Georgia, one of the ten states that has yet to fully expand Medicaid under the Affordable Care Act (ACA), is once again at a critical juncture regarding its healthcare future. With one of the highest uninsured rates in the nation, the state faces mounting pressure from both local political forces and federal lawmakers.
A new commission is set to launch its review this month, tasked with examining the healthcare needs of low-income and uninsured Georgians. This effort is seen as a direct challenge to the state’s long-standing opposition to traditional Medicaid expansion, spurred by a fresh openness among some top Republicans to explore alternative coverage models.
The State Debate: Pathways vs. Alternatives
The nine-member commission was created earlier this year after a proposal to adopt an «Arkansas model» of expansion—which uses federal funds to purchase private insurance instead of expanding the state-run Medicaid program—was narrowly defeated. The commission is viewed as a way to sustain the conversation while giving Governor Brian Kemp’s limited expansion program, Georgia Pathways to Coverage, more time to demonstrate results.
The commission will hold its first meeting soon and is required to report its findings to the Governor and state lawmakers in December 2024, ahead of the 2025 legislative session. The panel is set to disband at the end of 2026.
Governor Kemp, however, remains a staunch opponent of full Medicaid expansion, calling it a «broken, unsustainable state system.» He has instead defended his limited program, Georgia Pathways to Coverage, which offers eligibility only to low-income Georgians who complete 80 hours of work, school, or other qualifying activities each month.
Pathways’ Slow Start
Despite initial projections that up to 100,000 people would sign up for Pathways (with 345,000 potentially qualifying), only about 4,300 people had enrolled as of June. Kemp has blamed the slow start on the Biden administration, citing delays stemming from a federal challenge to the program’s work requirement.
Kemp insists a full Medicaid expansion is «not the best way forward» and has pledged to continue building «Georgia’s unique health care system.» Caylee Noggle, President and CEO of the Georgia Hospital Association (GHA) and the newly appointed commission chair, acknowledged the challenge: “We recognize that we have a lot of work that we still need to do.”
The Federal Work-Around: «Bridge to Medicaid»
Simultaneously, U.S. Senator Raphael Warnock (D-GA), with support from Senator Jon Ossoff (D-GA), is introducing a new federal legislative proposal called the «Bridge to Medicaid» Act. This bill aims to create a temporary federal backstop for the hundreds of thousands of Georgians who fall into the «coverage gap.»
The coverage gap exists in non-expansion states where low-income residents earn too much to qualify for traditional Medicaid but too little to afford subsidies on the ACA marketplace.
How the «Bridge» Works
Slated to start in 2026 and last for three years, the proposal would use tax credits—similar to existing ACA subsidies but more generous—and expand their application to cover deductibles and copays.
«While we’re talking about tax cuts for the wealthiest, I think we really need to talk about how to provide tax credits that will provide healthcare for the mobile nurse, the truck driver, someone who paints houses for a living,» Warnock said. He argued that the failure to close the coverage gap results in a «sick and less productive workforce.»
The program is intended as a stopgap solution. Leah Chan, director of health justice at the Georgia Budget and Policy Center (GBPI), noted that the temporary nature of the federal proposal would allow Georgia to «test that idea and see what works and what doesn’t,» facilitating a smoother eventual transition to a permanent security gap plan.
Advocates Weigh In
The federal proposal has garnered support from advocacy groups, including the GBPI and the American Cancer Society Cancer Action Network.
Fabienne Antoine-Nasser, the Georgia government relations director for the American Cancer Society Cancer Action Network, stressed the life-saving potential: “Closing the coverage gap could provide access to life-saving screenings and primary care for more than 400,000 underserved Georgians to detect cancer at an earlier stage and increase their chances of survival.”
However, Senator Warnock clearly stated that the long-term solution remains full expansion: «This is only a three-year program. So, at the end of those three years, our state leaders will have to decide whether they think people ought to continue to have health insurance, and the best way to provide them with health insurance would be to expand.»
The twin efforts at both the state and federal levels ensure that healthcare access will be a dominant and highly politicized issue in Georgia well into 2026.
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