On the narrow question of creating a state version of the health insurance exchange, Deal might have made the right decision for the wrong reasons. While Georgia politicians were playing a delaying game, hoping that ObamaCare would be killed by the courts or the voters, other states that intend to launch their own exchanges have been working on the programs for months if not years. Trying to play catch-up at this point might very well not be worth Georgia’s investment of time, energy and political capital, particularly with a federal exchange as an backup option.

However, the larger and by far more consequential question involves Georgia’s participation in an expanded Medicaid program offered through ObamaCare beginning in 2014. If Georgia ultimately decides to take part, Medicaid coverage would be extended to an additional 600,000 lower-income Georgians. (For a family of four, households with an income of roughly $32,000 and below would be eligible for coverage.) Those Georgians would get covered at very little cost to state taxpayers.

Under ObamaCare, from 2014 to 2016 the federal government will pay 100 percent of the costs for insuring those additional Georgians. In later years, the share covered by the federal government will drop slightly — Uncle Sam will cover 95 percent of the cost in 2017, 94 percent in 2018, 93 percent in 2019 and then 90 percent from 2020 on out. (For comparison’s sake, Georgia pays a little over a third of the cost for current Medicaid recipients.)

Nonetheless, Deal announced at the Republican National Convention in August that Georgia would refuse to take advantage of the expanded Medicaid program. Even with the federal government paying all or most of the cost, Deal said, the state simply couldn’t afford the additional expense.

That’s a foolish decision, especially given that Georgia has the fifth highest rate of uninsured in the country. In effect, Deal would be denying health insurance coverage to some 600,000 Georgia citizens just to make a partisan political point. It also means turning away billions of federal dollars — an estimated $14.5 billion over the first six years — that would flow into the state’s health-care delivery system. That’s a benefit of particular importance to rural Georgia, where the health-care infrastructure is skeletal at best because so many residents are uninsured and have few resources from which to pay medical bills.

By Jay Bookman

http://blogs.ajc.com/jay-bookman-blog/2012/11/21/its-time-for-gop-to-acc...