The Georgia Jobs Program is evaluating how Trump might reform Medicaid

Daphne Young, 61, was recovering from cervical cancer and a serious heart condition when she arrived late last month at her Atlanta job eager to get Medicaid coverage.

In July, Ms. Young, a reporter, had moved from California to Georgia, a state with strict Medicaid eligibility limits and one of only 10 that has not expanded the program to adults under a Price Control Act. The monthly premium she wrote for herself and her son was too high to qualify, she said.

Instead, Ms. Young was directed to a table of possible alternatives: a new Medicaid program called Georgia Pathways to Coverage, which would require enrollees to with an income up to 100 percent of the federal poverty level to work, study or perform at least community service. 80 hours a month to get coverage.

Pathways, which launched the anemia registry ahead of its scheduled deadline next year, is the subject of a bitter legal and philosophical battle over the future of Medicaid, the federal federal program that accounts for 10 percent of of the government budget and is comprehensive. 75 million Americans, most of them low income.

Health policy experts have said that Georgia has served as a kind of safe lab for Medicaid, testing potential changes if former President Donald J. Trump wins the White House in November.

Democrats have taken up the future of the program at a crucial time in the campaign.

“Finally let’s expand Medicaid in Georgia so people can take their child to the doctor or go to the emergency room without going into medical debt,” Vice President Kamala Harris said in a recent campaign speech in Savannah , Ga.

Mr. Trump, who was the president called for major cuts to Medicaid in his budget proposals, did not say much about how he would change the welfare program. In a presidential press conference this week, he suggested he has “planning ideas” for changes to the Affordable Care Act that he would soon share, which he could use to call for significant spending cuts. of Medicaid money.

Edwin Park, a Medicaid expert at Georgetown University, said the battle in Congress next year over the tax-deductible measures signed into law by Mr. Trump in 2017 could lead lawmakers to hunt for cut big from government health programs.

“And where would you go without Medicaid?” Mr. Park said. “If we take President Trump’s claims about protecting Medicare and Social Security right, Medicaid will be a huge source of savings.”

Republican lawmakers and policy experts, some of whom served in the Trump administration, are busy pressing their own case that the recent expansion of Medicaid has put unsustainable pressure on federal budgets. and government.

House Republican budget proposals, along with Project 2025 and conservative think tanks, have argued that expanding the program to cover more adults has diverted resources from other Medicaid recipients. needy, such as children, pregnant women and people with disabilities.

The authors of Project 2025, which the Trump campaign has rejected, called Medicaid “a heavy, burdensome and unaffordable burden for almost every state.”

The Pathways program is at the center of the Republican vision to rethink Medicaid. About a dozen states received approval from the Trump administration to tighten work requirements in their Medicaid programs, but were stopped by the Biden administration.

Republicans have also called for a reduction in federal funding that states receive for their Medicaid programs or recipients, a process known as “block grants” or “per capita caps.” The Trump administration in 2020 began authorizing such a plan.

And they have proposed reducing the portion of Medicaid spending that the federal government covers, or the so-called flat rate. Under the Medicaid expansion, which covers poor seniors, the federal government picks up 90 percent of the costs, making the option attractive even in Republican-led states.

States that lose a large share of federal funding to Medicaid may have to increase their own funding to make up the difference, or cut more money to Medicaid.

Big changes to those matching rates could entice states to roll back their expansion of the program, which Republicans sought during Mr. Trump’s first term. Republican state lawmakers, including in Idaho, have begun considering such a measure.

The lines, which used mainly federal funds, were written in opposition to the expansion of Medicaid, reflecting the Republican emphasis on personal responsibility as a condition of publicly funded health care.

But health policy experts said the approach hit people like Ms Young hard, putting people on low incomes in charge of complicated lives unless they could raise their incomes.

This program served as a warning sign of how those improvements are being used. By July, a year into the Pathways program, fewer than 4,500 people had signed up — a fraction of the roughly 168,000 that state officials estimated were eligible to enroll.

A spokeswoman for the Georgia Medicaid agency did not respond to follow-up questions about Pathways’ latest enrollment numbers.

“The goal of Georgia Pathways is not — and never has been — to keep hundreds of thousands of Georgians on government-run health care forever,” said Brian Kemp, the Republican governor of government, said at a recent health care roundtable event. He said broadcasting was “a path to education, work, employment and a better life without government assistance.”

Street critics have expressed opposition to the program: To reduce the federal government’s role in health care, the government created a massive federally funded health care program that spent little on health care. . As of March 31, about $25 million of the $32.5 million spent on the program was for administrative costs.

Leah Chan, a health policy expert at the Georgia Budget and Policy Center, a nonprofit research firm, said those administrative costs mean the state is spending more on Pathways certification than on expansion. traditional Medicaid.

“The most responsible fiscal decision is to close the coverage gap,” he said, referring to the roughly 175,000 Georgians who earn too much to qualify for the state’s Medicaid program but not enough for subsidized plans in the Affordable Care Act markets.

Like the Pathways model, some health policy experts have suggested that states take an in-between position: allowing adults with incomes up to 100 percent of the federal poverty level to qualify for Medicaid, and those above it receive substantial financial assistance to purchase plans through the Affordable Care Act marketplaces.

With the help of those grants, about 1.3 million Georgians signed up for market plans this year. About 400,000 people who were on Medicaid now had plans in the marketplace that offered “good coverage, more coverage, while saving taxpayer dollars,” Mr. Kemp said at the roundtable event.

Government officials are standing by the Pathways program, announcing a marketing campaign of more than 10 million last month in order to register juice.

At a recent registration event at a federal building near the State Capitol, a small group of contractors recruiting for the program provided Pathways hand sanitizer, first aid kits, umbrellas and ponchos.

Security often gives recipients access to other security programs. Diamond Carter, a 23-year-old Pathways recipient from Atlanta who is raising a daughter, said her enrollment gave her access to the Special Nutrition Program for Women, Infants and Children, a program sponsored by funded by the government known as WIC which covers the cost. of groceries.

“I can go in at any time and apply for anything I need,” Ms. Carter said, referring to the online application she uses for Pathways.

Ms. Young, a prospective Pathways recipient, said she raised about $30,000 at a private hospital in Atlanta before being transferred to a public hospital that typically treats the uninsured. He stayed there last week, and plans to finish his Pathways application as soon as he can, he said.

The part-time job she started wouldn’t come with health insurance, Ms. Young noted. He hoped to work about 80 hours a month while he fixed his health problems, leaving him on track to qualify for Pathways.

“How are you supposed to live?” he asked.