Rick Jackson’s campaign got front-page treatment for a healthcare plan with very few numbers. Here’s a little arithmetic.

Tip your hat to whoever runs communications for Rick Jackson.

On Tuesday, September 8, the Republican nominee for governor stood in a ballroom at the Westin Atlanta Perimeter and made a promise with an unmistakable cadence to it.

“ … On day one,” Jackson pledged, “I will close the coverage gap with intelligent Medicaid expansion.”

By Thursday morning that promise was on the front page of the Atlanta Journal-Constitution’s ePaper — “Jackson outlines ‘intelligent Medicaid expansion’ idea.” Capitol Beat News Service carried it to WABE, the Valdosta Daily Times, the Moultrie Observer, Forsyth News and points beyond. Atlanta News First built a segment around it. The Georgia Chamber of Commerce’s political arm endorsed him the next day.

That is about as good a week as a campaign gets. And nearly all the coverage barely touched on the central question.

The AJC got to it in the thirteenth paragraph: “important details of Jackson’s plan remain unresolved, including exactly who would qualify, how the state would structure the program and how much it would cost.” That was well after readers had been exposed to Jackson’s enthusiastic rhetoric. Capitol Beat allowed that the proposals were “broad in scope but narrow in detail,” then applied that observation to price transparency rather than to Medicaid. Only the Georgia Recorder’s Alander Rocha put it in the lede, under a headline that said what the story found: “but offers few specifics.”

Rocha also pinpointed the hole in the plan. Jackson wants the enhanced federal match — presumably the 90 cents on the dollar Washington pays states that expand Medicaid. Georgia currently gets about 66 cents for Governor Brian Kemp’s Pathways to Coverage program.

But federal law ties the 90% match to covering adults up to 138% of the federal poverty level, roughly $22,000 for an individual. Jackson has said flatly he won’t do that: “We will not force the 500,000 people who have subsidized private plans onto a government plan.” His campaign says it will seek “a new waiver.” It has not said what would be different this time — and there is a this time, because Kemp asked the first Trump administration for exactly that deal and was told no. Georgia built Pathways without the enhanced match, which is a good part of why Pathways costs what it costs (a lot more money) and covers whom it covers (a lot fewer people).

Here is the part that ought to have made the story. Last month, Kemp’s own Department of Community Health told federal regulators that new rules under the One Big Beautiful Bill Act — which force Georgia to exempt more people from the Pathways work requirement — will add roughly 100,000 enrollees and render the program financially unsustainable at its current match. Their remedy? Ask Washington for 90%. “The federal government fundamentally reshaped the operational and financial realities of Georgia’s waiver,” DCH’s Stuart Portman told the feds.

So the sitting Republican administration is already pursuing Jackson’s plan, has already been refused once, and is asking again on a waiver that expires in December.

Meanwhile, many of the 500,000 Georgians Jackson pledges to protect from a government plan are being removed from their private ones by the market. Congress let the enhanced ACA premium tax credits lapse on December 31, 2025. Georgia’s marketplace enrollment fell from 1.3 million in April 2025 to about 950,000 this April — a 27% collapse, some 350,000 people — according to data the Georgia Office of the Commissioner of Insurance released to The Current under an open records request. The average premium Georgians actually pay went from $74 a month to $164. The Urban Institute projects Georgia’s health sector loses more than $3.5 billion this year.

That is the status quo Jackson is promising to preserve, financed by a match that doesn’t exist, replacing a program that has enrolled fewer than 20,000 Georgians in three years against the 90,000 Kemp’s office once projected. Democratic gubernatorial nominee Keisha Lance Bottoms’s plan, whatever else you think of it, at least names the threshold, the program it would end, and the money.

In February 2013, Georgia State University’s William Custer published an analysis for Healthcare Georgia Foundation projecting what Medicaid Expansion would do here: 70,343 jobs, $8.2 billion in annual economic output, $276.5 million a year in state and local taxes. Buried in Table 3 is the number that matters for this post. Metro Atlanta, home to about half of all Georgians, would capture just under 37% of those jobs. Nearly two-thirds would land outside the metro.

Thirteen years later, North Carolina ran the experiment.

Same size state — 11.2 million people to Georgia’s 11.3 million. Same rural crescent. Prodded by then-Governor Roy Cooper, now the Democratic nominee for one of the state’s U.S. Senate seats, the Republican legislature passed Medicaid Expansion in 2023; it took effect December 1 of that year, financed through a hospital assessment rather than the general fund. As of last month it covered just under 735,000 people, 10.6% of the state’s working-age adults.

Georgia’s Pathways covers 19,397 — 0.28%. At North Carolina’s rate, Georgia would cover about 737,000.

And Custer’s forecast appears to hold in North Carolina. North Carolina’s rural counties hold roughly a fifth of the state’s adults and account for 34.9% of expansion enrollees — 256,436 people, signing up at about twice the urban rate. Even North Carolina’s worst-performing county covers 5% of its adults, roughly eighteen times Georgia’s statewide rate.

Custer was projecting jobs, not enrollment, but the underlying logic is the same: expansion dollars flow toward the places with the most uninsured people and the thinnest health care economies. North Carolina’s enrollment pattern says he had the geography right. The benefit went where Custer said it would, and exactly where Georgia needs it most.

Mr. Jackson has made billions of dollars running health care companies. He presumably knows the difference between a campaign brochure and a business plan. Georgia’s voters should demand the latter.