Biden and Georgia Are Waging a Fight Over Medicaid and the Future of Obamacare

The Affordable Care Act was once a potent electoral issue that could swing campaigns with its more familiar moniker, Obamacare. But the 2010 health law did not factor into last week’s Republican National Convention.

The Republican National Committee’s platform made only vague reference to a Trump health plan, saying that the party will “increase transparency, promote choice and competition, and expand access to new affordable health care.” Former President Donald J. Trump, who said last year he was “seriously looking at alternatives” to Obamacare, made little reference to health policy in his speech on Thursday accepting the Republican nomination.

The fight over Obamacare has instead shifted more to state capitals, in part because a provision of the law allows states — which jointly finance Medicaid with the federal government — to expand their programs to cover more adults.

No state represents the continuing divisions over the Affordable Care Act’s place in the safety net more than Georgia, one of the last 10 holdouts that have refused to take up Medicaid expansion.

Last July, Georgia officials implemented a stricter alternative to Medicaid expansion, known as Georgia Pathways to Coverage. The new program required participants to show that they were working, enrolled in college or doing community service for at least 80 hours each month — activities that Republican state lawmakers said would encourage a spirit of accountability among recipients of publicly subsidized health benefits.