A bill authorizing Gov. Brian Kemp to pursue Medicaid waivers passed the state Senate on Tuesday amid criticism from Democrats that Republicans rushed to approve the governor's proposal without considering amendments.
The measure cleared the Senate 32-20. It now goes to the House for consideration.
Kemp applauded the passage of the bill, calling it a "critical step toward more innovative, accessible, and affordable health care for hardworking Georgians."
The governor said he doesn't understand Democrat opposition to a provision in the waiver focused on driving down private sector health care costs. He called their insistence on full Medicaid expansion "stubborn."
"It's OK to disagree on one part of the bill, but it's still worth going through the exercise, even if you don't agree with our position," Kemp said.
Kemp has stated that full Medicaid expansion, which Democrats support, isn't an option. His measure would give Georgia the flexibility to adopt a more conservative plan.
Georgia is one of 14 states that haven't fully expanded Medicaid as prescribed under the Affordable Care Act. The expansion was intended to be nationwide, but a 2012 Supreme Court ruling effectively made it optional for states.
Democrats worry Kemp's Medicaid waiver plan will increase health care costs and cover fewer people compared to a full Medicaid expansion.
Among their biggest concerns: Kemp's proposal will not cover Georgians who fall slightly above the poverty line, as was required under the original call to expand Medicaid under the 2010 Affordable Care Act, also known as Obamacare. Kemp's bill would cap that eligibility at the poverty line, limiting the number of people who could receive Medicaid benefits.
Tillery, one of the bill's main supporters, stated that those above 100 percent of the federal poverty line who would not be included in Kemp's Medicaid proposal can still apply for subsidies on the Affordable Care Act "This bill does nothing to say that's not possible," Tillery said.
"It's a very simple three-page bill that can do miraculous things for health care and health care costs," said Republican Sen. Blake Tillery of Vidalia, Kemp's floor leader in the Senate. "This bill doesn't just address the rich. It doesn't just address the poor. It covers the gambit of Georgians."
Senate Democrats accused their Republican counterparts Tuesday of shutting down debate on the plan after the Senate voted to consider the bill without allowing for any amendments.
"This is life or death. We should be ashamed that we are not letting this be open to debate," said freshman Democratic Rep. Zahra Karinshak of Duluth.
Simple amendments would improve the bill and give it a chance for bipartisan support, said Senate Democratic Leader Steve Henson of Stone Mountain, one of the measure's most vocal critics.
Henson has authored a bill advocating for full Medicaid expansion that has not been heard in committee.
"This bill does not have safeguards. It does not have a backup plan," Henson said. "That's what we're ramming through today and it's problematic."
Democrats frequently noted that the federal government has agreed to pay 90 percent of the cost to expand Medicaid if the state government includes people slightly above the poverty line, as required by the ACA.
They said that Kemp's plan could preclude them from such a deal, noting that states like Massachusetts and Arkansas failed to get such a high match rate from the federal government, after trying to cap Medicaid eligibility only up to the poverty line.
Democratic Sen. Jen Jordan from Atlanta grilled the bill's author, repeatedly asking whether any state has been granted a federal waiver after capping Medicaid eligibility at the poverty line.
"Just because a state has not been approved, it does not mean Georgia should not try," Tillery said. He said that some applications are pending now.
Jordan also asked Tillery whether Kemp's plan would cover 240,000 Georgians.
Tillery said it was not yet clear if the bill would "cover one person or 100," as all it currently allowed was for the governor to start meeting with consultants and experts to start working on the waiver.
Jordan replied: "We basically don't know what this bill does as we stand here, even though we all said it's the most significant piece of legislation that's going to be passed out of this body."
