Georgia Governor Kemp Eases Health Care Facility Limits Amid Medicaid Debate

The governor signed a high-profile health-care bill into law on Friday, paving the road for complete Medicaid expansion next year – but not before raising new questions about whether another year will change his mind.

In strong remarks delivered Thursday at an event organized by the Atlanta Journal-Constitution, Gov. Brian Kemp reiterated his opposition to completely expanding the public insurance program. “I’m in the ‘no’ camp,” Kemp explained. “I support what we did. We need more time to continue implementing and getting people to sign up for Pathways.”

Pathways to Coverage, the governor’s program, was started in July and has partially increased coverage for some low-income Georgians who complete 80 hours of job, education, or other qualifying activities per month.

That program has covered less than 4,000 of the 350,000 Georgians who are eligible, but the governor has blamed the delayed start on delays caused by the Biden administration’s attempts to prevent the program. The state has sued the federal government for additional time to ramp up the program, which is scheduled to expire next fall.

The bill approved by the governor on Friday focuses mostly on the state’s certificate-of-need standards, which determine how many healthcare services are permitted in any particular area of the state. However, the measure also establishes a commission to investigate healthcare issues affecting Georgia’s low-income and uninsured residents.

Kemp will pick a health policy expert to lead the nine-member council, which must be established by July. It is entrusted with submitting a report by the end of the year, ahead of the following year’s session, which begins in January.

Kemp touted an increase in the amount of state dollars going to the state’s rural hospital tax credit program, raising a cap from $75 million to $100 million, as well as changes that will ease the state’s regulations on new or expanded health care facilities, during a bill signing ceremony in Athens Friday.

“Now Georgians will have greater access to several important areas of health care, including psychiatric and substance abuse inpatient programs, basic prenatal services, birthing centers, general acute hospitals, and much more,” Kemp said in a statement.

During this year’s congressional session, the bill was carefully monitored for its potential to fully expand Medicaid. Separately, a state Senate committee held a hearing on a proposal for an Arkansas-style Medicaid expansion that uses federal funds to purchase private insurance for individuals who qualify. That bill was narrowly defeated in committee during the final days of the 2024 session.

“We were fine with the Legislature having a conversation about that,” Kemp said at the AJC luncheon on Thursday. “That’s entirely up to them. I was respectful of that. But when they talk about going to the floor and voting, they should have a fiscal note.”

The governor, who is in the middle of his final term, also claimed that complete Medicaid expansion would drive individuals away from private health insurance, which pays providers a higher reimbursement rate.

However, the impetus to reverse course is expected to increase, particularly if Pathways enrollment continues to underperform. Georgia is one of ten states that did not completely expand Medicaid under the Affordable Care Act.

“I’m in the yes camp,” state Rep. Scott Holcomb, an Atlanta Democrat, wrote on social media Friday. “Georgia has the second-highest uninsured rate in the country. We have fragile hospitals that treat those without insurance. Georgia Pathways is not working and costs significantly more than complete growth. It is foolish not to consider.”

Some advocates argued the governor’s words were consistent with previous pronouncements.

“We hope that the study commission established in HB 1339 will shine a light on the need to close Georgia’s healthcare coverage gap and that we’ll see a change of heart,” said Natalie Crawford, executive director of Georgia First, a bipartisan group formed in 2022.

The focus will now shift to the new commission.

“We are excited about the creation of the Comprehensive Health Coverage Commission to explore Medicaid expansion and how best to expand health coverage to the many uninsured Georgians,” said Monty Veazey, president and CEO of the Georgia Alliance of Community Hospitals.

“This could herald a new era for Georgia health care and help hospitals – especially rural hospitals – continue to serve their patients and improve their outcomes.”