Georgia governor's race a bellwether for 'Obamacare'

Republican incumbent, funded by health insurance monopoly, confronts popular support for Medicaid expansion

June 6, 2014 2:15AM ET
The Republican Governors Association bought television ads tying Democratic challenger Jason Carter to Obamacare.

The Republican Governors Association (RGA) was clearly worried about news that Georgia Democratic gubernatorial nominee Jason Carter, grandson to former governor and president Jimmy Carter, was outpolling incumbent Republican Gov. Nathan Deal. In late May, the organization bought more than $500,000 worth of airtime for an attack ad in the Peach State.

The RGA ad is revealing for what the party is and isn’t willing to say in its campaign to protect the endangered incumbent. The ad’s narrator says “Obamacare” five times and accuses Carter of wanting to “expand” it.

Actually, Carter has been critical of the rollout of the Affordable Care Act, saying it was a “mess.” He insists, however, that Georgia should take the federal dollars offered as part of the ACA’s Medicaid expansion and utilize them either to expand Georgia’s Medicaid program or to subsidize the health exchange market, which is what Arkansas and Kentucky did.

The RGA likely studied the polls before deciding to avoid mentioning Medicaid altogether. Almost 6 in 10 Georgians support Medicaid expansion, which makes Deal’s opposition unpopular in a state where four rural hospitals have shut down in the past two years and as many as 30 more face large cuts or closure altogether due to lack of funding.

But the RGA’s ad isn’t just another political hit piece that spins the issue and denies talking about the underlying facts. It’s also a smooth act of political money laundering, in which a special interest group was able to pump money into Georgia’s political system without having to put its name on a single commercial.

In January, Blue Cross Blue Shield (BCBS) gained exclusive control over the health insurance plans offered to Georgia teachers and other state employees — a $3 billion program. This sparked protests from teachers outraged that their health care options would be limited to a single private insurance company that was free to charge higher and higher copays. Following the backlash, Deal promised teachers that they would get more health insurance options next year and created a review panel to help choose the plans, appointing a single teacher to the evaluation team.

If the review process concludes that BCBS shouldn’t have exclusive control of the state health benefit plan — which competitor United Health Care called “state-sponsored bid rigging” — then the company could lose a great arrangement it has received from Deal’s administration.

So it is no surprise, then, that BCBS is the third-largest donor to the RGA in 2014, having given $1,026,093 — the only larger donors are Koch Industries (at $1.7 million) and Elliott Management (at $1.25 million). BCBS even gave more money to the group than the notorious Sheldon Adelson’s Las Vegas Sands (edging it out by $6,093). 

Health Affairs estimates Georgia will experience 561 to 1,176 deaths as a result of failing to expand Medicaid.

If attack ads funded by BCBS can shift the tide back against Carter, then Deal will likely use his influence on his own review board to make sure the company stays in charge of the health plans of state employees, keeping tax dollars flowing to the organization.

But the stakes for the company are even higher than retaining control of state employee health benefits. The health insurance industry’s main lobbying group, America’s Health Insurance Plans, spent more than $100 million trying to sink the Affordable Care Act. Although the law included many giveaways to the health care industry, it did establish various regulations that the industry opposed, such as banning discrimination against pre-existing conditions and restricting the ability of health insurance companies to end a paying customer’s coverage for little or no reason.

According to researchers at the Georgia Budget and Policy Institute, the “bulk” of the Medicaid program in Georgia is not operated purely by a public insurer — as, say, Medicare Part A is — but rather by private insurers themselves: Centene, WellCare Health Plans and Amerigroup. Thus, if Medicaid were to be expanded to up to 138 percent of the poverty line (around $32,900 for a family of four), these competing insurers would be grabbing a lot of BCBS’s potential business — business that, right now, is hardly competitive in parts of Georgia. In rural southwestern Georgia, one of the poorest parts of the state, BCBS is the only insurer available in the federal marketplace, making the region “one of the most expensive places in the nation to buy health insurance,” according to The Washington Post. “The only places with higher premiums are the Colorado mountain resort areas around Aspen and Vail, a high-cost-of-living area unlike Georgia.” To understand how important it would be to the people of southwestern Georgia if Medicaid were to be expanded, just look at the fact that median household income in Albany, one of the region’s larger cities, is around $26,000, making people too rich to qualify for the current Medicaid program and too poor to take advantage of Blue Cross Blue Shield’s monopoly prices.

There are few states where politicians have done as much to side with the health insurance industry and undermine these new regulations and expansion of health care. Georgia’s Insurance Commissioner Ralph Hudgens privately bragged to fellow Republicans that “we’re doing … everything in our power to be an obstructionist.” And months before Deal signed away his own power to expand Medicaid by giving it to the far-right Republicans in the Legislature, it was revealed that Aetna, Humana, Blue Cross and other health-insurance companies had donated to a political action committee that was giving direct payments to Deal’s family and business partner. The whole affair is emblematic of the crony capitalism that Sarah Palin and tea party conservatives rail against.

This rush to side with the health insurance industry has had devastating consequences for the state, which has the sixth-highest number of uninsured residents in the country. Take the case of 59-year-old Doris Lewis, an uninsured Atlanta woman who was turned away from four hospitals that refused to operate on her beach-ball-size tumor because she couldn’t pay. Although Lewis was eventually able to find a hospital that provided her with care, many others will not be even that fortunate. The prestigious peer-reviewed journal Health Affairs estimates Georgia will experience 561 to 1,176 deaths as a result of failing to expand Medicaid.

The political philosopher John Dewey once noted that “politics is the shadow cast on society by big business.” In a Georgia where health insurance giant Blue Cross Blue Shield is reaping huge business from state contracts and holding federal health exchange customers captive in the poorest parts of the state, the halls of the governor’s mansion are pitch black.  

Zaid Jilani is a former senior reporter and blogger at ThinkProgress and a freelance journalist. He is a Syracuse University graduate student seeking his MPA.

The views expressed in this article are the author's own and do not necessarily reflect Al Jazeera America's editorial policy.

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