ATLANTA (AP) — Following several of his Republican colleagues in other states, Gov. Nathan Deal says he has no intention of expanding Medicaid insurance eligibility under President Barack Obama's 2010 health care overhaul.
"I think that is something our state cannot afford," Deal told reporters gathered Tuesday in Tampa for the Republican National Convention.
Deal, meanwhile, repeated his previous statements that he will wait until after the Nov. 6 election to decide whether Georgia will run its own private insurance exchange or punt the job to federal officials. The state has until Nov. 16 to decide.
Medicaid expansion and the state insurance exchanges, which would allow uninsured individuals to shop for private-sector policies, are the anchors of Obama's Affordable Care Act.
Medicaid is government health insurance for low-income Americans, mostly children. It is financed jointly by the federal government and the states, with the state's share based on per-capita income. Poorer states pay a smaller portion of their Medicaid spending than wealthier states.
Initially, the Affordable Care Act of 2010 required that states, beginning in 2014, cover anyone in households earning up to 133 percent of the federal poverty level. The expansion would add about 620,000 people to Georgia's current enrollment of 1.5 million.
But the U.S. Supreme Court ruled in June that expansion must be optional. Republican Govs. Rick Scott of Florida, Bobby Jindal of Louisiana, Phil Bryant of Mississippi, Nikki Haley of South Carolina and Rick Perry of Texas have said they will not expand their programs.
At the time of the ruling, Deal was noncommittal on Georgia's plan, noting the possibility that the Medicaid and exchange questions could become moot if GOP challenger Mitt Romney defeats Obama and Republicans claim both houses of Congress. In that case, Republicans have promised to repeal all of the law.
Deal spokesman Brian Robinson said Tuesday that the governor's Tampa comments do not represent any change.
"The governor's position remains the same: The state of Georgia will not move on implementing any portion of Obamacare before the November election," Robinson said. "Today, the governor said if the state's only options remain the ones that are available today, he would oppose taking part in the expanded Medicaid program."
Deal cited estimates that Georgia would have to spend more than $4 billion over 10 years on the additional coverage.
Georgia's annual Medicaid budget is $8 billion. The federal government pays almost two-thirds of that total, while Georgia covers the rest. The 2010 law would have left the traditional income-based split in place for anyone eligible under current rules.
Childless adults and older children would be the biggest beneficiaries of higher income thresholds. The state agency that runs Medicaid estimates that an expanded program would cover another 526,225 adults and 93,948 more children in 2014.
The federal government, meanwhile, would cover 100 percent of the new beneficiaries in 2014, with that proportion dropping to 90 percent permanently by 2020. Deal questioned whether the federal government would be able to keep that bargain.
Deal's financial projections do not address the Obama administration's argument that Medicaid expansion and insurance exchanges would either save many states money or, at worst, be revenue neutral.
Separate from individual Medicaid coverage, states already must put up their own money to draw federal support to compensate hospitals for treating the uninsured. The Affordable Care Act assumes that with more people insured, those "uncompensated care" costs will go down over time.
House Speaker David Ralston, the Legislature's most powerful figure, said through a spokesman that he supports Deal in not expanding Medicaid.
The Blue Ridge Republican got out in front of the governor, however, on insurance exchanges. "My belief is that the state can do a better job creating and running an exchange than the federal government could in what would be a top-down approach," Ralston said. "How we move forward and address this decision will be part of an ongoing discussion House Republicans will be having throughout the fall."