to pay some of the costs for the sickest patients with the highest bills, thus allowing reduction in monthly premiums for all customers. The governor’s office estimates there would be a $282 cut in areas of the state with premiums now topping $1,000. Residents could also sign up for coverage with an insurance provider or broker website instead of having to use the Healthcare.gov website. All insurance plans would be required to cover pre-existing conditions. The bottom line: access to more health care coverage options.

The second proposal would offer a pathway for uninsured Georgia adults who make no more than the federal poverty level (about $12,490 a year for an individual) to access Medicaid or an employer plan funded by the federal government. To qualify, a recipient would have to spend at least 80 hours a month on a job or volunteering, training or studying, and pay monthly premiums. Kemp’s office said this is a conservative reform, one that “honors work” and “champions individual responsibility.” Of an estimated 408,000 uninsured adults in the required income level, only about 50,000 would be covered eventually at any one time, according to the Kemp administration. That represents about one-tenth of the estimated number of low-income Georgians who would be covered under so-called “standard” Medicaid expansion for which 36 other states have opted, according to Georgia Health News. But such expansion would cost Georgia billions of dollars, Kemp says, contrasting his plan’s price tag of $35.6 million in the first year for a startup in July 2021.

Kemp’s approach affirms his gubernatorial campaign pledge that he would not expand the state’s Medicaid program because the costs are too high. As expected, Democratic leaders and consumer advocates faulted the governor’s plan. Rep. Bob Trammell, D-Luthersville, the state House minority leader, argued that “standard” Medicaid expansion is the most fiscally responsible approach, citing an analysis showing such a step would cover up to 526,000 people at a cost of nearly $148 million in FY 2020. Trammell told Georgia Health News that Kemp’s plan “sounds like health care by lottery” and “falls disappointingly far short of what could be accomplished.” Laura Colbert of Georgians for a Healthy Future said the Medicaid waiver plan “will not work for the large majority of low-income people in the state.” She described the waiver as “insufficient and punitive,” saying the work requirements would reduce enrollment. To that point, how is it punitive to require work? A little history is instructive: In 1996, Democratic President Bill Clinton signed “welfare to work” reform legislation requiring recipients to work, among other provisions reflecting traditional American values. If that approach was a good idea in 1996, why isn’t it so today? Indeed, work has intrinsic value in terms of building self-respect and self-reliance, bedrock virtues of our society.

On a realistic note regarding Kemp’s proposals, a physician and hospital administrator, state Sen. Dean Burke, R-Bainbridge, told GTN: “In our world, any coverage is better than no coverage.” He said, “I’m OK with incrementalism. It’s important to realize this is just the start,” pointing out that Medicaid waiver plans can be amended later as needed. That is on target, for fixing health care needs is a work in progress and the Legislature as well as the public will have a say on the proposals.

As always, the issue comes down to money. Families know the challenge of trying to balance health care costs with other necessary expenses. Doesn’t the same hold true for the government? Gov. Kemp is seeking to improve health care resources for thousands of residents with his proposals. The plans are “just the start,” as Dean Burke, the physician-senator, observed. Furthermore, the public will have opportunities for input in six hearings scheduled around the state, and there may be ways to improve on the plans in the future to the benefit of more Georgians.

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