Kemp signs bill to ease limits on new health care facilities while restating opposition to Medicaid expansion

The governor signed into law a high-profile health care measure Friday that is seen as a potential pathway to passing full Medicaid expansion next year – but not before casting fresh doubts on whether another year will change his mind.  

Gov. Brian Kemp restated his opposition to fully expanding the public insurance program in strong comments made at an event Thursday that was hosted by the Atlanta Journal-Constitution.

“I’m in the ‘no’ camp,” Kemp said. “I am supportive of what we did. We need some more time to continue to implement and get people to sign up on Pathways.”

The governor’s program, Pathways to Coverage, launched last July and partially expanded coverage for some low-income Georgians who complete 80 hours of work, school or other qualifying activity each month.

That program has covered less than 4,000 people out of the 350,000 Georgians who could be eligible, but the governor has blamed the slow start on delays resulting from attempts by the Biden administration to block the program. The state has sued the federal government for more time to ramp up the program, which is otherwise set to expire next fall.

The bill signed by the governor Friday is mostly focused on the state’s certificate-of-need rules, which control how many health care services are allowed in any given area of the state. But the bill also creates a commission that will look at health care issues affecting low-income and uninsured Georgians.

The nine-member panel will be led by a health policy expert who is appointed by Kemp and must be in place by this July. It is tasked with submitting a report by the end of the year and ahead of next year’s session, which starts in January.

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

“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.

The bill had been closely watched during this year’s legislative session as a potential opportunity to fully expand Medicaid. Separately, a state Senate committee held a hearing on a proposal calling for an Arkansas-style model of Medicaid expansion, which uses federal dollars to purchase private insurance for those eligible. That bill narrowly failed in committee in the final days of the 2024 session.

“We were fine with the Legislature having a conversation about that,” Kemp said at the AJC event Thursday. “That’s certainly up to them. I was respectful of that. But when they start talking about going to the floor and going to a vote, they need to be having a fiscal note.”

The governor, who is in the middle of his last term, also argued that full Medicaid expansion would steer people away from private health insurance, which pays a higher reimbursement rate to providers.

But the pressure to change course will likely continue to mount, especially if enrollment in Pathways continues to lag. Georgia is one of 10 states that have not fully expanded Medicaid under the Affordable Care Act.

“I’m in the yes camp,” state Rep. Scott Holcomb, an Atlanta Democrat, said on social media Friday. “Georgia has the 2nd highest rate of uninsured in the country. We have vulnerable hospitals that serve populations w/out insurance. Georgia Pathways is not working & costs MUCH MORE than full expansion. It’s absurd not to consider.”

Some advocates said they saw the governor’s comments as being consistent with his earlier statements.

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

Attention will now turn 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.”