Georgia
Can a Medicaid plan that requires work succeed? First year of Georgia experiment is not promising
ATLANTA (AP) — By now, Georgia officials expected their new Medicaid plan, the only one in the nation with a work requirement, to provide health insurance to 25,000 low-income residents and possibly tens of thousands more.
But a year since its launch, Pathways to Coverage has roughly 4,300 members, much lower than what state officials projected and a tiny fraction of the roughly half-million state residents who could be covered if Georgia, like 40 other states, agreed to a full Medicaid expansion.
Georgia Gov. Brian Kemp’s office has presented Pathways as a compromise that would add people to Medicaid while also helping them transition off it. Blaming the Biden administration for delaying the program’s start, Kemp’s office says it’s redoubling efforts to sign people up.
Health and public policy experts believe the enrollment numbers, dismal even compared to what Kemp’s office had said Pathways could achieve, reflect a fundamental flaw: The work requirement is just too burdensome.
“It’s clear that the Georgia Pathways experiment is a huge failure,” said Leo Cuello, a research professor at the Georgetown University McCourt School of Public Policy.
Pathways requires all recipients to show at least 80 hours of work monthly, volunteer activity, schooling or vocational rehabilitation. It also limits coverage to able-bodied adults earning no more than the federal poverty line, which is $15,060 for a single person and $31,200 for a family of four.
Cuello noted the program makes no exceptions for people who are caring for children or other family, lack transportation, suffer from drug addiction or face a myriad other barriers to employment. Then there are people with informal jobs that make documenting their hours impossible.
In rural Clay County in southwest Georgia, Dr. Karen Kinsell said many of her patients are too sick to work. Over the last year, Kinsell has suggested Pathways to about 30 patients who might meets its requirements, but none have signed up.
“I think the general idea is it would be too much work and too complicated for little benefit,” she said.
Just going online each month to submit proof of work can be a significant obstacle, said Harry Heiman, a health policy professor at Georgia State University.
“For low-income people who are worried about staying housed and putting food on the table, one more thing to do is often one thing too many,” he said.
The program’s poor showing so far may have implications beyond Georgia. Republicans in other states in recent months also have proposed requiring work to get Medicaid. In Mississippi, Lt. Gov. Delbert Hosemann in February cited Georgia’s Pathways program as a model.
A second term for former President Donald Trump would significantly boost the prospects for such programs. The Trump administration approved Medicaid work requirement plans in 13 states, only to have the Biden administration revoke those waivers in 2021. Pathways survived after a court fight.
Georgia launched the program on July 1, 2023 with little fanfare, and public health experts say they have seen scant effort to promote it or sign people up.
The launch coincided with a federally mandated review of the eligibility of all 2.7 million Medicaid recipients in the state following the end of the COVID-19 public health emergency, another challenging task for Georgia officials.
Still, they did not scale-back their enrollment expectations. Days before the launch, then-Georgia Department of Community Health Commissioner Caylee Noggle told The Associated Press that Pathways could cover up to 100,000 people in year one. The 25,000 estimate had been in the state’s 2019 application for Pathways.
Garrison Douglas, a spokesman for Kemp, said in a statement that Pathways had received “extraordinary interest from thousands of low income, able-bodied Georgians,” and the state was “still fighting to reclaim the time stolen” from it by the Biden administration.
The program was supposed to launch in 2021, but the Centers for Medicare and Medicaid Services objected to the work requirement that February and later revoked it. Georgia sued and a federal judge reinstated the work mandate in 2022.
As of June 7, 2024, Pathways had 4,318 members, according to the Georgia Department of Community Health. The agency said in an email that promotion efforts have included social media content and streaming ads on TV and radio, while a “robust” outreach campaign was being planned.
“Pathways deserves more time to see if it reaches its potential,” said Chris Denson, director of policy and research at the conservative Georgia Public Policy Foundation.
Denson said there is general agreement even among Pathways’ supporters that the state could have done a better marketing job. But he said a fundamental tenet of Pathways — transitioning people through employment, job training or other qualifying activities to private insurance — is sound, particularly given that many primary care physicians in the state are not accepting new Medicaid patients.
