Is the Georgia Pathways Program Really the Right Path?

Georgia has taken a different approach to Medicaid compared to most states. While traditional Medicaid expansion under the Affordable Care Act would cover over 400,000 low-income adults based on income alone, Governor Kemp launched the Pathways to Coverage program in 2023. 

Unlike full expansion, Pathways adds strict work and activity requirements—at least 80 hours a month—to qualify and limits coverage to those earning below 100% of the federal poverty level. As a result, only about 90,000 Georgians are expected to gain coverage. Pathways creates unnecessary barriers and leaves thousands uninsured, while supporters claim it promotes responsibility and workforce participation.

Where Georgia Pathways Falls Short

• Bureaucratic Obstacles - The work requirement may seem reasonable, but in practice, it’s hard to navigate.  Many people find issues reporting the work hour requirements. Even those who qualify are overwhelmed by the complicated application process. Furthermore, it's been described as “nightmarish,” with confusing paperwork, poor administrative support, and vague reasons for being denied. As a result, there are only about 7,447 enrollees to date, falling far short of the state’s projections.

• Burdens Vulnerable Communities - Rural hospitals depend heavily on Medicaid funding to stay open. But with limited Medicaid expansion, they’re at risk. Over the past decade, nine rural hospitals have closed, and nearly 20 more could follow. When hospitals close, local economies suffer, jobs disappear, and entire communities are left without essential care.

• Punishes Parents - Unlike similar programs in other states, Georgia Pathways does not exempt caregivers. This forces families to choose between getting health insurance or staying home to care for their children, and with childcare becoming more expensive, working while paying for care is not feasible for many low-income families.

The Impact of Trump’s “Big Beautiful Bill”

In May, the House passed the "One Big Beautiful Bill Act," a Republican-led budget reconciliation package that proposes significant tax cuts, spending reductions, and regulatory changes. Key provisions include:

• Imposing work requirements for Medicaid nationwide, which the Congressional Budget Office estimates could lead to over 8.6 million people losing coverage by 2034.

• Eliminating automatic re-enrollment for Affordable Care Act coverage jeopardizes millions' insurance access. 

• Limiting judicial oversight powers, raising alarms concerning federal overreach and undermining judicial authority. 

• Raising the nation’s debt limit by $4 trillion which could trigger a potential financial crisis if Congress fails to act in time.

These sweeping changes risk compromising critical support systems for millions of Americans. The bill is currently under debate in the Senate, and Trump has called for it to reach his desk by July 4th. As the bill moves forward, its long-term repercussions could reshape the country’s welfare and healthcare infrastructure and the relationship between the government and its citizens.