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A plan by state Senate Democrats and some Republicans to fully expand Medicaid coverage in Georgia was shot down Thursday by the narrowest margin – a tie vote in a Senate committee.

Sen. David Lucas, D-Macon, working with Sen. Matt Brass, R-Newnan, brought a proposal to expand Georgia’s Medicaid program through a waiver the state would seek from the federal Centers for Medicare and Medicaid Services.

Georgia’s Republican governors and legislative leaders have refused to consider fully expanding Medicaid coverage for more than a decade since a then-Democratic Congress passed the Affordable Care Act, citing the cost.

But if the feds approved the waiver, Georgia would receive a $1.2 billion “signing bonus” from the federal government to implement the program during the first two years, according to a state audit. The program would cover an estimated 500,000 to 1 million Georgians.

“We can’t kick the can down the road anymore,” Lucas told members of the Senate Regulated Industries Committee Thursday. “$1.2 billion is waiting in (Washington), D.C., for Georgia to expand (Medicaid). But how long is it going to be there?”

“It would be a massive reduction in how many uninsured Georgians we have,” added Laura Colbert, executive director of Georgians for a Healthy Future, a nonprofit that has long supported Medicaid expansion.

But several Republicans on the committee said fully expanding Medicaid now would undercut two waiver programs the Kemp administration has put in place or is working to implement.

After a lengthy court struggle with the Biden administration, Gov. Brian Kemp’s Georgia Pathways to Coverage program took effect last summer. The Kemp administration also has a second waiver program called Georgia Access, a state-based health-insurance exchange directing people to private health insurers and brokers.

“Governor Kemp has taken a very strong stand on using private health care through the waiver process,” said committee Chairman Bill Cowsert, R-Athens, who cast the deciding tie vote that sank the expansion bill. “We may be rushing the gun here to undercut his efforts.”

But the bill’s supporters argued Georgia Pathways is only covering 2,900 enrollees despite having spent $26 million. Georgia Access is expected to enroll 50,000 Georgians in its first year and 85,000 by its second year, said Sen. Ben Watson, R-Savannah, chairman of the Senate Health and Human Services Committee.

“I think we need to give this more time,” he said.

While Georgia Access covers Georgians with incomes up to 138% of the Federal Poverty Level – the same as fully expanding Medicaid – Georgia Pathways covers only those with incomes up to 100% of the poverty limit.

Brass said a fully expanded Medicaid program would allow him to cover workers at his business who could qualify at the 138% income level but don’t meet the 100% threshhold

“As a small business owner who can’t afford insurance for my employees … I want my guys insured,” he said.

Lucas said a full expansion of Medicaid would help financially struggling hospitals in rural Georgia keep their lights on.

“Your zip code ought not to matter for your health care,” he said. “That’s what’s happening in Georgia.”

Cowsert noted a provision in a separate bill reforming Georgia’s Certificate of Need law governing hospital construction would create a state commission to examine how Georgia can improve health-care access, including the Medicaid expansion option.

“This has been an ongoing conversation for many years in Georgia,” he said. “Why shouldn’t we give the governor a chance to see if Pathways can succeed?”