To critics, the actual first-year figure is all the more galling given how many people full Medicaid expansion could cover at no extra cost to the state, at least initially.
An analysis by the left-leaning Georgia Budget and Policy Institute found Georgia’s Medicaid program would receive so much more federal funding under full expansion that in its first year the program could cover 482,000 residents for the same cost as 100,000 Pathways’ recipients.
North Carolina, which fully expand Medicaid in December, has enrolled nearly 500,000 people in about half the time Pathways has been in effect.
That broader Medicaid expansion was a key part of President Barack Obama’s health care overhaul in 2010. In exchange for offering Medicaid to nearly all adults with incomes up to 138% of the federal poverty level, states would get more federal funding for the new enrollees.
The higher eligibility limit is $20,783 annually for a single person and $43,056 for a family of four. None of the 40 states that have accepted the deal require recipients to work in order to qualify.
But Kemp, like many other Republican governors, rejected full expansion, arguing that the state’s long-term costs would end up being too high.
Republicans in the Georgia Legislature floated the possibility of full expansion in 2024 before abandoning the effort.
For now, Georgia officials show no sign of giving up on Pathways. The program is set to expire at the end of September 2025. But in February, the state sued the Biden administration to try to extend it to 2028. A federal judge heard arguments last month.
Georgia
Georgia Delegate to the RNC talks security and rhetoric changes in a contentious political season
COLUMBUS, Ga. (WRBL) — In the wake of the assassination attempt on former President Trump’s life, security is a front and center topic for those attending the Republican National Convention.
Long time Republican Party activist and Columbus resident, Alton Russell, is one of the 59 official delegates from Georgia who attended the convention. He has been to five conventions as a delegate or alternate expected security to be tight.
“They’re saying that they’ve not increased any security. But it’s obvious that they have. We had a just a little party last night — a welcome to Milwaukee — and they had seven or eight, you know things that you walk through to check your bags,” says Russell. “Security is a little bit tougher than than I think they than they had planned. We’ve got a security guy, a Secret Service guy on the bus with us as we go from one place to another.”
In addition to heightened security at the convention, the assassination attempt has drawn universal condemnation of political violence.
Sen. Ed Harbison, a Vietnam Veteran who remembers the assassinations and political unrest of the 1960s agrees with those condemnations. Harbison said the attempt on the former president’s life brought back painful memories.
“It is something that should be universally condemned. It is just reprehensible. And we should be reminded of what America is all about. People have a right to free speech and that kind of thing, but there is a line. And what happened there is just— I can’t say anything but reprehensible and should never be repeated. And we should all be standing guard against that kind of action anywhere at any time and condemn it for what it is, an assassin. It’s just something about that word just brings up, conjures up thoughts of evil doings and that kind of thing.”
Senator Ed Harbison, D-Columbus
The wake of Saturday’s events there has been call for everyone to tamp down the rhetoric in a contentious political season. Russell hopes people will take a step back and try to turn down the heat.
“Hopefully to tone down the rhetoric and somebody or whoever it is or quit saying that Trump is our next Hitler and he’s going to destroy civilization and he’s going to destroy democracy. You know, I think they need to tone that down. And I think I think Trump is saying is that he’s rewriting his Thursday night speech to start to move more towards unity. So I hope that’s what he’s going to do. And I expect that he will.”
Alton Russell, Georgia Delegate to the RNC
The RNC has just begun, with the Georgia delegation hearing from Faith and Freedom Coalition founder Ralph Reed this morning. Tomorrow morning, they are expecting to hear from Georgia Gov. Brian Kemp.
Who will win the 2024 SEC football championship?
Here’s a look at the USA Today Network’s predicted order of finish for the SEC.
SMG
DALLAS—Hanging on light posts near the Omni Dallas hotel where SEC Media Days opened Monday are two banners.
The quite familiar “It Just Means More,” and a sign of the times: “Now 16 Strong.”
Ushering in Texas and Oklahoma is a focal point of the four days of football chatter with more than 1,200 media members.
The Sooners hit the stage Tuesday and Longhorns on Wednesday.
Their additions meant the end of divisions and some familiar annual matchups taking a pause.
