The legislative session that just ended saw the most significant change to Georgia health care law in a decade, maybe in decades.
"It was pretty big," said state Sen. Ben Watson, R-Savannah, who for the first time served as chairman of the Senate Health and Human Services Committee.
Watson can list a raft of measures big and small that will affect Georgians: approving needle exchanges in concert with efforts to combat transmitted diseases and addiction; funding residency slots to create more rural Georgia doctors; and, of course, the biggest change, the “waiver” bill that gives Gov. Brian Kemp some big health care powers.
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“Under Governor Kemp’s administration this is, I think, the biggest piece of legislation he has done,” Watson said.
That remains to be seen; both in how Kemp uses, or doesn’t use, his new power; and in how important other bills end up being, for example the “heartbeat” bill that would ban most abortions. And while some issues remain festering, such as surprise billing, this session will go on record for what the government did to affect Georgians.
Medicaid and ACA waivers
The health care measure with the potential to affect the most Georgians, hands down, was the bill that gave Kemp the authority to expand the number of poor people in Georgia covered by Medicaid. Kemp signed it, and it’s now law. He would ask the federal government for “waivers” to tailor federal programs in ways specific to Georgia.
"Today's a truly historic day," state House Speaker David Ralston, R-Blue Ridge, told assembled reporters when it passed.
The bill, Senate Bill 106, also is the biggest mystery, though.
Basically, SB 106 gives the governor the ability to ask the federal government for changes to Georgia’s Medicaid and Affordable Care Act insurance programs. It spells out that he needn’t come back to the Legislature for permission once he decides what he wants to do.
Whatever it does to Medicaid, it can only include Georgians who make up to 100 percent of the poverty level — about $12,000 for a single individual.
But that could still mean hundreds of thousands of Georgians. People who have no insurance now might receive Medicaid. The hospitals that have to treat them regardless might finally be paid for it. People might finally start getting checkups instead of going to the hospital.
No one knows yet: Kemp and consultants have to work out the proposals.
In addition, Kemp has said he hopes with the waiver request he is considering for the Affordable Care Act, Georgians will pay less for health insurance.
Hospital competition
Patients with insurance may never know it, but there's been a years-long, red-hot war for their business in the Legislature. After more than a decade, this year the lines shifted.
The war concerns certificate of need, or CON, a regulation that limits competition against nonprofit hospitals. Nonprofit hospitals fear that new businesses could cherry-pick their few profitable services and leave them with the money-losers. So CON limits what new services can open. For their part, businesses say freeing them to open would give Georgians more choices.
With the passage of House Bill 186, health care entrepreneurs won the biggest battle against the CON regulation in at least 10 years. More Georgians will now be able to go to Cancer Treatment Centers of America, whereas up to now CTCA has been required to take most of its patients at its Newnan location from out of state.
Waging the battle on the other side were nonprofit hospitals. It's unclear at this point whether any Georgians are now more at risk of seeing their local hospital lose money as a result of this decision. Hospital groups were much more concerned about other pieces of CON legislation to free up outpatient surgery centers, such as House Bill 198.
That legislation didn’t pass.
Step therapy
Insurance companies are increasingly using their power to push back against rising health care costs. And the doctors and hospitals who bill those costs increasingly say they’re going too far, meddling in medical decision making.
“Step therapy” is one such instance, where an insurance company says a patient can’t have a medicine his or her doctor prescribed right away, at least not paid for by insurance. First, the company says, the patient must try a cheaper alternative. If that doesn’t work, then the patient might step up to the one prescribed by the doctor.
The problem, doctors say, is that “alternatives” aren’t the same drugs, and sometimes they don’t work and can do harm in delaying the working prescription.
A bill passed in the state Legislature this year attempts to compromise. House Bill 63 says patients can avoid step therapy with a "step therapy exception" in certain cases. Those include whether the drug "is expected to be ineffective" based on the patient's condition and the drug's characteristics, or if it will cause physical or mental harm to the patient.
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