As lawmakers prepare to return Monday, our team of journalists spends this week helping you better understand the issues facing the state. Today we look at the federal health care law.
Georgia legislators who oppose the federal health care law face a dilemma: Should they seize an opportunity to put their stamp on a state insurance marketplace prescribed by the law? Or, should they do nothing and hope the law is overturned by the courts?
With a presidential election and a Supreme Court decision on the law looming, many influential Georgians are arguing against preparing for the Patient Protection and Affordable Care Act — at least for now.
“The whole thing, from top to bottom, could be repealed,” said Insurance Commissioner Ralph Hudgens.
How legislators handle the issue has broad implications, especially for small business owners, people who buy their own health insurance and 1.9 million uninsured Georgians who would shop for coverage on a state exchange.
Georgia’s approach will also be important to doctors, hospitals, insurance companies and insurance agents, because health care payments and insurance products could be influenced by the design of an “insurance exchange,” which acts like a massive online insurance broker.
The exchange would direct consumers who do not get coverage at work to their options, including government plans for low-income families, private plans and subsidies to help pay for coverage.
Gov. Nathan Deal, House Speaker David Ralston and Hudgens say they do not want to move forward with designing an exchange until the Supreme Court decides whether the law is constitutional. Georgia is one of 26 states challenging the law in court.
“Our goal here remains the same: securing a victory in court,” said Stephanie Mayfield, the governor’s press secretary.
The wait-and-see strategy is risky, many experts say. If the law is upheld, Georgia will have little time to meet federal deadlines for setting up the exchange.
It’s a complex task that would likely require legislation — and it can’t be done overnight.
If Georgia doesn’t set up its exchange, the Obama administration will design and run Georgia’s marketplace, which Deal and other state officials say they do not want to happen. The Supreme Court will hear arguments in the case in late March, but may not rule on the matter until June.
Deal appointed a committee to study the exchange after last year’s legislative session. That group did not recommend moving forward with an exchange for individual consumers as called for by the law, but the committee did suggest a free-market exchange for small businesses that would not be tied to the requirements of the federal health care law.
Cindy Zeldin, a member of the committee who is executive director of Georgians for a Healthy Future, a statewide consumer organization, said it’s a mistake not to plan for a Georgia-run exchange.
“We’re shooting ourselves in the foot,” she said. “It’s an opportunity to do this in a way that is tailored to Georgia.”
But the time is not right to plan for implementation, said Ralston, the Speaker of the House. “My preference would be let’s see if this is going to become reality and then we’ll deal with it.”
Conservatives torn
The exchanges would open for business in 2014. States that want to run their exchanges must have most of the planning done by early next year.
Conservatives in many states such as Georgia are torn over whether to plan for an exchange while they battle against the law in court, said David Merritt, a health policy expert who until recently worked for Newt Gingrich’s Center for Health Transformation. “They have to understand that there will be consequences if they decide not to move forward” and the law is upheld, Merritt said. “ I would say most Georgians would agree that they would much rather control their own destiny than to have folks in Washington control it.”
Mayfield said Deal does not want the feds to design the Georgia exchange if the law is upheld and would find a way for Georgia to design its marketplace in time for the launch in 2014. That could be tricky since this year’s legislative session will have ended by the time the Supreme Court rules.
States face pushback
Thirteen states and the District of Columbia have passed legislation or executive orders to establish exchanges, according to the nonpartisan Kaiser Family Foundation, which focuses on health care issues. Some states, including Arizona, Rhode Island and Mississippi, have received tens of millions of federal dollars to push forward with planning efforts.
But many have faced pushback from state lawmakers unable to pass legislation necessary to set up exchanges, said Jennifer Tolbert, Kaiser’s director of state health reform.
In New Mexico, the governor vetoed legislation. Arkansas eventually conceded it couldn’t move forward, Tolbert said. An advisory committee in South Carolina recommended the state not move forward with establishing an exchange but should encourage private exchanges, she said.
The longer a state takes to lay the groundwork, the more likely the federal government will step in, Tolbert said.
What a federally-run individual exchange would mean for consumers is unclear, said Tim Sweeney, a health policy analyst at the nonpartisan Georgia Budget and Policy Institute.
“We don’t know how the national exchange is going to look,” Sweeney said. “We don’t know how to compare it to what Georgia could have done.”
While there would be limitations for states that opt to run exchanges, they should still have flexibility in who runs the exchange, whether to negotiate with insurance plans and other issues that could affect prices for consumers or how clearly their plan options are presented, Sweeney said.
It’s difficult for lawmakers to make decisions when the federal government still hasn’t provided many specifics on how exchanges will work, said Ed Painter, a tea party representative who describes himself as a “free-market person.” What is clear is that small business owners want to provide their employees with health coverage, which has become increasingly difficult, said Painter, who owns a small photo shop in Dalton.
If the law is struck down, state officials must be prepared to take on the responsibility of improving its health care system, said Ron Bachman, CEO of Healthcare Visions, which promotes free market-based health care solutions. Georgia, he said, needs to restructure its insurance market, expand its free clinic network and make other changes to make coverage more accessible, Bachman said.
“There’s no one silver bullet,” he said.
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