Before the economic downturn, Georgia's largest free clinic mostly saw people who had been without insurance for many years: the homeless and minimum-wage earners.
The $4.5 billion is an inflated figure, said Timothy Sweeney, director of health policy for the Georgia Budget & Policy Institute, a nonpartisan organization in favor of the expansion.
He said the $4.5 billion estimate includes costs that are separate from the Medicaid expansion and does not include projected revenue from a premium tax paid by managed-care companies that administer Medicaid under state auspices.
Even so, the Deal administration's estimate represents less than a 2 percent increase in state spending over the next decade, Sweeney said.
"This is not a budget buster."
Can't afford to say "no"
The state cannot afford to pass up the opportunity to have more of its citizens covered, proponents of expanding Medicaid say.
For instance, providing Medicaid coverage for middle-aged people would ease the later financial burden on Medicare, the federal government's health insurance program for people 65 and older, Sweeney said. That's because chronic health conditions would be better managed before people qualify for Medicare.
It also would boost the state's economy because of additional payments to doctors, nurses, hospitals and pharmacies, he said.
Opting out of the Medicaid expansion will continue to put pressure on the safety net that includes free clinics and public hospitals, AARP Georgia and other advocates say.
"If we shine a light on what the expansion will do for the state, I think we have a shot," said Kathy Floyd, AARP Georgia associate state director for advocacy.
During the legislative session, AARP Georgia will support a bill to allow workers to use their sick time to care for an ill family member.
Ann Hardie is a writer living in Atlanta.