Colleagues from the Georgia State House: Medicaid expansion is not planned for 2024.

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Updated [hour]:[minute] [AMPM] [time zone], [full month] [day], [year] Atlanta (AP) - Georgia's House speaker has opened the door to expanding the state's Medicaid program, but that path now appears to be closing for 2024. A bill introduced Tuesday by a top aide to Republican John Burns would create an Integrated Health Care Commission that could foreshadow additional health coverage in the future, but not this year.

Supporters of Medicaid expansion have already concluded that chances for 2024 are becoming unlikely as more than half of the legislative session has passed without a proposal being introduced by Rep. Butch Parish, a Swainsboro Republican whom Burns appointed to lead the discussions.

Republican Governor Brian Kemp's decision this month to sue the federal government to extend his Georgia Pathways program is widely seen as a sign that he opposes expanding health care coverage.

Georgia Pathways provides insurance to adults earning up to the poverty level - $14,580 for a single person or $24,860 for a family of three. However, people must document 80 hours of work, training, rehabilitation or volunteering to be eligible. Only 2,350 people were insured in the program from July 1 through mid-December, far fewer than the 100,000 people the Kemp administration projected. The program is set to expire in 2025, but Kemp has sued to extend it to 2028.

After North Carolina began providing Medicaid to uninsured adults on Dec. 1, that leaves 10 states without coverage for people with incomes up to 138% of the federal poverty level. More than 430,000 uninsured adults in Georgia could get coverage if Medicaid were expanded, predicts health research group KFF.

“The governor is balking,” said House Opposition Caucus Leader James Beverly of Macon.

“In a handout to the federal government and his assertion that Pathways is the way to go, 500,000 Georgia residents are left without health care for another year. And that's a tragedy.”

Burns, a Newington Republican, said in a statement that he still “100 percent supports” Pathways, but that Georgia should consider other options in case Kemp doesn't win the lawsuit. Burns expressed support for using Medicaid money to buy private insurance for residents, as Arkansas does, a path that could increase payments to hospitals, doctors and other health care providers.

The Speaker said that because Pathways could end in 2025, “we also want to take time, gather facts, listen to policy experts and stakeholders, and come up with the best possible policy to support our low-wage, uninsured population across the state that will help patients and providers,” Burns said.

Advocates are urging lawmakers to continue working on the expansion this year. “People with cancer are being diagnosed today who can't wait for treatment,” Julie Voytek, director of government relations for the American Cancer Society's Cancer Action Network, said in a statement.

“It's important that we keep all options open during the 2024 legislative session.”

The group brought dozens of cancer patients, survivors and family members to the state Capitol earlier this month to advocate for Medicaid expansion, urging lawmakers to keep working on expansion this year.

Supporters had hoped the state Senate could explore Medicaid expansion in exchange for reducing or eliminating licensing requirements for hospitals and health care. That has been a top priority of Deputy Governor Burt Jones, the Republican who leads the Georgia Senate, though the House has fought back against repealing the rules on requiring certification.

Parish's bill proposes a phased relaxation of certificate of need standards. First, it removes monetary limits on how much existing hospitals can spend on new or renovated buildings or new equipment if they do not offer new services.

It also relaxes rules to increase the number of beds in hospitals and allows them to move 5 miles (8 kilometers) without a new permit, instead of the current 3 miles.

The bill would allow new hospitals to be built in counties with fewer than 50,000 residents, as long as they agree to provide a certain amount of free medical care, join a statewide trauma system, provide “comprehensive mental health services” and agree to be teaching hospitals for medical students.

The clash between Jones and Burns last year centered in part on plans for a new hospital in Butts County, where Jones lives. The existing hospital there is opposed to the plan.

However, Parish's measure would still require state authorization to offer the new service, which many hospitals believe is a necessary mechanism to prevent new operators from oversubscribing cost-effective services.

Jones said Tuesday that he is “pleased to see the chamber engaged in this effort to increase competition in the health care marketplace and lower costs for Georgia families.”

Associated Press writer Sudhin Thanawala contributed.