By State Sen. Ben Watson, MD.
As the 2022 Georgia General Assembly reconvenes in January, one of the biggest issues we will face is the subject of Medicaid. The Affordable Care Act, commonly referred to as “ObamaCare,” allowed states to provide for innovative strategies in providing some leeway to reduce costs and provide equal or better health care.
Instead of expanding Medicaid in a very costly manner that covers anybody regardless of their socioeconomic strata, we in a bipartisan effort, chose a more responsible effort to control costs and yet provide a hand-up to all Georgians. The previous presidential administration allowed Georgia in 2020 to regulate Medicaid costs by reviewing the process that created waivers for two different parts of the process.
The first waiver is the section 1115 waiver that covers people below the 100% federal poverty rate. Section 1115 waivers offer states an avenue to test new approaches in Medicaid that differ from what is required by federal statute and can provide states considerable flexibility in how they operate their programs.
Under this provision of the Social Security Act, the U.S. Secretary of Health and Human Services can waive federal guidelines on Medicaid to allow states to pilot and evaluate innovative approaches to serving beneficiaries.
The section 1332 waiver is for coverage for those people between the 100% and 137% of the federal poverty rate. In order for a section 1332 waiver to be approved, the Department must determine that the waiver will provide coverage that is at least as comprehensive as the coverage provided without the waiver; provide coverage and cost-sharing protections against excessive out-ofpocket spending that are at least as affordable as without the waiver; provide coverage to at least a comparable number of residents as without the waiver; and not increase the federal deficit.
The Georgia General Assembly took care of the required Medicaid expansion by requiring that in order for those individuals in the section 1115 waiver to receive Medicaid coverage, they had to do one of four things:
• Work part time for at least 20 hours
• Do 20 hours of community service
• Attend a trade school learning a skill
• Attend college. In the view of most members of the General Assembly, these were simple tasks that would make those receiving state benefits productive members of our state and take some ownership in helping themselves to move out of the bottom tier of poverty.
For those in the section 1332 tier, we covered those individuals with the state purchasing reinsurance for coverage as most of these people were already working in some way. As I mentioned, the previous president and his department of Health and Human Services agreed with both Georgia’s waivers and approved them. The Presidential administration of Joe Biden decided this year to reverse the Trump administration’s approval of Georgia’s 1115 waiver, and thus reverted the program back to past rules that could not contain costs.
With the federal government’s rejection of Georgia’s section 1115 waiver, our governor, Brian Kemp, has sued the federal government to reverse this course of action and reinstate the plan that we in Georgia have laid out.
Sen. Ben Watson, M.D., represents Bryan County in the Georgia General Assembly.