How One Governor Is Trying To Avoid Responsibility For Denying Health Care To 600,000 Poor People

Gov. Nathan Deal (R-GA) in a 2012 state meeting with reporters CREDIT: AP PHOTO/DAVID TULIS
Gov. Nathan Deal (R-GA) in a 2012 state meeting with reporters CREDIT: AP PHOTO/DAVID TULIS

Georgia Gov. Nathan Deal (R) has the power to follow several other GOP governors’ lead and negotiate an alternative to the Affordable Care Act’s optional Medicaid expansion — a provision that would extend basic health benefits to more than 600,000 of the poorest Georgians — with the Obama administration. Instead, Deal’s administration is pushing a GOP-sponsored state bill that would take the matter out of the executive branch’s hands and require lawmakers to give legislative approval to any Medicaid expansion plan.

Deal has always been open about his support for the proposed bill, HB 990. But emails obtained by the Atlanta Journal-Constitution under Georgia’s Open Records Act show that Deal’s staff actually helped write and even strengthen the legislation.

The administration is defending its position by arguing that legislators should have a say when it comes to such an important provision. “It is an issue that has huge economic impacts and would seriously affect any budget that the General Assembly would come up with,” said Deal in a press conference last week. “And I think on that basis since they are responsible for passing a budget and yet have no say so under the current process about something that could tremendously impact what a budget might look like, I think it’s altogether appropriate.”

But critics say it amounts to shirking a controversial issue and stymieing future administrations that may want to negotiate with the Obama White House. Since the federal government will supply 100 percent of the funding for the first three years of Medicaid expansion, Georgia’s state Medicaid budget will be largely unaffected by embracing the expansion for the next several years.


“To me, it is more evidence that [Deal’s] doing everything he can in refusing the responsibility of leadership,” said state Sen. Jason Carter (D) — former president Jimmy Carter’s grandson and a candidate for the 2014 Democratic nomination to challenge Deal this fall — in a statement earlier this month. “It’s an unbelievable example of him passing the buck.”

Republicans have over two-thirds supermajorities in both Georgia legislative houses, making passage of a Medicaid expansion bill highly unlikely if HB 990 receives final approval. Meanwhile, the state is already facing the consequences of refusing Medicaid expansion.

Since the health law originally intended every state to expand Medicaid, it includes funding cuts to hospitals that serve large numbers of poor and uninsured patients who often can’t pay their medical bills — cuts that were meant to be mitigated by an influx of newly-insured poor people under the Medicaid expansion. But when the Supreme Court ruled the expansion optional for states in 2012, rural hospitals in anti-Obamacare states found themselves in a precarious position. Four rural Georgia hospitals have closed their doors in the last two years over excessive uncompensated care costs — a trend that’s expected to continue in states refusing the expansion.

A study by the Commonwealth Fund found that Georgia taxpayers will be forced to shell out $3 billion through 2022 to help fund other states’ Medicaid expansions, even though state residents won’t enjoy any of the benefits of the health law provision themselves.

Deal has previously come under fire for accepting more than $550,000 from health care lobbied interests — including more than $100,000 from private insurance companies opposed to the ACA — while refusing the generous federal funds to extend health benefits to more than half a million poor Georgians.