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Medicaid expansion: An evidence-based response to COVID-19, unemployment, & racial disparities

“Any plan that does not address the coverage gap is insufficient and ultimately fails Georgians. Refusing to address coverage on the front end means that our friends and family lead less productive lives and end up (with) bills they cannot afford that get left with the state at the end of the day. This is our problem one way or the other and the Governor’s Medicaid plan does not address the fundamental problem facing Georgians, which is the lack of basic health care.”

— Commenter

Georgia remains one of 14 states that has not yet expanded Medicaid to cover low-income adults. As a result, more than 400,000 poor, uninsured Georgians have no health coverage during a pandemic, a number that is growing as more Georgians lose their jobs and their job-based coverage.

While the health and economic impacts of COVID-19 are hitting Georgians of color hardest, uninsured rates were consistently higher among Black and Hispanic Georgians compared to whites even before the pandemic began. Thirty six percent (36%) of those in the coverage gap between Medicaid and the Affordable Care Act’s marketplace are Black and 22% are Hispanic.

In the face of clear evidence that Medicaid expansion would benefit Georgians impacted by COVID-19, support Georgia’s COVID-19 response efforts, and reduce health disparities experienced by Black and Hispanic Georgians, Governor Kemp continues to pursue a plan that he put forward in 2019 that would allow Medicaid to cover a small fraction of low-income, uninsured Georgia adults and cost the state three times more per person to operate. The plan would not cover any additional Georgians until July 2021.

In November 2019 and January 2020, Georgians were asked to participate in two 30-day public comment periods to tell state decision makers and federal health officials what they thought of Governor Kemp’s Medicaid plan. Over 2,700 comments were submitted during the two comment periods.

GHF conducted an analysis of all available comments and found that by a 9-to-1 margin, commenters were opposed to Gov. Kemp’s plan and preferred a full Medicaid expansion. Commenters largely felt that Gov. Kemp’s plan did not cover enough people, ignored the great financial deal offered by a full Medicaid expansion, and imposed too many barriers to health care.

Even though the comment periods occurred before the health and economic impacts of the COVID-19 pandemic unfolded and the movement for racial justice was sparked by the violent deaths of Black Georgians and others, commenters touched on themes relevant to both:

“Medicaid helps my community by increasing the health and longevity of parents and children, especially in communities of color, in order to be able to provide increase parenting skills and empowerment for adults, and healthier growth and development for the children. It also decreases the equity gaps produced by centuries of inequities in all areas of our state institutions. This is turn contributes to better educational attainment and decreased crime—a direct correlation with better and preventative healthcare provided by Medicaid—which benefits all of us!”

— Commenter

“I am a person living with HIV and Medicaid expansion is critically important for me. Under the partial Medicaid expansion proposal, I would not be eligible because I make too much. However, I am in between jobs and don’t have the resources to pay for healthcare coverage. I am concerned that the funds allocated could be better utilized to serve more Georgians like myself. Georgia would have to pay 3 times more per person than it would under Medicaid expansion.”

— Commenter

“I have a severe disability that limits my ability to work, so I work part-time from home. Every extra bureaucratic step involved in getting the medications and healthcare I need to function well, directly lowers the number of hours I can work and engage with my community. Delays in receiving this care can impact me for weeks, months, or years, potentially resulting in permanent loss of function. I want all of my neighbors, friends, and family to be able to access the care they need to live fulfilling lives. Instead of opting for the Governor’s expensive Medicaid waiver that will leave hundreds of thousands of Georgians uninsured, please expand Medicare coverage instead. . . Georgians want everyone who needs healthcare to get coverage, not to institute needless and complicated barriers to care. Our generosity in caring for each other is what will make our state great.”

— Commenter

“I am one of 5,000 volunteer caseworkers with St Vincent de Paul Georgia working each day around our state to help low income people in need. We meet working people every day who cannot pay their rent because of unexpected medical bills. We see people going without medical care and needed medications and their numbers are growing…The recent coronavirus outbreak and shocking mass shootings should drive home the fact that denying people access to primary care and mental healthcare makes all of us vulnerable…”

— Commenter

“ Governor Kemp’s plan is fiscally and morally irresponsible. This plan will cost more money to cover fewer Georgians than full Medicaid expansion leaving thousands of Georgians who would be eligible for Medicaid without healthcare….This plan is bad for Georgia and bad for our budget.”


The COVID-19 pandemic and the uprising for racial justice have added urgency to the calls for an equitable health system that is accessible and affordable for all Georgians. Medicaid expansion will help Georgia meet this moment.

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