Last week, Rick Jackson unveiled a proposal to close the health insurance coverage gap in the state by implementing what he called “intelligent Medicaid expansion.”
“We will cover those who need it the most and keep work requirements in place for those who are able,” said Jackson, the multi-billionaire Republican nominee for governor and magnate of a private healthcare staffing company profiting off of Georgia’s dire health worker shortages.
The truth, artfully avoided in his statement, is that Mr. Jackson’s proposal isn’t “Medicaid expansion” at all–at least not in the way that it’s conventionally understood.
Nor is it remotely intelligent in a state with among the highest percentage of uninsured residents in the United States.
“Medicaid expansion,” of course, refers to the provision in the 2010 Affordable Care Act allowing states to transformatively shrink the number of Americans who lack health insurance. These patients in the “coverage gap” Jackson gestures to are patients who make too much money to qualify for state Medicaid but still don’t earn enough to purchase health insurance on the marketplace.
In Georgia, it turns out, that’s hundreds of thousands of people.
Traditional Medicaid in Georgia sets its income eligibility punishingly low. In 2026, a parent or caretaker in a family of three generally must make no more than about $551 a month — just $6,612 a year — to qualify through the traditional parent/caretaker Medicaid category. That is roughly 24% of the federal poverty level for a family of three. That traditional eligibility threshold is among the most restrictive in the country.
Georgia has created a separate Pathways program that can cover some adults with incomes up to the poverty level, but it requires participants to meet work or other qualifying-activity requirements.
Full Medicaid expansion under the ACA is designed to close that coverage gap. It offers states the chance to raise Medicaid eligibility up to 138% of the FPL, covering more low income individuals who would not be able to afford health insurance coverage otherwise. In exchange, 90% of the cost of this expansion of coverage would be covered by the federal tax dollars Georgians have already been paying for more than a decade.
That’s right, for every dollar the state would spend to cover more than half a million uninsured patients, federal funds would match that dollar ninefold.
As a result, the state would pay far less money to cover far more patients in that coverage gap, and avoid the expense of costly–often catastrophic–uncompensated care, the burden of which has been a major factor leading to the closure of roughly 18 hospitals and healthcare facilities across the state since 2013.
If you find it utterly perplexing that Georgia has not availed itself of this option, you’re not alone. Forty other states and the District of Columbia have already fully expanded Medicaid under the ACA, and as a result have seen their uninsured populations drop and their hospital closures plateau.
Which is to say: the Affordable Care Act works when you allow it to.
Rick Jackson has insisted that he opposes full Medicaid expansion adopted by the vast majority of the country, including many Republican states. However, he also insists that if elected governor, he will “close the coverage gap,” on “Day 1,” echoing his idol Donald Trump, who bragged on the campaign trail that he would “bring down the prices of all goods” on Day 1.
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Candidates may campaign in bumper sticker poetry, but must govern in rubber meets the road prose.
And that’s where the wheels come off the bus.
The reason Rick Jackson can’t share the details of his plan is that he has none.
As best as most can tell, Jackson’s intention is to double down on the Republicans’ failing “Pathways to Coverage” program, which Georgia’s own Department of Community Health insists costs too much and will go bankrupt without accessing the federal money it could access with full ACA Medicaid expansion.
His “intelligent” solution here? To demand the federal money anyway, without actually complying with the law regulating allocation of those funds.
How do Jackson et al. know the federal government will agree to giving Georgia this money even without fully expanding Medicaid? They don’t.
Perhaps Jackson hopes his commitment to being “Trump’s favorite governor” will grease the skids. But you will have to forgive patients and the professionals who care for them for having a little less confidence in a plan contingent on brown-nosing hard enough.
Voters don’t become stupid during election years. It’s just campaigns who treat them like they’re stupid.
If you need to insist so stridently that your plan is “intelligent,” it likely isn’t.
And you can try to sell voters a bridge, but don’t be surprised if they’re not buying.
Rep. Michelle Au, M.D., M.P.H., D-Johns Creek, is a practicing physician in metro Atlanta and represents Georgia’s 50th House District.
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