Efforts to repeal and replace the Affordable Care Act may face an uncertain future in Washington, but for many Georgians health insurance is a problem that needs immediate attention.
Some Georgia lawmakers are trying to move ahead in spite of the uncertainty. Lt. Gov. Casey Cagle’s state senate health care task force heard testimony Monday about hundreds of thousands of Georgians who lack any insurance at all. Not to mention those who have it, but can’t afford the increasingly expensive out-of-pocket costs.
Cagle hopes his task force can help Georgia benefit from, or even shape, whatever Congress eventually passes. And on the front lines, U.S. Sens. Johnny Isakson and David Perdue are already outlining their positions. They spoke to the AJC last week.
The takeaways: All three are Republican, and all three say they’re for repealing and replacing Obamacare. But all say the U.S. House version needs work. And all acknowledge it could be months before any of that actually happens.
“It may be Christmas Eve again,” Isakson quipped, recalling the historic early-morning vote that made Obamacare.
“There’s still quite a bit of uncertainty,” Cagle conceded. “But that should not be a deterrent to us as a state.”
Georgia State University experts outlined many problems with the state’s health insurance landscape Monday:
- The private group health insurance plans that Americans typically think of as providing the best health care in the world have now shrunk to the point that fewer than half of Americans have one. They're still shrinking.
- There may be little an employee can do to get one. Fewer than half of U.S. firms even offer employees insurance, and Georgia's average is even lower: 40 percent.
- When they have private insurance, out-of-pocket costs are increasing to the point where employees can't afford them. That's putting an extra burden on health care providers, who are increasingly taking on bad debt when such patients don't pay.
- On the Obamacare insurance exchanges, costs are rising too. Deductibles and premiums are increasing, and some insurers are dropping out of offering plans.
“It’s like a false sense of security,” said Renee Unterman, chairwoman of the state senate’s health committee. “Yes, they may have insurance and they have a card in their wallet,” but with the out of pocket expenses, “The question is can you use your insurance.”
What’s next?
Georgia’s U.S. senators aren’t considered big holdouts in this particular debate — Isakson is known among GOP leaders as a team player and U.S. Sen. David Perdue has positioned himself as a key ally of President Donald Trump and his agenda. Their support, however, is crucial to the survival of any GOP plan.
Among their top priorities is making sure that the 19 states that didn’t expand Medicaid under Obamacare, including Georgia, don’t get financially disadvantaged under such legislation.
“I want to get something that works for the people who need it and that we maintain the independence for the states in terms of taking care of their own people,” Perdue said.
Both want to work with Democrats but indicated they weren’t sure whether any proposal could win their colleagues’ support, much less that of the 50 other Republicans.
Isakson, who had earlier backed a separate GOP health care plan that would let states decide whether to keep Obamacare or pursue something different, repeatedly emphasized that he did not want to commit himself to specific policy proposals at the expense of a final deal.
“You’ve got to consider everything in the totality of the proposal,” he said.
The House GOP’s bill would fundamentally change the way the federal government pays states for Medicaid, the health care program for the poor. The federal government has for years paid states a certain percentage of all of their Medicaid costs. The measure passed by the House instead would allow states to opt for “block grants,” which would pay states lump sums based on a predetermined formula.
Isakson and Perdue say they worry that a state with a growing population such as Georgia could end up worse off: locked into an outdated formula that could limit the stream of federal dollars.
Here is where the two stand on some of the health care debate’s biggest fault lines:
Medicaid expansion:
Georgia leaders don’t want to be punished for the fact that they didn’t expand Medicaid as the Obamacare law intended. Cagle, who is running for governor, said it’s still not time to do that. But he wouldn’t rule it out.
Tax credits:
The House’s health care plan would provide tax credits to help people pay for insurance based on age, not income as Obamacare does. The GOP plan would also give wealthier Americans tax breaks.
Perdue said he does not think “anybody making $200,000 needs a tax credit to pay for their health insurance” and that both age and income should be determining factors. Isakson previously supported a GOP proposal that would means test the House GOP’s age-based tax credits. In other words, it aims to redistribute the benefits toward lower-income people by phasing out the credits for wealthier individuals.
Pre-existing conditions
One of the Affordable Care Act’s most popular provisions bars insurers from denying people coverage if they have pre-existing medical conditions. President Trump and congressional Republicans have promised to keep that intact. But the trick is, insurers might be able to raise the price so high that no one with a pre-existing condition can afford it. The Georgia senators shied away from implying that would be okay, though they didn’t have airtight solutions.
It’s possible that waivers to the current health care law could help Georgia innovate some freer-market solutions. The senate task force is pushing waivers that allow states to work on such programs. But the programs’ track record is mixed.
In general, the three GOP leaders seemed to teeter between fiscal conservatism and compassion.
“We have a financial responsibility to ensure that we are financially solvent as a state,” Cagle said. “And we’re going to be committed to that. Not forgoing, obviously, a responsibility to the poor, to the elderly, to the disabled. Obviously that’s something we’re very committed to.”
How all that gets paid for is yet to be determined.
