Republican Resistance Remains
“There’s reason to be a little more optimistic than one year or two years ago, but there’s not a groundswell of support and willingness to change the status quo on the part of the Republican members of the legislature,” said Harry Heiman, a health policy professor at Georgia State University.
Georgia Pathways Presents Obstacle
The biggest obstacle is Georgia Pathways, the state’s limited Medicaid expansion that includes the nation’s only work requirement for Medicaid recipients, said Laura Colbert, executive director of the advocacy group Georgians for a Healthy Future.
Kemp’s Political Capital at Stake
Republican Georgia Gov. Brian Kemp has championed the program, which launched in July. Though it is off to a rocky start, with just under 2,350 people enrolled as of mid-December, the Kemp administration has sought to extend it past its September 2025 expiration date. “Governor Kemp has put a lot of political capital into Pathways,” Colbert said.
Optimism for Fuller Expansion
Colbert said she was optimistic that Georgia would eventually approve a fuller expansion of coverage for low-income adults, but not necessarily this year.
Republican Backlash Possible
Kyle Wingfield, president of the conservative Georgia Public Policy Foundation, said he, too, was skeptical Kemp would be willing to retreat from Pathways. He also warned that Republican lawmakers could face backlash for any Medicaid deal from Republican primary voters.
Acceptance of Affordable Care Act
Expanding Medicaid to low-income adults who make up to 138% of the federal poverty level, with the federal government picking up 90% of the cost, was a key part of the Affordable Care Act. Georgia is among 10 states that have not done it. Wingfield said he thinks Republicans in Washington, and to a lesser extent in Georgia, have accepted that the Affordable Care Act is here to stay, but that acceptance may not be shared by rank-and-file GOP primary voters.
Political Risks and Rewards
But Brian Robinson, a Republican political consultant, says he thinks Republicans face little risk from primary opponents if they vote for Medicaid. Conversely, Republicans also risk alienating the conservative organization Americans for Prosperity with a vote to expand Medicaid coverage.
In contrast, Wingfield raised the possibility that some Democrats could balk at a deal, noting that Medicaid expansion has been a key political issue for the party in Georgia.
Democratic Pressure and Hope
The Democratic caucus organized a lengthy hearing focused on the economic and health benefits of expansion that featured health care providers, advocates, and policy experts. Democratic state Rep. Michelle Au expressed hope that all options would be considered during the legislative session.