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A decade after the Affordable Care Act became law, 10 states have declined to expand Medicaid. Most are in the South, where Republicans control the legislatures. But now GOP powerbrokers in Mississippi, Alabama and Georgia suggest they might be open to expanding Medicaid coverage. Here's WABE's Sam Gringlas.
SAM GRINGLAS, BYLINE: Donny Lambeth is a Republican state representative in North Carolina. He spent almost a decade trying to convince his colleagues in the GOP-controlled legislature to expand Medicaid.
DONNY LAMBETH: It was not a very pleasant journey early on because I was one of the few Republicans. My party did not accept it. But I would tell you, you need to be patient, but don't give up.
GRINGLAS: Over plates of fried chicken and mashed potatoes, Lambeth told a recent gathering of Georgia lawmakers, many Republicans, that several times he almost did give up. But he stuck with it, telling colleagues stories he heard from people around the state.
LAMBETH: Tree farmers in Ashe County, the strawberry farmers down east. The theme that they all told me - we don't have health insurance, but we have a family farm that we're going to lose if we were to have a catastrophic event.
GRINGLAS: Now, 600,000 low-income North Carolinians are eligible for coverage. Expansion in Georgia would cover roughly 400,000 people. But for many Republicans, Medicaid expansion is still a toxic phrase, tied closely to former President Obama. So some GOP-led states have put their own spin on the program. Republican lawmakers in Georgia are now eyeing a model deployed by Arkansas, where some Medicaid expansion dollars are used to buy private insurance plans. Cindy Gillespie, the former Arkansas health secretary, told the group of Georgia policymakers that her state's approach infused money into rural areas over the last decade.
CINDY GILLESPIE: In Arkansas and the surrounding states, you had 58 hospitals close. None are in Arkansas.
GRINGLAS: In rural Georgia, nine hospitals closed, and free clinics have been forced to fill the void. Nurse Glenda Battle volunteers at a clinic in south Georgia.
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GLENDA BATTLE: Our patients depend on us for their routine checkups and medications. They have higher morbidity and mortality rates.
GRINGLAS: Battle testified at a recent legislative hearing.
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BATTLE: Medicaid expansion is an economic agent. It will allow struggling hospitals to remain open to serve the uninsured, low-income in their area and keep others employed.
GRINGLAS: Many Republicans have come to acknowledge these gaps, but the response so far from Georgia Republican Governor Brian Kemp, a limited expansion with a work requirement, has enrolled only about 2,300 people since it launched last year. That's about half a percent of what full Medicaid expansion could cover and at a higher cost per person. But Kemp says he's not yet interested in full expansion.
BRIAN KEMP: You'll have to talk to the people that are proposing that. I mean, those are not my proposals.
GRINGLAS: Meanwhile, Georgia has left billions of federal dollars on the table.
CHUCK HUFSTETLER: The numbers show that we're being penny-wise and pound-foolish if we don't go forward with this.
GRINGLAS: At the luncheon, Georgia Republican Senator Chuck Hufstetler says Georgia has attracted billions in new investments from companies that make batteries, solar panels and electric vehicles. But he worries it could become harder to compete for jobs with states like North Carolina that have expanded Medicaid.
HUFSTETLER: We need workers. We need healthy workers. The No. 1 issue we have in Georgia right now is workers.
GRINGLAS: For now, a lot of the recent rumblings about Medicaid expansion have been just talk. And this week, top Republicans in the Georgia legislature suggested they plan to delay action for another year. But as more Republican states sign on for Medicaid expansion. A growing number of lawmakers believe the question is not if, but when.
For NPR News, I'm Sam Gringlas in Atlanta.
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