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Dig Deeper - Medicare expansion debate | Links, sources, campaign statements

In our series, we took a look at the politics behind expansion, analyzed what it would cost state taxpayers and took a closer look at campaign promises.

ATLANTA — The Peach State has spent over a decade debating Medicaid expansion. And as voters near the 2022 General Election on Nov. 8, this issue has become a key one in the governor's race.

People still have varying questions about the debate over the program, and11Alive is pushing beyond campaign rhetoric to look deeper into what expanding this healthcare program means. 

The four-part series aired every weeknight on 11Alive and our YouTube channel at 6 p.m. through the week of October 4. 

Link | Read 11Alive's full report - What you should know about the debate over whether to expand Medicaid

Below is more background, including the links to studies mentioned in this report, who we spoke to and answers from the gubernatorial candidates' campaigns.


Kaiser Family Foundation | Summary of 600 studies on the impact of Medicaid Expansion

Kaiser Family Foundation | Building on the Evidence Base: Studies on the Effects of Medicaid Expansion, February 2020 to March 2021

Kaiser Family Foundation | What is the coverage gap?

Georgia Department of Community Health | Georgia Pathways to Coverage Application

US District Court Ruling on Georgia Pathways

Grady Health Systems Response to Medicaid Expansion

National Association of State Budget Officers | Fiscal Survey of States 

Healthinsurance.org | Summary of Medicaid expansion

Georgia Budget & Policy Institute | Fast Facts on Medicaid expansion

Georgia Public Policy Foundation | The Misconceptions of Medicaid Expansion

Foundation for Government Accountability | A Budget Crisis in Three Parts: How ObamaCare is Bankrupting Taxpayers

The New England Journal of Medicine | The Oregon Experiment — Effects of Medicaid on Clinical Outcomes


Jaylen Black, Campaign for Stacy Abrams

Tate Mitchell, Campaign for Brian Kemp

Leah Chan, Georgia Budget & Policy Institute

Erin Fuse Brown, Director, GSU Center for Law, Health & Society

Chris Denson, Georgia Public Policy Foundation 

Dr. Andra Gillespie, Emory University 

Georgians for a Healthy Future

Robin Rudowitz, Director for Program on Medicaid and the Uninsured, Kaiser Family Foundation 


11Alive spoke to Mitchel Tate on behalf of Gov. Brian Kemp. Answers transpired over several conversations, and responses have been consolidated for clarity.

What are the fundamental concerns Governor Kemp has with expanding Medicaid eligibility to 138% of the federal poverty level to close what is referred to as the coverage gap? 

Georgia Pathways would provide Georgians who are below 100% of the federal poverty level (FPL) and who meet the qualifying activities outlined in the waiver with access to either private sector insurance or Medicaid - depending on if the private insurance is available to the individual and which is more cost-effective to the state.

Georgians between 100% and 138% of the federal poverty level already have access to heavily subsidized - or free - healthcare insurance on the federal exchange. Putting hundreds of thousands of able-bodied adults on Medicaid when they are currently eligible for higher-quality, private-sector insurance would significantly burden doctors - many of whom are not taking new Medicaid patients due to low reimbursement rates - and the healthcare system at large. 

What SPECIFICALLY is Kemp referring to when he calls Medicaid a “broken government program?” What about it is broken? 

Medicaid costs continue to skyrocket for both the state and federal government without corresponding improvements in health outcomes for those who are enrolled. Georgia Pathways would provide insurance to those who need it while also incentivizing them to gain training, work experience, education, or soft skills that would empower them to move onto employer-sponsored insurance that is tailored to the individual needs of the consumer - not subject to a one-size-fits-all government framework.

Furthermore, concerning the private sector health insurance marketplace, Governor Kemp rolled out Georgia Access and Georgia Pathways in the Fall of 2019. Between 2017 and 2019, the cost for an average individual insurance plan on the Marketplace increased between 27% and 41%, making it one of the largest and most unpredictable expenses for hardworking Georgians.

Additionally, in 2019, 74% of Georgia's counties only had one carrier offering insurance in the individual marketplace. Since implementing elements of the Patients First Act of 2019, that number has plummeted to 2%. The aim of Governor Kemp's health care reform package has always been to increase private sector competition in order to drive down costs and increase the number of options available to Georgians across the state.

Why is the work/volunteer component so important to Governor Kemp as part of his effort to expand eligibility to 100% of the federal poverty level? 

The Georgia Pathways program will create a new opportunity for the nearly 408,000 hardworking Georgians who make less than 100% of the federal poverty line (FPL) to afford health insurance. If you are working part-time, enrolled in school, or volunteering in your community at least twenty hours a week, the state will pay for your portion of employer-sponsored insurance or enroll you in Medicaid. Just like commercial insurance, the new enrollee will be required to pay a nominal premium – based on a sliding fee scale – and rewarded for practicing healthy behaviors. This component of Georgia Pathways is meant to give Georgians a hand up and a path to more affordable, more reliable private sector coverage. 

Georgia Pathways was designed to give the aforementioned group of Georgians (below 100% of FPL, who meet the qualifying activities) a pathway to the private sector or employee-sponsored insurance. State estimates show that over 50,000 Georgians would enroll and qualify in year one. Given that the state requested - and received - a five-year waiver from the Trump administration, the state estimated that at the end of the five-year waiver, over 400,000 would enroll and benefit from Georgia Pathways.

How is the Governor’s plan fiscally responsible to Georgia taxpayers? Arguments have been made that implementation of the work/volunteer component would require more staff, costing taxpayers further, and not qualify for added federal dollars toward expansion. 

Governor Kemp's plan makes health care accessible to thousands for the first time and more affordable for millions more in our state without raising taxes on Georgia families in the long term - which is what full expansion would ultimately require in the inevitable event the federal government reaches the point where it can no longer subsidize 90% of full expansion costs for every state in the country. Average additional cost increases year over year for the state of Georgia with the current Medicaid population can exceed $200 million. What would be the added cost of hundreds of thousands of able-bodied adults onto the Medicaid rolls years from now?


The same questions were posed to Stacy Abrams. Her team referred 11Alive to a video produced by her campaign and to her website, where she addresses several of these topics:

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