Like Georgia-South Carolina.
The teams won’t play this season or next—barring an SEC championship or playoff matchup—for the first time since 1992. That’s when the Gamecocks joined the SEC.
Not playing the beast that is Georgia could be looked at as a welcome break.
That’s not what the Gamecocks said.
“I always looked forward to playing Georgia every year,” said redshirt senior Luke Doty, who has played in four games against the Bulldogs including throwing for 190 yards in his first career start at quarterback against Georgia in 2020 and starting last season at wide receiver in the game. “It’s definitely going to be weird not playing them, Tennessee or Florida this year just because we’ve played them for so long.”
The Gamecocks led Georgia 14-3 at halftime in a week 3 game last season, but lost 24-14, their eighth defeat in the series in the last nine games.
South Carolina delivered Georgia their last home loss in the 2019 season.
Alex Huntley was there on a recruiting visit to Georgia. He’s now a fifth-year Gamecocks defensive tackle and would prefer to get a shot at what could be the preseason No. 1 ranked Bulldogs.
“I actually wasn’t a fan of it,” Huntley said. “I looked forward to playing Georgia. …I was there when South Carolina beat Georgia. I was at that game. So I kind of wanted that opportunity as well. Last year we had that opportunity. We came up short. I kind of wanted another shot.”
Georgia also won’t play Missouri or Vanderbilt the next two regular seasons. The Tigers are a tougher test now entering their fifth season under Eli Drinkwitz whose team went 11-2 and won the Cotton Bowl last season.
Georgia won its 10th straight against Missouri last season, but the teams were tied at 10 in their Nov. 4 game in Athens before the Bulldogs pulled out a 30-21 win after Nazir Stackhouse’s interception return set up a fourth-quarter field goal.
In Shane Beamer’s fourth season as South Carolina coach, the Gamecocks also avoid Texas, but play at Alabama and Ole Miss in back-to-back weeks in October.
“You want to compete against the best, you want to coach against the best,” Beamer said. “We ain’t far off. We’ve had some fantastic wins over the last three seasons…There’s teams to be considered to be in the mix for that playoff that we have beaten.”
South Carolina went 5-7 last season and the Gamecocks aren’t expected to rise this season.
“I really like our football team, most of you don’t,” Beamer said.
He said he expects his team t be picked 13th or 14th.
The Gamecocks were picked 13th in the USA Today Sports predicted order of finish ahead of only Arkansas, Mississippi State and Vanderbilt.
Georgia was picked first, getting all but one vote to win the SEC title. The other went to Texas.
South Carolina lost quarterback Spencer Rattler. Redshirt freshman LaNorris Sellers is in line to replace him.
“We’re young, we’re talented as an offense, but the question is how fast we can come together?” Beamer said.
Huntley is certainly confident.
Here’s what he said of not playing Georgia.
“We don’t see them on the regular schedule,” Huntley said. “I’m sure we’ll see them in the playoffs though or have that opportunity.”
Georgia
Georgia is on the frontline of the struggle between Russia and the west. Will its democracy survive? | Nathalie Tocci
Polarisation is growing across Europe and the west. Nowhere is this clearer than in the former Soviet republic of Georgia. The “Russian law”, a copycat piece of legislation imported from Moscow, which forces Georgian civil society groups to register as foreign agents if they receive more than 20% of their funding from abroad, was recently passed – despite massive protests and widespread police violence. The law is set to be implemented later this summer, just in time to cripple civil society and squeeze the opposition parties ahead of the country’s crucial parliamentary election on 26 October.
Against the backdrop of the protests, the governing party, Georgian Dream, lowered its mask. In a hyperbolic speech in April, the billionaire tycoon and behind-the-scenes leader of the party, Bidzina Ivanishvili, launched an all-out attack against the liberal west, rife with conspiracy theories about a putative “global war party” driven by Freemasons, traitors, foreign agents and more. Georgian Dream does not claim it wants to abandon the path to the EU and Nato. On the contrary, it boasts that under its watch, Georgia was recognised as an EU candidate. For its part, the EU took too long to distance itself from the government in Tbilisi, which brazenly dusted off the Russian law – postponed after the first protests last year – only weeks after Georgia was granted candidacy in December.
