Hudgens recently made a noisy attempt to stall approval of dozens of health plans that private companies will sell on a new insurance website, called an exchange, starting Oct. 1. And he stands firmly behind Gov. Nathan Deal’s decisions not to expand the state’s Medicaid program for the poor and to leave it up to the federal government to build the exchange.
Elizabeth Hartley Filliat, 70, a retired teacher who lives in Alpharetta, describes the state’s delaying tactics as a “matter of life and death.”
“No one who is battling so intensely for their lives should also simultaneously have to battle for-profit insurance companies,” said Filliat, who has a relative struggling to get insurance coverage. “And it seems totally unconscionable that politics should play such a strong hand from being fully enforced in Georgia.”
About one in five Georgians don’t have health insurance, one of the highest rates in the nation, and an estimated 650,000 low-income state residents would have gained coverage under an expanded Medicaid. Another 900,000 residents are expected to shop on the health insurance exchange that opens Oct. 1. Nonprofit groups say it’s left to them to educate consumers on the ins and outs of the exchange, and other aspects of the law, since state leaders have washed their hands of it.
Hudgens echoes Deal’s assertion that the state can’t afford to expand Medicaid, despite the $40 billion in federal funding that would accompany an expansion. On the contrary, Hudgens said, the expansion and other provisions of the law will ultimately sink the economy. And history, he says, will judge him right.
“I don’t think that it’s a workable solution to the problems that we have,” he said. “It’s going to lead to a single-payer system that’s going to compromise your health status.”
He did not explain how the law would lead to a single-payer system, in which the government takes over health care, since the law was designed as an alternative to such a system. He also refused, through an Insurance Department spokesman, a request that he explain his specific objections to the main provisions of the act.
‘So we’re going to make up the test’
Hudgens became Georgia’s first new insurance commissioner in 16 years when he emerged from a crowded Republican primary in 2010 and handily beat his Democratic opponent.
After 14 years representing a northeast Georgia district in the House and later the Senate, where he rose to chair the chamber's insurance committee, he was seen as a low-key successor to the publicity-seeking John Oxendine. But the fight against the health care overhaul has given him a sudden boost in popularity.
The white-haired 70-year-old has appeared on national news shows, at buttoned-down chamber of commerce luncheons and before the party’s faithful to outline his strategy. His views, if not his words, closely align with Deal’s. But Hudgens’ job intersects with the health care plan in a way that no other Georgia politician’s does.
His office licenses Georgia’s more than 130,000 insurance agents and polices its 1,600 insurance firms, including about 400 health insurance companies. Hudgens sees his office as a first line of defense against an overbearing federal government.
Hudgens and Deal are far from alone in their opposition to the law, and leaders in other Republican states are reading from the same playbook. The conservative American Legislative Exchange Council has spawned dozens of legislative proposals around the nation seeking to delay or neutralize the overhaul's impact.
Many of the states that have large numbers of poor, uninsured residents and stand to benefit the most from the law are also the ones that have been most vocal against it, said Gary Claxton, a vice president with the nonprofit Kaiser Family Foundation.
On a national level, opponents of the law have engaged in often empty gestures: dozens of House votes to repeal the act, and, lately, a proposal to adopt a spending plan that funds every part of the federal budget except Obamacare.
A quieter but perhaps more effective effort has unfolded in Georgia.
Hudgens’ strict standards for insurance navigators, over and above what the federal government requires, provide an example.
“The Obamacare law says that we cannot require them to be an insurance agent, so we said fine, we’ll just require them to be a licensed navigator,” Hudgens said at the Rome event. “So we’re going to make up the test, and basically you take the insurance agent test, you erase the name, you write ‘navigator test’ on it.”
In a later interview, he downplayed his remark as a “one-liner” meant to rev up a partisan crowd, but said the sentiment was correct. He offered: “Just like an insurance agent, the navigator needs to be able to pass a test to show that they’re qualified.”
‘I’m here to protect the consumers’
Hudgens also sent an “emergency” request to the Obama administration during the summer asking for more time to approve insurance rates for dozens of health plans that private insurers plan to sell on the insurance exchange.
He said it was his duty to protect consumers from “massive” rate increases that could jump up to 198 percent for some. When pressed on whether the costs will actually jump that high Hudgens conceded that example was extreme. But he said his office’s projections showed rates would inevitably rise.
“I’m here to protect the consumers of the state of Georgia,” he said. “This is not working out the way it was supposed to. There’s so much uncertainty. These products are going to be phenomenally expensive. Buckle your seat belt after Jan. 1 because you’re in for a surprise. It’s not the Affordable Care Act, I can assure you of that.”
U.S. Health and Human Services Secretary Kathleen Sebelius ignored the request for a delay, and Hudgens approved the plans shortly after.
For Wendolyn Lanier, though, the debate goes beyond politics. Lanier, 53, lives in Gwinnett County and works as a caregiver for infants. She said she depends on health clinics to treat her diabetes and treat the nerve damage in her arms and feet because she couldn’t afford her medication for a year.
She would be one of the 650,000 people covered by the Medicaid expansion and said state officials are spitting in the eye of a “godsend” by refusing the expansion.
“I deserve better than I get. I shouldn’t have to wait until I’m a senior citizen until I get the care I need,” she said. “Medicaid expansion would do so much for so many people, and Georgia is just playing politics by refusing it.”
‘The potential to destroy our state’
Hudgens’ tactics have politicized the insurance commissioner’s office.
Gail Buckner, a former state senator who heads the Georgia Federation of Democratic Women, said Hudgens’ “close-minded” stance risks the well-being of hundreds of thousands.
Senate Minority Leader Steve Henson, another former colleague, said Hudgens’ views are rooted in selfishness.
“The insurance commissioner is supposed to serve the people and not the Republican Party,” said Henson, who represents Tucker. “It’s an opportunistic attempt to do everything he can to defeat Obamacare and not serve the people of Georgia.”
With the state refusing to participate, the challenge of educating consumers about insurance options and federal financial assistance through the exchange is that much bigger for nonprofit and community groups, said Amanda Ptashkin, director of outreach and advocacy for consumer group Georgians for a Health Future.
“It’s just unfortunate that the insurance department, which could have had input all along, has just decided to wipe their hands of it and say, ‘We’re not doing anything,’” she said.
To others, though, he’s become a conservative champion. Jenny Beth Martin, co-founder of the Tea Party Patriots, praised Hudgens at an event at the statehouse aimed at prodding lawmakers to defund the health care law. In an interview after the event, she said Hudgens was a rare politician who was “standing up and telling the truth.”
His friends said he’s simply carrying out his campaign promises.
“He has to protect Georgia, and this law has the potential to destroy our state,” said Barry Loudermilk, a Republican state senator who recently resigned to run for Congress. “This is exactly what I expect out of Ralph.”
Hudgens, for his part, is comparing notes with other GOP insurance officials over what to do next. He said he “unfortunately” can’t do anything more overt as Georgia’s insurance commissioner to stop the law’s implementation.
“However, that doesn’t mean that I will roll out the red carpet for a law that will ultimately increase costs, reduce choice, and damage this country’s health care system.”