STEVE INSKEEP, HOST:
Twelve states in this country have not expanded Medicaid. Obamacare back in 2010 allowed states to expand that health program with federal help. But many Republican-led states declined. Some have since come around, but others, including Georgia, have not. And it's an issue in Georgia's governor's race. Sam Gringlas of member station WABE in Atlanta reports.
SAM GRINGLAS, BYLINE: Expanding Medicaid will be a centerpiece of Democrat Stacey Abrams' campaign for governor this year. At a campaign kickoff this month, one attendee asked Abrams what separates her health care platform from Republican Governor Brian Kemp's.
(SOUNDBITE OF ARCHIVED RECORDING)
STACEY ABRAMS: No one should die from a preventable disease. And the fact that we are refusing to help people, not because we can't, but because he won't, is the real difference.
GRINGLAS: Medicaid helps low-income people get health coverage. In Georgia, low-income children, pregnant people, people with disabilities and some others can access Medicaid. What Medicaid expansion does is it allows any adult making below a certain income threshold to participate. But states have to opt in. The federal government pays 90% and states pick up the rest. For years, Georgia's governors declined, saying it would be too expensive. That was until 2020.
(SOUNDBITE OF ARCHIVED RECORDING)
BRIAN KEMP: There's no doubt that this status quo is simply unacceptable. It threatens our families, and it threatens our state's future.
GRINGLAS: That's Kemp acknowledging two years ago that Georgia is one of the least insured states in the country. And he promised to take action. He asked for a waiver from the Trump administration to allow a more limited expansion. It would cover fewer people. The feds would kick in less money. And most importantly, it included an 80-hour-a-month work requirement. Professor Jamila Michener studies Medicaid expansion at Cornell University. She says waivers give Republican governors like Kemp political cover.
JAMILA MICHENER: So states used waivers as a way of saying, fine, we're going to do this. But we're going to make it into something that fits a political profile that we are much more comfortable with.
GRINGLAS: Kemp's plan never took effect. Last month, the Biden administration denied its final approval, saying reporting work can be a barrier for people and doesn't actually serve the purpose of Medicaid. Politicians scurried to shape the narrative. Democrats criticized Republicans for not accepting a clean Medicaid expansion from the start. House Speaker David Ralston, a Republican, called Biden the Grinch for nixing their health care proposal right before Christmas.
MICHENER: So the Kemp camp is saying, no, no, no. It's Biden. And Stacey Abrams is saying, no, no, no. It's Kemp. And people don't know how to make sense of that if they haven't been following Medicaid politics closely. It really muddies the water.
GRINGLAS: On Friday, Georgia sued the Biden administration over their decision. For now, though, many people are still in limbo. The Kaiser Family Foundation estimates more than 250,000 Georgians don't currently qualify for Medicaid or for subsidies to help buy their own insurance. Amy Bielawski is one of them. She's an entertainer, mostly at parties and events.
AMY BIELAWSKI: Everything from face painting, balloon sculpting, belly dance and hula and fire eating.
GRINGLAS: Bielawski can't afford to buy her own insurance. So for years, she's gone without. She found a clinic that provides decent care. But when Bielawski had a health scare, it was terrifying.
BIELAWSKI: Not only what was happening to my body, but how much money is this going to cost me?
GRINGLAS: What to do for uninsured people like Bielawski is one question Georgia voters will face this year when they decide the state's next governor.
For NPR news, I'm Sam Gringlas in Atlanta.
(SOUNDBITE OF INSTUPENDO'S "FALLING") Transcript provided by NPR, Copyright NPR.
