Dale Margaret Gibson
Urgent!!An epic, hectic day for health care legislation in Ga. - critical reading for all hospital leadership and staff - this will affect every rural hospital in Ga - it is fully supported by all of the three leadership seats , Gov, Lt Gov, Speaker 1 message [email protected]
HomeTown Health CEO's and Senior Staff:
Reference: An epic, hectic day for health care legislation in Georgia
This is critical reading in that yesterday saw more health care legislation move than ever in recent history. There were three bills of several that moved as outlined in the three articles below: the bills are
1. SB106 - http://www.legis.ga.gov/legislation/en- US/Display/20192020/SB/106 a. Medicaid Waiver bill to allow governors to seek various waivers for best practices 2. HB321- http://www.legis.ga.gov/ Legislation/20192020/185944.pdf a. Approved extension of $1 billion Provider Fee Major support from Gov. Kemp due to huge budget implications b. Introduced Major transparency language to require full disclosure of hospital financial data c. Moves to Senate Rules and Floor for consideration and passage
3. HB 186 - http://www.legis.ga.gov/legislation/en- US/Display/20192020/HB/186 a. Toner Down CON to include
i. CTCA compromise
ii. Diluted language for Transparency
iii. Innovation center for study of health care best practices to be appointed by Governor
iv. Moves to Senate Rules and Floor for consideration
These bills will have profound effect on rural hospitals !! Read and pass to all hospital directors , Board members and C-Suite people.
Plan to come to the HomeTown Health Spring Meeting to get the full debrief for Lt. Gov Geoff Duncan , House Appropriations Chairman Terry England and Political observer and attorney Josh Belinfante. Register here if you have not already! Hospital Attendees: Register here! Business Partners: Register here!
An epic, hectic day for health care legislation in Georgia
March 25, 2019 Andy Miller | Georgia Health News0
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. The legislation, already approved by the Senate, now goes to Kemp for his signature.
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.’’
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.
AJC Reports
Georgia lawmakers adopted Gov. Brian Kemp’s Medicaid waiver plan and boosted legislation that would overhaul hospital regulations. But a third move on Monday that got less attention could also set up sweeping changes to the healthcare system. The Senate Finance Committee passed a surprise version of a Medicaid funding bill that was loaded with new transparency provisions that require nonprofit hospitals to post detailed financial statements, patient revenue details and the location and price of land they own. The nonprofit hospitals would also be required to list how much money each has in the bank and the salaries and the fringe benefits of their 10 highest paid administrators, along with the details from questionnaires and audits of programs.
After the disclosure requirements were slipped into House Bill 321, though, some lawmakers and lobbyists seemed caught off guard. It sparked little discussion after the bill’s sponsor, state Sen. Blake Tillery, introduced it as a way to add a “little bit of transparency” for hospitals.
A lobbyist for the Georgia Hospital Association said late Monday the group was reviewing the new provisions. Lt. Gov. Geoff Duncan, meanwhile, signaled his
“Are big Atlanta hospital conglomerates really going to oppose $900 million of Medicaid dollars because they’re opposed to basic transparency?” he wrote. “If so, it makes you wonder what they are hiding.”
Georgia lawmakers approve Kemp’s plan for Medicaid, Obamacare waivers AJC at the Gold Dome: Health Care 15 hours ago By
· Greg Bluestein
· Ariel Hart, The Atlanta Journal-Constitution
The Georgia Legislature on Monday approved Gov. Brian Kemp’s proposal to give his office new powers to pursue “waiver” programs that could pave the way to a limited Medicaid expansion and ease insurance costs for some poor and middle-class Georgians.
Senate Bill 106 cleared the Georgia House by a 104-67 vote mostly along party lines after more than an hour of tense debate. The proposal, which has previously passed the Senate, now heads to Kemp’s desk and he said he will “very quickly” sign it into law.
Kemp unveiled the proposal shortly after his election with a promise it would improve government-funded health care access. He also vowed it wouldn’t lead to outright expansion of the Medicaid program, which he campaigned against during the governor’s race.
It was staunchly opposed by Democrats, who say full-on expansion is the only way to spur the economy, cover hundreds of thousands of Georgians and help rural hospitals. Some appealed to the chamber’s pride: House Minority Leader Bob Trammell called it an “abdication” because it gives the governor broad new authority without requiring any final legislative sign-off.
“I know how that movie ends: It ends without Georgians who we could cover as a legislative body, today, not getting health care coverage,” Trammell said.
Republicans forcefully rallied around it as a concrete step to help struggling Georgians. State Rep. David Stover, R- Newnan, called on his colleagues to “trust our governor” and give him the ability to seek the waivers. Others said even a partial step sent a strong signal.
