Georgia showed us Medicaid work requirements don’t work

For years, Republican lawmakers have pointed to Georgia’s Medicaid work requirement experiment as proof that their approach “works.”

If you wanted to see what “reform” looked like, they said, look at Georgia. Now we know the dangers because the results are unmistakable: the purported solution was deeply inefficient and expensive and makes it harder — not easier — for people to get necessary care.

A new nonpartisan Government Accountability Office report found that Georgia’s Medicaid expansion work requirement program spent nearly twice as much on administrative costs as it spent on covering health care costs — with “over $54 million on bureaucracy versus $26 million on actual care costs,” according to the report.

Vendors made money, but desperate residents saw little in return.

This Republican disaster has not only been a waste of money — it has also generated massive administrative barriers and red tape that have resulted in fewer than 10,000 enrollees out of almost 250,000 Georgians who qualify. Among those affected are the thousands of Georgia veterans, particularly in South Georgia, who do not qualify for TRICARE or VA health care but still deserve access to affordable medical treatment.

Nearly 70,000 veterans in Georgia are uninsured — about 7.1% of the state’s veteran population — which puts us in the Top 10 of states with uninsured vets. Kemp’s Pathways program has proved to be an abject failure for those Georgians who served our country.

From our veterans to working families, the barriers were predictable and illogical: confusing digital systems, understaffed agencies and endless documentation requirements that became a second job for many trying to comply. Georgia built a program so complex that the bureaucratic process became yet another obstacle, adding insult to injury.

The program was designed to limit enrollment and neglect our communities — it has done just that, pulling necessary treatments away from our neighbors.

Yet, despite Georgia’s proven failure to meet minimum viable standards, Republican leaders in Washington, D.C., are preparing to make this model national. Instead of learning from Georgia’s mistakes, they’re doubling down on them. When the government breaks its promises and then breaks its own systems, the people pay the price.

This national push to force people off of Medicaid through administrative burden comes at the worst possible moment. Key Affordable Care Act tax credits — subsidies that keep health care premiums affordable for millions — are set to expire if Congress fails to act. In states that expanded Medicaid, some people losing subsidies still have a safety net. As we well know, though, Georgia’s Republican leaders have rejected Medicaid expansion for a decade — which means there’s no backup plan.

Families will face premium hikes with nowhere to turn, pushing more people to forgo critical care and face medical debt and financial crisis. This is not to mention the likely closure of more rural hospitals and urban safety net facilities. Among the highest risk closures are Flint River Community Hospital in Montezuma, Irwin County Hospital in Ocilla and Washington County Regional Medical Center in Sandersville.

In other words: Georgia already refused the lifeline of Medicaid expansion, built a failed work requirement scheme that cost more and covered less, squandered millions on enriching vendors who constructed a broken system, and now sits at the center of a national health care crisis it helped create.

This is not accidental mismanagement. It’s an intentional design. When government systems are built to fail, people understandably lose faith that democracy can deliver at all. That erosion of trust is part of the strategy — because when voters become disengaged, the same leaders who broke the system stay in power.

But the truth is simple: this can still be fixed. To start, Congress must renew the ACA tax credits, and every member of Congress that represents these areas should hear from you. This isn’t about partisanship. It’s about whether farmers can afford an accident or veterans will face health crises without help.

Closer to home, leaders in Georgia must make Medicaid expansion their priority and demand actual efficiency versus the waste of money and abuse of power shown by the Pathways program. Across Georgia and the South, we must reject a nationalized health care punishment scheme that has already proven to be a boondoggle and an ineffective, bureaucratic maze — forcing working people to beg for scraps of respect.

Democracy is supposed to deliver for people — helping bridge gaps created by systems that we can’t cross alone.

When it doesn’t, we have to demand better — and vote accordingly. Georgia is both the warning and the opportunity. What happens next depends on all of us.

Stacey Abrams is a bestselling author, entrepreneur and host of the podcast “Assembly Required.” She previously served as minority leader in the Georgia House of Representatives.