ATLANTA, GA - JUNE 24: Porchse Miller raises her fist to protest the Supreme Court's decision in the Dobbs v. Jackson Women's Health case on June 24, 2022, in Atlanta. The Court's decision in the Dobbs v. Jackson Women's Health case overturns the landmark 50-year-old Roe v. Wade case, removing a federal right to an abortion. (Photo by Elijah Nouvelage/Getty Images)

Medicaid expansion in Georgia is likelier than ever as Democratic gubernatorial candidate Stacey Abrams ties in the polls with Gov. Brian Kemp. 

Kemp and his two Republican predecessors have refused to adopt Medicaid expansion, while Abrams, a former state representative, recently told a crowd, “I’m going to talk about Medicaid expansion every chance I get.” She calls the state’s decade-long failure to enact the popular measure a “catastrophe”: 75% of Georgia voters favor Medicaid expansion, including 57% of Republicans.

Georgia is one of only 12 states that have barred expansion of the public health insurance program for low-income people in the U.S. since its inclusion in the 2010 Affordable Care Act (ACA)—despite having the second-highest uninsured rate in the country. Medicaid expansion would insure over 470,000 Georgians while infusing nearly $4 billion from the federal government into the state, bringing much needed relief to its escalating reproductive health care crisis. 

People who give birth in Georgia are more likely to die from pregnancy-related causes than in any other state, with Black people 2.3 times more likely to die from pregnancy-related complications than their white counterparts. About half of the state’s counties lack an OB-GYN, and eight of the state’s rural hospitals have closed down since 2010. In the wake of the U.S. Supreme Court ruling in Dobbs v. Jackson leading to the overturning of Roe v. Wade, a federal appeals court ruling recently allowed Georgia’s six-week abortion ban law, House Bill 481, to take effect after being blocked by litigation for three years.

A co-plaintiff in the initial lawsuit against HB 481 as well as the new complaint challenging whether the law violates the state constitution, Feminist Women’s Health Center (FWHC) in Atlanta isn’t falling victim to the despair often engendered by the state’s reproductive health, rights, and justice landscape. 

FWHC provides abortion care, sexual health and wellness, and transgender health services to thousands each year, along with advocacy, education, organizing, and public affairs programs. The Hyde Amendment prohibits federal Medicaid funds from covering abortion in most cases, which is one of many obstacles preventing FWHC from accepting the insurance (they offer a discount to Medicaid patients instead). 

This barrier hasn’t stopped them from pushing for all Georgians to have health insurance within coalitions such as the national, Black women-led Raising Women’s Voices and the Cover Georgia campaign for the past decade.

“We worked in the early days of the ACA to make sure people had good information: what it meant for them to enroll in coverage, expanding their health care literacy, how to advocate for themselves at wellness visits, and understanding the expanded contraceptive coverage,” said FWHC executive director Kwajelyn Jackson. “We’ve also been in the fight to make sure the Medicaid coverage gap is covered. Many patients we see are completely uninsured because they don’t have access to employer-based coverage, and they don’t qualify for Medicaid.” 

About 255,000 Georgians fall into the “coverage gap”: They can’t afford an ACA health care plan but earn too much to qualify for Medicaid.

FWHC helped advocate for extending Medicaid coverage for postpartum parents from 60 days to six months, which the state legislature voted in favor of in 2021 and extended further this year from six to 12 months. 

Jackson said the extension is a step in the right direction but isn’t a full solution to Georgia’s maternal mortality crisis.

“As we’ve been working more around maternal mortality and morbidity, we understand people’s access to high-quality, affordable preventative health care before they get pregnant certainly affects their ability to have good birth outcomes and if they can bring a pregnancy to term. Expanding access to Medicaid to people who can become pregnant when they’re not carrying a pregnancy acknowledges their health care is valuable,” she said.

Like FWHC, Spark Reproductive Justice Now in Atlanta has been part of the movement to win Medicaid expansion in Georgia for the past decade and pushed for the expansion of postpartum Medicaid. Spark shifts narratives through arts, culture, and media and builds power through organizing, advocacy, knowledge-building, and political development.

Spark’s policy and advocacy director Agbo Ikor said the organization envisions a state where everyone has access to health care, no matter the resources they have. 

“We’ve been advocating to expand Medicaid as so many other states have because we know there is a huge coverage gap for Georgians, particularly when it comes to our base: young Black queer and trans folks and young queer and trans folks of color. Those are the folks who are most likely to fall within that coverage gap,” she said.

Both Ikor and Jackson cited state leadership as a hindrance to Medicaid expansion. Republicans currently hold the office of governor, secretary of state, and attorney general and control both chambers of the state legislature. The party’s infamous voter suppression tactics target those who would benefit most from the full expansion of Medicaid.

In 2020, the Trump administration approved Kemp’s waiver plan to partially expand Medicaid for low-income adults who fulfill certain work and activity requirements, but the Biden administration rejected it. Earlier this year, Georgia sued Biden’s administration to be allowed to administer the waiver plan, which would be more costly than full Medicaid expansion, according to the Georgia Budget and Policy Institute (GBPI). 

“Partial expansion would cover 31,093 Georgians with the work requirement and 269,000 if the work requirement is removed, while full expansion would cover almost half a million Georgians. The federal government pays 90% of the costs for full expansion, but only 67% of costs for partial expansion,” said GBPI senior health policy analyst Leah Chan. “In other words, Georgia’s pending Medicaid waiver plan would provide health care coverage to fewer Georgians and at a higher cost compared to fully expanding Medicaid under the ACA.” 

President Joe Biden’s 2020 win in Georgia signals shifting politics in the state, as does the Medicaid Saves Lives Act introduced in 2021 by Georgia’s two Democratic U.S. senators, Raphael Warnock and Jon Ossoff. The bill would establish a federally funded program to insure low-income adults in states that haven’t expanded Medicaid. Another sign of progress, in a settlement this July, the Georgia Department of Community Health agreed to include gender-affirming surgeries in the state’s Medicaid program.

Politically, the tide is changing in Georgia, but not quickly enough to ease the ravaging effects of the COVID-19 pandemic on the Black, brown, LGBTQ+, low-income, and disabled people who seek out Spark and FWHC’s programs and services. Both organizations are embracing community care and mutual aid models to assist these populations while advocating for health care coverage for all Georgians.

Ikor said the state’s inaction on Medicaid expansion is symptomatic of a larger problem Spark is aiming to solve. 

“We’re addressing white supremacy, patriarchy, and all these other systems in order to reach the ideas of reproductive justice and what liberation looks like for us,” she said.

Neesha Powell-Ingabire is a coastal Georgia-born-and-raised movement journalist, essayist, grant writer, cat parent, spouse, and auntie living in Atlanta/occupied Creek territory. Their writing has been...