A deal too good to pass up
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More than 20 years ago, Georgia’s elected leaders recognized an opportunity to provide health insurance to more Georgia children. Those leaders worked across the aisle to adapt the federal State Children’s Health Insurance Program to Georgia. The result was PeachCare for Kids, an enormously successful program that has provided a healthy start in life to thousands of children in our state. Almost 150,000 Georgia kids are currently covered by PeachCare for Kids. 
Leads to another
Georgia has a unique opportunity to build on the success of PeachCare for Kids. Georgia can employ existing and new federal laws to lower Georgia’s uninsured rate again—this time among adults with no other pathway to health coverage and those who have lost job-based coverage as a result of job loss during the COVID-19 pandemic.
This move would make individuals and parents with incomes of less than 133% of the federal poverty line eligible for health insurance coverage. The Georgia Department of Community Health estimates that 560,000 Georgia adults could gain coverage under such a program.
A cost-effective solution for Georgia
A new federal law incentivizes Georgia to extend coverage to low-income adults by offering a two-year, 5% increase in funding for our existing Medicaid program. Georgia would earn an estimated $1.3 Billion from the increased federal funding.
After covering the costs of the new insurance program, Georgia would still have $710 million leftover that it could used to offset spending elsewhere.
After the initial two years of the program, Georgia would be responsible for only 10% of program costs going forward. This could save Georgia as much as $400 million compared to the state's current plan (sometimes called Pathways).[5,6]
A Georgia solution for Georgia’s health
Georgia has the third-highest uninsured rate in the U.S. Low-income Georgia adults remain uninsured because they work in low-wage jobs that do not offer benefits, are full-time caregivers to loved ones, are attending school, or are too disabled or sick to work.[7,8] The state’s high uninsured rate is a drag on our economy, hinders rural communities, and hurts the health of Georgia workers.
Coverage for low-income adults would address these issues and kick-start Georgia’s recovery from COVID-19:
- Rural communities would disproportionately benefit. Rural Georgians would gain coverage at higher rates than urban or suburban residents. Rural hospitals would see greater proportional increases in their revenues than urban hospitals as a result of the increased coverage.
- Children’s uninsured rates would drop. About one-third of Georgia’s uninsured, low-income adults are parents. Because of the welcome mat effect and other reasons, children’s uninsured rates are significantly lower in states that offer coverage to low-income adults.
- Other state agencies, including the Georgia Department of Corrections, benefit from savings. Because currently uninsured adults would be newly covered, their coverage would pay for some health costs that are now paid for by state agencies, including people incarcerated by the Department of Corrections (DOC). In addition to a $15 million annual savings, DOC could also expect to see a drop in people cycling in and out of jail/prison and in people entering jail/prison for the first-time because of the increased access to care.
- The program produces an estimated $50 million in new state revenues, due to increased economic activity generated by additional health care spending. This would primarily consist of additional state income tax and state sales tax revenue.
- Physicians’ offices and other health care providers could re-hire staff laid off during COVID-19. Many small and mid-size practices saw dramatic slowdowns of patient visits during the pandemic, and many had to lay off employees. The additional health care spending created by newly covered adults would likely increase in employment and help these practices rebound.
Two years of funding for other state priorities
Because of the extra funds allocated for this program by Congress, Georgia would gain an estimated $350 million beyond the costs of the program for each of the first two years. These savings would give Georgia the flexibility to address other challenges and priorities facing the state, such as:
- Full restoration of the FY20 cuts to education so that schools are fully funded
- Continue the expansion of broadband connectivity to thousands of rural Georgians
- Build roads, bridges, or other infrastructure projects that power Georgia’s economy
- Reduce or eliminate Georgia’s Medicaid waiver waiting list for people with disabilities
 Georgia Department of Community Health. Georgia Medicaid Enrollment Online Dashboard. Accessed February 26, 2021
 Georgia Department of Community Health, July 8, 2019. Georgia Environmental Scan Report.
 American Rescue Plan Act. For a summary of the health provisions in the American Rescue Plan, see this report from Georgetown University's Center on Children & Families.
 Kaiser Family Foundation, February 18, 2021. New incentive for States to Adopt the ACA Medicaid Expansion: Implications for State Spending
 Georgia Budget & Policy Institute, February 2021. Expand Medicaid Fully; Reject Risky and Expensive State Plan.
 State Auditor Greg S. Griffin, Fiscal Note House Bill (LC 46 0015). Georgia Department of Audits and Accounts, January 18, 2019. 2018 Annual Report. Georgia Department of Community Health, June 30, 2018.
 Georgia Environmental Scan Report
 Kaiser Family Foundation, February 11, 2021. Work Among Medicaid Adults: Implications of Economic Downturn and Work Requirements.
 Georgetown Center on Children & Families, September 2018. Health Insurance Coverage in Small Towns and Rural America.
 Kaufman, Brystana G. et al, September 2016. Medicaid expansion Affects Rural and Urban Hospitals Differently. Health Affairs
 Georgetown Center on Children & Families, February 2021. Children Are Left Behind When States Fail to Expand Medicaid.
 Fiscal Note House Bill (LC 460015)
 Guyer, Jocelyn et al, November 2015. Medicaid expansion and criminal justice costs.
 Fiscal Note House Bill (LC 460015)
 Newsweek, June 5, 2020. Nurses and Health Care Workers Experience Record Job Losses Amid Pandemic.