The Republican head of the Georgia Senate’s Health and Human Services committee says the state needs to “re-examine” expanding Medicaid.

State Sen. Renee Unterman (R-Buford) didn’t endorse the idea of Medicaid expansion under the Affordable Care Act, also known as Obamacare. Rather, she thinks the state should look at negotiating a federal waiver, as other Republican-majority states have done, to tailor how any potential Medicaid expansion would work.

“We have to open that box and look just a little bit and see what’s available,” Unterman said. “Hopefully, if you draw down federal dollars, you can free up some of those state dollars. Right now, we’re just pumping out state dollars to stay in the midst of the crisis.”

The “crisis” Unterman is referring to is the struggle many Georgia hospitals are facing to keep their doors open. At least four rural hospitals have closed in Georgia since 2013.

Unterman said for the last two years state lawmakers have “propped up our state budget with immense amounts of money trying to manage our way through a crisis.”

“At some point you have to look at sustainability. As one of those budget writers, you have to say ‘How many years in a row can we pump in hundreds of millions of dollars to hospitals that are closing, to physicians that are going to out of business?’” Unterman said. “We have to re-examine where we are.”

Georgia is one of 19 states that has not has expanded Medicaid. An estimated 400,000 residents fall in what’s known as the Medicaid coverage gap, meaning they make too much money to qualify for Medicaid, but not enough to receive federal subsidies that would help them pay for private insurance.

Under the ACA, the federal government expanded Medicaid coverage to all Americans under 65 years old whose income falls between 100 percent and 138 percent of the federal poverty level. That means the threshold for eligibility is about $16,400 for an individual in 2016, according to the National Conference of State Legislatures.

But some Republican-majority states, like Arkansas, Montana and Indiana, have accomplished the same expansion through a different program, called a 1115 Waiver. The program essentially allows the states to extend coverage on its own terms.

It’s the latter that Unterman says the state needs to consider. She pointed to Arkansas, which uses Medicaid dollars to buy private insurance for the poor on the federal insurance exchange.

“Why can’t we get some of those people in the gap onto those exchanges?” Unterman asked. “All Georgians are paying for those folks, unfortunately. You’re paying through increased interest premiums, and you’re paying when you go to the hospitals, because the hospitals are building in their losses.”

Unterman also endorsed the idea of having some Medicaid recipients pay premiums, as well as putting in work requirements for coverage, something other states with waivers have done.

The Buford Republican said she doesn’t know if there’s enough buy-in from other state Republicans lawmakers to get a bill passed next legislative session. The party currently holds majorities in both the House and Senate.

GOP lawmakers, including Gov. Nathan Deal, have so far refused to consider Medicaid expansion, arguing the state can’t afford to do it.