Bottoms wants to expand Medicaid in Georgia, but can she?

Just hours earlier, 72 miles north in Statesboro, she delivered the same message to supporters gathered at a local coffee shop and stressed the need to vote in Democrats up and down the ballot.

“It’s going to be about us being able to not just flip the governor’s seat — which is extremely important — but also those House and Senate seats,” she said. “I will not have the power unilaterally to expand Medicaid.”

Bottoms is looking to become the state’s first Democratic governor in more than two decades, but even if she’s successful, she faces the prospect of navigating a Republican-majority state legislature that has turned down earlier attempts to expand Medicaid.

“We’re going to keep trying until it passes,” she said. “Failure is not an option.”

Credit: Riley Bunch

Credit: Riley Bunch

In 2024, the Georgia Legislature considered following an expansion model adopted in Republican-led Arkansas as part of a compromise to roll back hospital regulations. That effort ultimately ran out of gas, and that was without the complication of a divided state government.

Conversations around expansion this election cycle have been heightened by new, difficult realities: hundreds of thousands of Georgians lost their healthcare when Congress voted to allow enhanced federal subsidies under the Affordable Care Act expire.

In Brunswick, President & CEO of Southeast Georgia Health System Christy D. Jordan said that since the subsidies expired, the number of uninsured and self-pay patients in their facilities has spiked while the number of patients covered by the Affordable Care Act has dropped.

“We’re a nonprofit, so we’re caring for them, but you can’t continue to remain financially viable if you’re not getting paid for your services,” she said.

Bottoms’ opponent, Republican nominee Rick Jackson, has said since the launch of his surprise bid that he opposes expanding Medicaid and instead promises to bring down costs with a more efficient state-level program.

“I am telling you, the feds aren’t going to solve this. I’m going to solve it in Georgia. And it’s going to be a model for the nation,” he said in an interview after he entered the race in February. “If we don’t have the most affordable healthcare plan in the United States, I will quit. I am that confident.”

Credit: Arvin Temkar/Atlanta Journal-Con

Credit: Arvin Temkar/Atlanta Journal-Con

The former Atlanta mayor said Wednesday she’s ready to capitalize on any level of appetite from Republican legislators to get it done and isn’t concerned about lingering feelings over her history of butting heads with state Republicans during the COVID-19 pandemic.

While media headlines focused on the city’s battles with Republicans during that time, she said there were still bipartisan steps taken to address the crisis.

“I’m no stranger to sitting with Republican leaders and trying to hash out how we can get things done that works best for everyone — it won’t be my first time at that rodeo.”

The healthcare divide has also spilled into the race between U.S. Sen. Jon Ossoff and Republican U.S. Rep. Mike Collins.

In a news conference Thursday outside Monroe County Hospital, Collins outlined a plan for more federal funding for rural hospitals, expanded tax credits, negotiations to lower prescription drug prices and greater transparency aimed at hidden fees.

He said the measures would make “healthcare more accessible and more affordable to every person in our state.”

Ossoff and his allies counter by pointing to Republican opposition to Medicaid expansion and President Donald Trump’s Big, Beautiful Bill, which is projected to cut more than $1 trillion from federal healthcare programs over a decade.

A 2025 study from the American Hospital Association estimated Georgia’s rural hospitals could lose $540 million over that span.

More than just Medicaid

Credit: Riley Bunch

Credit: Riley Bunch

At the roundtable in Jesup, 73-year-old Linda Lockley Kelly asked what it will take for Georgia to finally expand Medicaid and recalled a local grassroots effort to push the issue years ago.

“We were calling our congressmen; we were emailing our senators, and none of that really had an impact on the voting,” she said.

The retired Wayne County educator of more than 30 years said that the few doctors practicing in southeast Georgia rarely stay long.

“We cannot keep physicians here,” she said.

Over the course of Bottoms’ multiday healthcare tour, supporters saw Medicaid expansion as one step toward fixing the state’s strained healthcare system. Some cited rural infrastructure as key to solving access problems.

Living on one of Bulloch County’s 700 dirt roads could mean the difference between life and death in a medical emergency.

Dr. Nancy Hurlock, a geriatric nurse practitioner in Statesboro, said while she traverses the bumpy terrain to get to older patients, some medical transportation companies will not.

“Our elderly patients in rural care that are down the dirt roads, who don’t have the internet and can’t get telehealth, are falling through the cracks,” she said.

Other southeast Georgia residents like Teresa Johnson said Wayne County’s mazelike roads and spotty cell service mean emergency crews can get lost responding to a crisis.

“They can’t find us,” Johnson said pointing to a recent death of a teenager during an ATV accident.

“We still don’t have systems in place in 2026 that help to guide the medical facilities to get to patients, and that’s a problem,” she said.

Credit: Riley Bunch

Credit: Riley Bunch

And even if a patient is able to find transportation, the lack of hospitals and specialized facilities — birthing units in particular — mean sometimes hours of travel to help.

Statesboro Mayor Jonathan McCollar said Wednesday that the healthcare gaps in the area are being filled by volunteers and nonprofits stepping in.

“If it was not for the people in this community, many folks in our community would go without,” he said.

Chief political reporter Greg Bluestein contributed to this report.