The state House passed a high-profile bill Monday that would allow Gov. Brian Kemp to seek health care “waivers’’ from the federal government to expand and improve coverage in Georgia.
And in another big vote, the Senate approved a bill to change Georgia’s controversial certificate-of-need system regulating medical providers.
These votes were part of a flurry of action Monday on major legislation affecting health care in Georgia, including on issues such as HIV, prescription drugs, services for seniors, and a Medicaid budget hole.
Industry experts said the votes Monday amounted to the biggest single legislative day on health care issues in memory.
“Gov. Kemp has made health care a priority,’’ said state Rep. Jodi Lott (R-Evans) as she presented Senate Bill 106 on waivers.
The legislation has two parts. One waiver would involve adding people to the Medicaid rolls. The other would allow Georgia to revise the set-up of the state health insurance exchange, created by the Affordable Care Act for people who don’t have coverage from employers or government programs.
The cost and coverage issues in the Medicaid waiver plan split the Legislature along party lines.
The federal government, up to now, has not approved a Medicaid waiver as envisioned by SB 106 — adding people at up to 100 percent of the federal poverty level, roughly $12,500 for an individual, to the program, at the Medicaid expansion reimbursement match.
In states that have adopted full Medicaid expansion, covering people up to 138 percent of the federal poverty rate, the federal government has pledged to provide 90 percent of the cost for the newly eligible members.
So at 100 percent of poverty, the state presumably would be in line for its regular Medicaid match, which in Georgia would be 67 percent, unless the Trump administration grants an exception for the 90 percent match. Federal health officials said recently that they were reconsidering the matching rate for states wanting the 100 percent of poverty threshold.
Democrats argued that the measure, Senate Bill 106, is not as good a deal for the state as a standard, full Medicaid expansion. “It would cover 200,000 less people [than expansion], and we would likely be paying more,’’ said Rep. David Dreyer (D-Atlanta). Republicans, who control the Georgia governorship and both legislative chambers, have consistently rejected standard expansion.
Mary Frances Williams, a Marietta Democrat, said the bill’s section on private insurance could potentially let Kemp take such actions as reducing the list of essential health benefits, restructuring subsidies for individuals, or creating high-risk pools for people with certain health conditions. “I know we’re better than this legislation,’’ she said.
House Minority Leader Bob Trammell (D-Luthersville) said Republicans won’t guarantee even that all those under 100 percent will get coverage. “We don’t know what [the bill] will do. People are going to be left out. We’re keeping people from being able to go to the doctor.’’
Trammell said that under the bill, the Legislature would not get a final say on whatever waivers are developed.
Republicans argued that the bill would give Georgia more flexibility to change the Medicaid program.
Rep. David Stover, a Republican from Newnan, said the proposal allows “a comprehensive remodeling’’ of the federal-state program.
Lott said that those above 100 percent of poverty “do have access to health insurance on the federal exchange with significant subsidies.’’
“This bill is only a beginning,’’ said state Rep. Lee Hawkins (R-Gainesville), who added that voting against the legislation would deny coverage to many Georgians.
The waivers aren’t ‘’a silver bullet,’’ said Republican Rep. Butch Parrish of Swainsboro. But Senate Bill 106, he said, “is a step in the right direction that will improve health care and access in this state.’’
The vote was 104-67 in favor of Senate Bill 106.
CON overhaul measure toned down
The certificate-of need bill that passed the Senate would be less sweeping than an original House proposal restructuring the health care regulatory process.
The short debate and then 51-4 approval was probably the fastest vote ever on CON.
CON regulates how health care facilities function in Georgia. A provider must get a “certificate of need” from the state to proceed with a major project, such as building or expanding a medical facility or changing what services are available to patients.
Sen. Chuck Hufstetler, a Rome Republican who sponsored the new version, said the Georgia Hospital Association, a longtime opponent of CON changes, had signed off on the bill.
“We have worked it out where everyone was in agreement,’’ he told GHN after the vote.
But what happens next is up in the air. The new bill now goes to the House for approval. “I know they’re working on a competing bill,’’ Hufstetler said.
The newly reworked House Bill 186 contains some proposals from the original House Bill 198. It would limit the rival health care entities that can object to a CON application to those within a 35-mile radius of the proposed project. Currently there are no geographic restrictions on who can object.
Other provisions include:
** Giving Cancer Treatment Centers of America (CTCA) a pathway to add more beds and serve more Georgia patients at its Newnan hospital
** Increasing financial thresholds for hospital construction and medical equipment
** Prohibiting hospitals from purchasing or holding ‘’medical use’’ rights of properties
The CTCA compromise, in particular, was one that had eluded lawmakers for years.
Last week, Kemp jumped into the debate to push CON reforms.
“As governor, I am committed to pursuing free-market solutions that lower health care costs, eliminate barriers to access, and improve quality of care in every region of our state,’’ he said. “To reach these goals, I firmly believe that we need meaningful reform of Georgia’s certificate-of-need laws and regulations. We must be bold. The time is now.’’
Gov. Kemp with Lt. Gov. Geoff Duncan
The Kemp administration says White House officials have indicated they would be more receptive to a waiver request on Georgia health insurance rules if the state would take action on CON reforms.
But the amended bill does not contain any provision allowing a sports medicine and training center in Alpharetta, a project that has many high-profile backers in the sports world. And the bill would not let hospital organizations establish standalone ERs, or allow for cardiology ambulatory surgery centers.
The new bill significantly weakens the financial disclosure requirements that the original House bill urged.
But in a surprise move, the Senate Finance Committee passed legislation on Medicaid funding that contained provisions expanding transparency on the financial holdings of non-profit hospitals.
House Bill 321’s main provisions are to extend the hospital provider fee. The payment program, which draws extra federal funding, fills nearly a $1 billion hole annually in the state Medicaid budget.
The program is scheduled to “sunset” (expire automatically) next year. The legislation, sponsored by Rep. Lott, would extend that date to 2025.
These health care bills reflect that “everybody realizes health care is a huge issue,” said Rep. Matt Hatchett, a Dublin Republican who has pushed CON reforms. “The efficiency, access and quality are all important. We’re addressing it.”‘
In addition, the state Senate unanimously approved a bill Monday to limit health insurers’ protocols on patients taking certain medications. The protocols, known as “step therapy,’’ require that a patient “try and fail” on one or more meds before insurers provide coverage for a drug that was originally prescribed.
The legislation would help patients obtain exceptions to these drug requirements.
A similar bill last year passed the House, but went no further. “This is one small step for patients in Georgia to get the medicines that their doctors think they should have,’’ said Rep. Sharon Cooper, a Marietta Republican who sponsored the bill.
Fighting HIV and protecting seniors
Another proposal gained more legislative traction than in previous years.
The Senate passed legislation to facilitate needle exchange programs to help prevent new HIV and other infections among intravenous drug users. It’s part of a group of bills aiming to address the HIV epidemic in Georgia.
Georgia is the No. 1 state in rates of new infections, and metro Atlanta is No. 3 among the nation’s metropolitan areas.
Several items in the state 2020 budget, passed by the Senate on Monday, will help seniors, said the Georgia Council on Aging.
“Many elderly Georgians will be better off as a result of the 2020 state budget approved today by the state Senate,’’ Vicki Johnson, chair of the Georgia Council on Aging, said in a statement,
“The budget includes extra money to combat elderly abuse, to deliver meals to older Georgians and to help our seniors stay in their homes as long as possible.”
Among the provisions, the council cited more funding for the Aging and Disability Resource Connection; and the Senate adding $157,000 for “assistive technology” to help older Georgians continue to live in their homes and communities.