By coincidence, the two-part big reveal of Georgia Pathways, Gov. Brian Kemp’s health care proposal, was sandwiched around Democratic Sen. Elizabeth Warren’s announcement of her health care plan, if you can imagine a sandwich with meat that thick and bread that thin.
The two plans — Kemp’s, worked out in close consultation with the White House, and Warren’s, released after her Democratic rivals demanded she show the math that made it possible — couldn’t differ more in their approach to health care at the state and national levels. But they have one big thing in common: Both Kemp and Warren go to some trouble to make it clear that their plans aren’t Obamacare.
Therein lies one of those ironies that makes politics perplexing. In national polls, Obamacare has risen modestly in popularity since its inception. But the real story is what has happened when Obamacare’s core component, a wide expansion of the Medicaid program, has been tested at the ballot box.
In 2018, voters in Nebraska, Utah and Idaho approved Medicaid expansion plans by margins of 53%, 54% and an eye-pooping 62%. Maine’s voters had already voted for an expansion, and when its Republican governor stonewalled its implementation, they elected a Democrat to be his successor. Oregon approved a tax increase to continue its program. Montana narrowly turned down a similar measure, which was pegged to a $2-a-pack increase in the tobacco tax. That brought in Big Tobacco, which spent heavily in the campaign to defeat the measure.
That record at the ballot box in mostly deep red states would suggest that Kemp isn’t stepping out very far with his extremely limiting acceptance of the centerpiece of Obamacare. But from his approach, you might think so.
We should have known there would be a website redesign involved — that being the way organizations large and small deal with their identity issues these days. The current healthcare.gov site will be replaced by one less cumbersome and confusing, Kemp promised. But the new site will fill the same purpose of connecting customers to insurers as the site created under Obamacare, just as the federal subsidies the state wants to control are the same funds provided under Obamacare. The wheel isn’t being reinvented, just rebranded.
To help it design the waivers to the Affordable Care Act, which were unveiled Thursday and Monday, the state paid $1.9 million to Deloitte, the biggest of the Big Four accounting firms. Deloitte issued a report last summer fleshing out with numbers what we knew already: Georgia has a very high rate of uninsured residents, which relates directly to the crisis the state’s rural hospitals are facing.
Precisely how Deloitte’s findings factored into the completed waiver proposal isn’t clear. At least 300,000 of the uninsured identified in the consulting firm’s report would remain uninsured under the proposed waiver. The proposals for a work-study-volunteer component, limited help for the uninsured and an emphasis on bringing down insurance rates for working families sound much like what Kemp pledged to do during his 2016 campaign for governor.
Kemp’s plan aims to get rates under control by taking control of the $2.7 billion ACA exchange market and sinking more than $300 million in additional money, about a third of it to come from the state, into a “reinsurance fund” that would reimburse insurers for high-cost claims.
It’s understandable that the benefits of this program would go disproportionately to South Georgia residents, because that’s where rates have gone sky-high. But at some point, metro legislators are going to question whether their tax dollars are being used to address the root causes for those high rates or simply to subsidize the problem.
Courts have blocked implementation of work requirements in three states, but four states have had work requirement waivers approved and nine more have waiver requests pending.
Whether the wording of Georgia’s waiver passes muster will, presumably, be one measure of Deloitte’s adroitness.
Georgia Pathways has been planned as a fast track, with a quick listening tour of the state and submission of the waiver to Washington by the end of the year. There are a lot of questions that should be asked in that short time, but one is likely to hover, unasked, over all the others: Is this plan really better than the one it’s trying so hard to erase?
Tom Baxter is a veteran Georgia journalist who writes for The Saporta Report.