Georgia is facing an unprecedented healthcare crisis. Federal cuts to Medicaid and the expiration of premium tax credits will threaten access to healthcare for roughly 500,000 Georgians over the next decade.
Fortunately, there is a way for Georgia to help offset these changes: Closing the coverage gap by expanding Medicaid, which will increase healthcare coverage for hundreds of thousands of Georgians and thereby bring in extra federal funding to our state’s healthcare system.
In states that have expanded Medicaid access to people making up to 138% of the federal poverty level, the federal government funds 90% of costs for new enrollees. Today, only ten states have yet to take this funding opportunity to expand Medicaid. Georgia is one of them.
Instead, Georgia implemented a partial expansion program called Pathways to Coverage. Pathways was originally estimated to cover roughly 30,000 Georgians at the end of its first year in July 2024. Almost two years past that deadline, we are still at just half of that goal. Meanwhile, the program has cost taxpayers more than $147 million, with a vast majority going toward administrative and consulting costs — and not actual healthcare services for Georgians.
Georgians are also facing the issue of the expiration of enhanced premium tax credits (EPTCs), which until recently, helped make marketplace coverage more affordable for families throughout the United States. Unfortunately, Congress allowed these EPTCs to expire at the end of last year.
We know that 1.4 million Georgians relied on these EPTCs before they expired to afford their health coverage. Upon expiration, these Georgians were forced to choose between medical care and other necessities. Already, over half a million Georgians have dropped their Georgia Access coverage since last year.
The expiration of EPTCs in combination with the 2025 federal Medicaid cuts leave Georgia’s healthcare system in deep danger. The combined impact is expected to strip coverage from roughly 500,000 Georgians over the next decade. That is on top of the more than 1.3 million people in our state who are already uninsured and without affordable access to healthcare.
This crisis will negatively affect all Georgians. When more uninsured Georgians seek the healthcare they need, our healthcare system absorbs more uncompensated care, which we know can drive up premiums for everyone. The hardest hit will be rural hospitals. New analysis shows that nearly 2 in 5 of our state’s rural hospitals are in danger of closing their doors, in part fueled by the Medicaid cuts and expiration of EPTCs.
As a fiscally conservative Republican, I was once skeptical about the benefits of expansion. But I quickly found the data compelling. To that end, let’s look at those 40 states plus D.C. that have expanded Medicaid under the ACA. We know that those states’ rural hospitals are performing better financially than non-expansion states like Georgia. We know that expansion is linked to overall better health outcomes, improved access to care for those living with chronic diseases, earlier detection of medical conditions, and even reduced debt and more economic mobility.
I firmly believe Georgia must join those 40 states plus D.C. in expanding Medicaid. Medicaid expansion would increase the number of eligible Georgians and get us the extra federal funding to cover them. Under expansion, the federal government pays 90% of costs for expansion enrollees compared with the 66% it currently pays for the Georgians who have Pathways coverage. Expanding Medicaid would bring this critical funding home to Georgia, and could help stabilize our struggling rural hospitals, cornerstones for our rural communities.
Expansion would also unlock a new Medicaid option for hundreds of thousands of our friends, family members, and neighbors. These include Georgians who earn too much for Pathways but not enough to afford coverage through Georgia Access; Georgians who Pathways has failed to cover for years; and Georgians we know won’t be able to — and already can’t — afford Georgia Access without EPTCs.
Fewer insured Georgians means folks missing out on the care they need, which contributes to worsening conditions for those with chronic diseases, and ultimately leads to unemployment. To keep our thriving economy healthy, we must ensure hardworking Georgians have access to care.
It’s clear: Medicaid expansion is a win-win for the health of Georgians and our economy. But progress takes participation; I urge all readers to call your state representative and tell them why you’d like them to prioritize closing the coverage gap by expanding Medicaid.
— Natalie Crawford, Executive Director
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