Sen. Dean Burke

Sen. Dean Burke 

ATLANTA – State lawmakers appear to be teed up for a long-awaited debate over health care this session and how the state’s insurance program for the poor and disabled factors into a possible solution.

For now, legislators on both side of the aisle say they are encouraged by Gov. Brian Kemp’s plan to add $1 million to this year’s budget to explore a waiver that would give Georgia more leeway in how it uses its federal Medicaid dollars.

House Minority Leader Bob Trammell, who hails from rural Luthersville and who has filed a measure that would fully expand Medicaid, said Friday that the “ground is softer” this year for a major health care measure.

“The mere presence of (the waiver) in the budget is a signal that there is momentum on the issue,” Trammell said in remarks at the left-leaning Georgia Budget and Policy Institute’s conference in downtown Atlanta.

Sen. Dean Burke, a Republican from Bainbridge and an influential voice on heath care in the Senate, said he believes there is a growing acknowledgement that more resources need to go toward rural health care.

He said there is significant momentum for a waiver, although much will depend on the details of such a proposal, and that he anticipates a “robust discussion” on how a waiver is designed.

“There are strong, strong feelings on both sides of that issue,” said Burke, who is also a doctor and an administrator at a rural hospital. “If it was a simple issue, we would have settled it by now.”

He said the appearance of the money in the budget for a waiver “is a great sign that there is a willingness in the governor’s office to have those conversations.”

“That’s something that’s been absent for the last few years,” Burke said.

Former Gov. Nathan Deal resisted expanding Medicaid, citing the cost to the state over time and the risk of the federal government ending its contribution at some point. And a push for a waiver sputtered out of gas after the 2016 presidential election renewed talk of repealing the Affordable Care Act.

Kemp, who was sworn in last week, is fresh off a close gubernatorial race that was largely dominated by the issue of Medicaid expansion. Georgia is one of 14 states that did not expand eligibility to low-income adults under Obamacare.

About 71 percent of Georgians surveyed this month said they support expanding Medicaid, according to a new poll conducted by the University of Georgia’s School of Public and International Affairs for the Atlanta Journal-Constitution.

Kemp said during a budget hearing this week that a waiver would enable the state to “pursue flexibility options for Georgia’s Medicaid program to expand access without expanding a broken system.”

Kemp cited the physician shortage around the state: 79 counties without an obstetrician and gynecologist, 64 counties without a pediatrician, and nine counties without any physician at all.

“We must find innovative ways to expand health care access through innovation and competition,” he said.

Budget analysts recently concluded that Trammell’s proposal to pursue full expansion would cost the state somewhere between $188 million and $213 million by 2020 and extend health care coverage to another 500,000.

“The rhetoric around Medicaid expansion for those who have opposed it does not match the hard facts and the hard numbers,” Trammell said in an interview. “This shows that we need to do what 36 other states have already figured out and that’s expanding Medicaid is a good investment for the state.”

But the cost isn’t the only issue for some lawmakers. Sen. Kay Kirkpatrick, a Republican from Marietta, argued that some providers do not want to accept Medicaid because of its low reimbursement rate and the bureaucratic strings attached.

“If we do expansion without reform, I think we’re shooting ourselves in the foot,” Kirkpatrick said.

Jill Nolin covers the Georgia Statehouse for CNHI's newspapers and websites. Reach her at

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