Gov. Brian Kemp unveiled legislation Wednesday that could remake health care for hundreds of thousands of Georgians. Or just a few.

The Patients First Act would give the governor wide latitude to approve a range of options in pursuit of federal “waivers” with the aim of improving government-funded health care access for the poor and middle class.

The Utah Legislature on Monday passed a bill to replace the voter-approved Medicaid expansion with a skinny expansion, a move that may encourage other states to seek similar scaled-back expansions with full federal funding.

The Republican-controlled Utah Senate approved legislation passed by the state House of Representatives Friday that replaces the voter-passed expansion to adults with incomes up to 138% of the federal poverty level with an expansion only to 100% of the poverty level. It passed on a near party-line vote, with one Republican joining all Democrats in opposition.

Health policy analysts have long been puzzled that millions of uninsured people snub the government’s offer of free health benefits. The Kaiser Family Foundation estimates that seven million of the 27.5 million nonelderly people who were uninsured in 2016 were eligible for Medicaid. That’s more than one-fourth of the uninsured population. Another eight million were eligible for Obamacare premium subsidies, meaning that more than half the nonelderly uninsured didn’t avail themselves of government-subsidized health coverage.

Academic research suggests one possible reason: Medicaid recipients aren’t the primary beneficiaries of the program’s spending.

The Senate gave final approval Monday to a replacement plan for the voter-approved full Medicaid expansion after more than an hour of debate — and a last-minute update to the price tag.

Health care advocates called the bill — which would forgo $1 billion in federal matching funds — a “bridge to nowhere.”

The 22-7 vote — with all six Democrats and Sen. Todd Weiler, R-Woods Cross, opposed — didn’t change from the initial vote on SB96 last week, on the third day of the 2019 Legislature.

The shrill criticism of the Arkansas’s Medicaid work requirements is not supported by facts. Health policy analysts have long been puzzled that millions of uninsured people snub the government’s offer of free health benefits. The reason so many Medicaid recipients failed to comply with the Arkansas work requirement may be as simple as this: They didn’t consider the benefits worth the effort.  Yet, a study by the Buckeye Institute found that people who favorably respond to work requirements will earn far more—in some cases nearly $1 million more—over the course of a lifetime than those who remain on Medicaid and don’t increase their work efforts.

The federal government now finances 90% of the cost of Medicaid expansion, but that doesn’t make it free. A recent report found that Medicaid represents about 29.7% of total state spending in fiscal year 2018. In 2008 it was 20.5%. These numbers will continue to grow, sucking up more of our limited funds.  Thanks to a lack of fiscal discipline from both parties—and the unwillingness of the American people to confront our perilous finances—we are currently running trillion-dollar deficits and the national debt stands at around $22 trillion. We can’t pay for the government we have; expansion will just add to the burden of future generations. 

The Trump administration approved Arizona’s request to attach work requirements to Medicaid coverage, making it the eighth state to condition benefits on seeking a job, going to school or otherwise engaging in the community.

Enrolled members of federally recognized Indian tribes — who noted their sovereignty — will be exempt from the rules, which will take effect in January 2020, the Centers for Medicare and Medicaid Services said.

For several months, the Trump administration has been engaged in an internal debate over the merits of allowing states to partially expand Medicaid under the terms of the Affordable Care Act (ACA). Now, after losing the House to Democratic control (and thus also losing any opportunity to repeal and replace the ACA until at least 2021), the administration is said to be ready to make a decision in favor of allowing partial Medicaid expansion to proceed under state waiver requests.

Federal law might be hard to change in Washington, but in some cases, states are able to take advantage of flexibility built into federal law to develop new programs and approaches. This is true under federal Medicaid law and it is also true under the ACA, which is why CMS recently stepped up efforts to support state-specific strategies to improve their individual health insurance markets and to develop alternatives to Obamacare that better meet the needs of their residents.

More than 12 million nondisabled, working-age Americans are enrolled in Medicaid. They receive medical care that is virtually free, and in most states they are under no obligation to work or seek work.

Sounds like a great deal.

Until you consider how much these “free” benefits may cost a recipient over the course of a lifetime. That could total more than $323,000 in foregone wages for men and over $212,000 for women, according to a study by the Buckeye Institute, an Ohio-based free-market think tank.