Investigative journalism that exposes the truth
“I wish I could feed everybody, I wish I could clothe everybody,” said state Rep. Ed Rynders, R-Albany. “We should all do our share. And our share is a simple yes vote.”
The vote was a victory for Kemp’s office, restoring powers the Legislature stripped during Gov. Nathan Deal’s re- election run in 2014. It now sets up a tight timeline: Kemp wants the waivers to be approved by 2020 — in time for the presidential election.
Shortly after the measure passed, Kemp highlighted the bipartisan nature of the final vote — six Democrats voted for it, while three Republicans opposed it — and promised a transparent waiver application process.
“I know that they’re giving me a lot of trust with this. But I promised them that I’d be a trustworthy public servant and do the right thing and move the needle on health care in Georgia,” he said. “And that’s what we plan on doing.”
Under pressure SB 106 would allow Kemp to pursue two separate waivers from the Trump administration seeking more flexibility to use federal funds.
The first is an Affordable Care Act waiver, which became a staple of Kemp’s campaign in the final weeks before the election. It could create a fund designed to lower premiums on the health insurance exchange market, possibly by subsidizing private insurers’ coverage of high-risk customers with pre-existing conditions.
The second, and more contentious, waiver idea emerged shortly after Kemp took office.
It would involve very poor people with incomes up to the poverty level, which is about $12,000 for a single individual. But it forbids the waiver from covering Georgians who make above that level. Full Medicaid expansion would cover more people, up to those who make about $16,000 for an individual, or 138 percent of the poverty level.
The governor campaigned last year against an expansion, saying that adding more than 500,000 Georgians to the state’s rolls could be too costly in the long run. But pressure has built on Kemp since his narrow November election win to take more significant health care action.
Atlanta Journal-Constitution polls have consistently shown that more than 70 percent of Georgians support expanding Medicaid coverage for the poor. And a growing number of Republicans, unnerved by rural hospital closures and rising premiums, have embraced the idea.
Evans Republican state Rep. Jodi Lott, Gov. Brian Kemp’s floor leader, responds to questions from House Minority Leader Robert Trammell, D-Luthersville, while presenting Senate Bill 106. The measure, which would allow the governor to pursue health care waivers from the federal government, passed mostly along party lines in 104-67 vote. Bob Andres / [email protected]
Photo: The Atlanta Journal-Constitution
A 2020 countdown
Still, the waiver process could put Kemp in dicey territory. The waivers are contingent on approval from the federal government — no certainty despite the governor’s ties to the White House. And some conservatives fear even a limited expansion could leave taxpayers on the hook if the federal commitment to cover most of the tab ever fades.
Kemp has budgeted $1 million to hire a consulting team to review statistical and population data, and begin the work of navigating the process with federal decision-makers in Washington. The federal government will chip in another $1 million.
Throughout the debate, Republicans accused Democrats of turning down help for the poor in an all-or-nothing political quest for a larger Medicaid program. Democrats said a “no” vote would force new negotiations to get a broader measure passed to help more constituents.
The legislation promises to have far-reaching consequences.
The Medicaid debate involves between 300,000 and 600,000 Georgians, according to estimates from health advocacy groups. Those people are too poor to be eligible for Obamacare subsidies but are not eligible for Medicaid. They have no coverage but sometimes show up at emergency rooms, where they run up costs for hospitals that treat them anyways.
An estimate prepared by state analysts earlier this year showed the cost of a full Medicaid expansion would be about $200 million a year, a sum that would be matched 9-to-1 by the federal government. It’s not yet clear how much the waiver proposal will cost the state.
Kemp’s aides say the Medicaid waiver could be modeled on other states that have used waivers to add hundreds of thousands of residents to their rolls through work requirements and other conservative elements. But they stressed that the governor wants to see all his options first. His allies also pleaded for patience.
“This is a big-picture debate. Health care is complicated,” said state Rep. Jodi Lott, one of Kemp’s top allies in the House. “It’s complex. This is the first part. It’s the first piece of the pie.”
Democrats’ opposition centered on the people who would not be included in the bill, those who make between 100 percent of the poverty level and 138 percent.
Republicans stressed that those people are already eligible for heavily subsidized health insurance under the Affordable Care Act. “It is our intent to give health care options to all groups, not just those below 100 percent and not just those above, but all,” Lott said. Democrats stressed that for many of them it’s not as good a deal as Medicaid. They must pay premiums, and for many of them the costs rise into thousands of dollars a year in out-of-pocket costs. Experts say that for people at that income level it’s a financial burden that is a barrier to health care.
“Aside from us to continuing to punish people for being born poor and deprive opportunities to rise out of poverty through hard work, the most bizarre thing about what we’re doing is we’re leaving out hardworking Georgians making between $25,000 and $35,000 a year” for a family of four, said state Rep. David Dreyer, D-Atlanta.
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