House leaders want a say on Medicaid expansion

You can follow the progress of House Bill 990 on our Georgia Legislative Navigator excusively online at MyAJC.com/navigator. Readers can keep track of every bill, every vote and every lawmaker.

Obamcare’s massive expansion of Medicaid has always faced long odds in Georgia, and last week the road to expansion became all the more impassable.

Currently, the decision rests with one man — Gov. Nathan Deal, who has steadfastly opposed the Affordable Care Act. A House bill introduced Tuesday would strip Deal of that power and confer it on the state Legislature — where the chances of expansion would melt from somewhat slim to nearly none as long as Republicans remain in charge.

The Affordable Care Act would have extended Medicaid coverage to about 650,000 lower-income Georgians who currently are uninsured and probably will remain so.

The anti-expansion measure, 41 lines of legalese filed as House Bill 990, might resemble a blunt instrument that grabs power from the governor. In reality, it provides an extra layer of political cover for Deal as he faces re-election in 2014.

For May’s primary, Deal’s conservative base is delighted with his opposition to Obamacare. In November’s general election, however, Deal will face an electorate that largely favors the Medicaid expansion. (A recent AJC poll of registered voters statewide found that 57 percent back the expansion.) HB 990 would enable Deal to point out that the issue is the Legislature’s decision, not his.

Support for the bill has the highest profile. The first name on the measure, introduced late Tuesday as snow and ice bore down on the state, is that of Speaker Pro Tem Jan Jones, R-Milton, followed by her boss, Speaker David Ralston, R-Blue Ridge. The GOP majority leader and his top deputy are included as is — significantly — the governor’s top floor leader in the House, Rep. Chad Nimmer, R-Blackshear.

Jones said the bill is simply good policy. The General Assembly is responsible for setting the state’s spending priorities and expansion of Medicaid would require a massive infusion or redirection of state revenue, she said.

“Where do you come up with half a billion dollars?” Jones said. “To raise the taxes sufficient to cover that would require a vote of the Legislature. That’s why the governor supports it.”

Ralston said the bill is not evidence of concern over Deal’s chances at re-election.

“I’m totally confident that Nathan Deal is going to be re-elected governor,” he said. “This is simply an opportunity for the Legislature to stake out this area as a matter of policy.”

‘Take the monkey off the governor’s back’

Democrats were sharply critical, describing the bill as “straight-up political.”

“It’s designed to … take the monkey off of the governor’s back in an election year and put it in the hands of the people who would not pass it,” said Liz Flowers, spokeswoman for the Senate Democratic Caucus.

State Sen. Vincent Fort, D-Atlanta, says Medicaid expansion not only would save lives but would, according to one authoritative study, generate 70,000 jobs statewide.

“It just shows the length Republicans will go to deny Georgians health care,” Fort said. “This ought to be a bipartisan issue.”

The U.S. Supreme Court ruled in 2012 that the federal government couldn’t force states to expand the health program for the poor — a key pillar of the Affordable Care Act. The law calls on states to expand their Medicaid programs to include people with incomes up to 138 percent of the federal poverty level, or about $27,000 for a family of three.

Expansion would bring $30 billion in new federal funding to Georgia over a decade and create about 70,000 jobs.

Deal has said the state can’t afford to broaden the already overburdened program. His office has estimated the expansion would cost Georgia $4 billion over 10 years, though supporters argue the cost would likely be closer to half of that.

Governor: ‘I’m fine with that, yeah’

In an added wrinkle to the new proposal, Deal would cede executive authority to the legislative branch, an exceedingly rare occasion in Georgia government. But, in addition to Nimmer’s name appearing as a co-sponsor, Deal himself said last week of the bill, ““I’m fine with that, yeah.”

His political opponents clearly are not.

“To me, it is more evidence that he’s doing everything he can in refusing the responsibility of leadership,” state Sen. Jason Carter, D-Atlanta, Deal’s likely opponent in November, said. “It’s an unbelievable example of him passing the buck.”

If the bill passes, Carter would be unable to expand the health care program for the poor and disabled should he win in November.

Deal’s campaign spokeswoman replied in kind.

“So Senator Carter believes cutting a backroom deal with the Obama administration is preferable to giving the people’s representatives, himself included, a say in how hundreds of millions of their taxpayer dollars are spent?” Jen Talaber said.

The back-and-forth comes as health care for more than a half-million Georgians appears to be on the line.

“In the meantime, we’re missing out on $250 million in new federal funds each month and Georgians are missing out on being able to go to the doctor when they need to,” said Tim Sweeney, a health care policy expert at the left-leaning Georgia Budget & Policy Institute.

‘We’re talking about billions of dollars’

Georgia is among 19 states that have rejected expansion. But a growing number of states, including some with Republican governors like Utah, have chosen to move forward with expansion or at least explore the possibility.

“The governor of Utah recently said in their move to expand that doing nothing is not an option,” Sweeney said. “It should not be an option in Georgia either.”

Legislative approval should be required for fundamental changes in state programs, including an expansion of an entitlement program like Medicaid, said Kelly McCutchen, president of the Georgia Public Policy Foundation, a right-leaning think tank. The group opposes expansion and has advocated for a market-oriented alternative.

“We’re talking about billions of dollars,” McCutchen said.

With great awareness of the political necks that have been stuck out on HB 990, top health care groups in the state are being careful in their statements about HB 990.

Donald Palmisano, executive director of the Medical Association of Georgia — the 7,000-member doctors group — said while his group hasn’t taken a position on HB 990 yet, the state needs to look for new ways to cover more people whether through expansion or another route.

A spokesman for the Georgia Hospital Association, too, made no waves.

“We will continue to work with Georgia’s elected officials regarding all issues that affect hospitals and the patients they care for,” Kevin Bloye said.

Community hospitals support Medicaid expansion

One group willing to raise concerns about the bill was the Georgia Alliance of Community Hospitals.

“We would oppose any effort to restrict the governor from expanding Medicaid,” Alliance president Monty Veazy said.

Veazy, noted, however, that any effort to create a hybrid program, similar to the one in Arkansas, would likely require legislative action anyway.

Meanwhile, HB 990 has diverted attention from another, broader attack on Obamacare in Georgia. House Bill 707, by Rep. Jason Spencer, R-Woodbine, would bar any state resources from being used to implement the Affordable Care Act, unless the secretary of Health and Human Services specifically requests it of the state and the General Assembly then agrees.

Spencer’s bill, currently in the House Judiciary Committee, has received three hearings and has nearly three dozen co-sponsors. But it also terrifies some Republicans, who fear it goes too far; the Affordable Care Act also reauthorizes Medicaid and the program that funds PeachCare for Kids. Their concern: If Secretary Kathleen Sebelius doesn’t acquiesce to Spencer’s bill, would those programs be illegal in Georgia?

But, in an election year and with Obamacare anathema to many conservative voters, Spencer’s bill has gained more momentum than some expected.

The Jones-Ralston bill may stop Spencer’s or the two may move concurrently. Spencer favors the latter.

“I think our bill does have life,” he said. “Our bill draws a broader line in the sand. House Bill 990 essentially binds future governors from expanding Medicaid.”