European leaders and institutions condemned the law and the police violence against demonstrators, who mobilised for the second time in the spring to stop the law – this time to no avail. Yet in the eyes of civil society and the opposition, European criticism was too timid. As one opposition leader put it to me in Tbilisi a few days ago: “When you’re in a room with a snake, you don’t engage with it or seek to understand its ‘legitimate concerns’. I was shocked to watch on television the EU ambassador cut ribbons with top Georgian Dream leaders while I was in hospital with a concussion caused by police violence.”
The EU has now toughened up. A few days ago it formally suspended Georgia’s accession process and froze €3om (£25m) in financial aid for the country’s defence ministry. Meanwhile, the EU has rightly agreed to move forward with Ukraine and Moldova’s accession negotiations.
But more is needed. So far the Georgian government has had its cake and eaten it. When the Russian law comes into effect, the EU should consider personal sanctions and travel bans on individuals in the political, business and media circles of the regime. Were the authoritarian squeeze to continue in the event of Georgian Dream’s electoral victory, the EU should revoke Georgians’ free movement across Europe without the need of a visa.
The opposition knows that the autumn election is a fight for life or death. As one academic and renowned opposition figure told me: “Georgia is already lost. This is our last chance to recover our country.” Opposition leaders are having tactical discussions on how to create a united alliance to avoid splitting the opposition vote, especially given the 5% electoral threshold below which parties are not represented in parliament at all. Yet they know that they can’t afford to blow this chance: it may be their last to restore liberal democracy in Georgia.
However, the outcome is uncertain. Alongside the skewed political playing field – with funds, social welfare programmes, police forces, a well-oiled propaganda machine and the upcoming repression of civil society on its side – Georgian Dream has a story to tell. The message is simple: war versus peace. In its narrative, the opposition fell into Russia’s trap in 2008, led by an irresponsible Mikheil Saakashvili and egged on by a hypocritical west, which then abandoned Georgia to its destiny when Russia invaded. Playing on citizens’ fears, exacerbated by the trauma of Russia’s invasion in 2008, the government portrays itself as the party of “peace”. In contrast, the opposition, which now firmly backs Ukraine’s resistance against Russia, is depicted as the “global war party”. Glossing over its ever closer ties to Moscow, Georgian Dream depicts itself as the bulwark against a new, unwinnable war against Russia.
The opposition also has a strong story to tell: it’s about Europe and freedom versus Russia and repression. An electoral victory in October, it says, represents the only route for Georgia to avoid sinking deeper into a post-Soviet authoritarian swamp. The mass demonstrations against the Russian law, both in 2023 and this year, tell us that it has a compelling case, capable of mobilising people and putting Georgia back on track towards democracy and the EU.
But it will not be easy. Georgian Dream also has a unified Russia backing it up. The opposition has a distracted and divided west. The divisions in the west mirror precisely those in Georgia. Georgian Dream could not win the election on a clear anti-west and anti-European ticket. Georgians know that their country’s independence and freedom (from Russia) is tied to the west. But is it an open, democratic and law-abiding west, or a closed, nationalistic and socially conservative one? If it’s the west represented by Viktor Orbán, Marine Le Pen, Giorgia Meloni and Geert Wilders in Europe, flanked by Donald Trump on the other side of the Atlantic, Ivanishvili may be quite comfortable with being pro-west. Probably Vladimir Putin would too.
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Tiny Georgia is a microcosm of the fight for liberal democracy in the west. For years, Georgian democrats pleaded for their western partners to wake up to the threat posed by Russia. But as those eyes started opening after the full-scale invasion of Ukraine, the Georgian government turned towards Moscow in a tragic twist of history. Paradoxically, it did so just as Georgia came a step closer to joining the EU, riding the wave of the revival of its enlargement policy and spurred on by the Ukraine war.
In older democracies, where institutions are stronger, liberal democracy can withstand (for a while) the election of autocrats, nationalists and populists. In young and fragile democracies on Russia’s doorstep, in contrast, democracy, has to be supported and saved. If not, it can quickly end with a bang.
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