Today is the fourth birthday of the Affordable Care Act. Strictly speaking, this is not news, but a predictable, calendar-based event.
Rather like a Legislature in Georgia passing a gun bill in an election year. You can nearly set your watch by it.
No, news is the unexpected. It is man bites dog – which is silly. Or Vladimir Putin sending an apology and flowers to Ukraine – which is pure fantasy.
News is an elected Republican endorsing an expansion of Medicaid in Georgia. Which may be just as inconceivable, but really happened.
One of the year’s grandest acts of political rebellion in the state Capitol took place last Tuesday, deep into the 39th day of a 40-day session of the Legislature.
“I am concerned that my party is going to lose thousands of health care workers and independent voters over this,” said state Sen. Chuck Hufstetler, R-Rome. “The majority of Georgians do oppose Obamacare, but six out of 10 believe we ought to expand Medicaid. There is a difference between the two.”
Hufstetler is a first-termer and a back-bencher. Literally. His seat is on the final row. But he is the sleepy, quiet type. No bomb-thrower. In fact, by trade he is an anesthetist at Redmond Regional Medical Center, the smaller of two hospitals in his district.
The occasion of Hufstetler’s outburst was the Senate debate over HB 990. The bill was the lesser of two anti-Obamacare measures in circulation, a greased piece of legislation that would take the decision of whether to expand Medicaid, as recommended by the ACA, out of the hands of the governor. Legislative approval would be required.
Gov. Nathan Deal had endorsed the whittling of his own authority, so the Senate vote and the words that went with it were mere formalities. Until Hufstetler took the well.
First, the former member of the Floyd County Commission presented his credentials. He had opposed the 2009 passage of the Affordable Care Act, he said, primarily because of its mandate that individuals purchase insurance or be fined.
But President Barack Obama has issued so many waivers for the requirement that it is almost meaningless, Hufstetler said.
What worried the Rome senator was Gov. Nathan Deal’s decision – which will soon be in the hands of the GOP-controlled Legislature – to refuse to expand the federal-state health care program for low-income Georgians.
Hufstetler cited a list of Republican governors in Arizona, Pennsylvania, Michigan, Ohio and Utah who have made their peace with the Affordable Care Act, expanding health care coverage to poorer residents in their state.
In Georgia, Medicaid expansion would wrap in an estimated 650,000 more low-income earners. The program currently covers about 1.7 million children, pregnant women, plus elderly and disabled residents.
The federal government would cover the entire cost of Medicaid expansion for the first three years, with its share gradually dropping to no less than 90 percent thereafter – a promise that most Republicans treat with high skepticism.
But Hufstetler sees something else. He sees his state giving up billions upon billions of dollars at the cost of thousands of health care jobs. With no impact on the federal deficit. Money will be flowing out of Georgia into states that have accepted Obamacare.
“I believe this transfer of wealth is going to hurt Georgia as numerous studies by Kaiser [Permanente], the University of Georgia, and Georgia State have pointed out,” Hufstetler said.
Huftsetler was the only Republican to cast a vote against HB 990. He also voted against a measure sent to the governor that will eventually force the University of Georgia to drop a federally funded program to train the “navigators” that point consumers to health insurance exchanges.
“I don’t know why we as Republicans would vote to not allow the University of Georgia to help enroll people at no cost to the state, to help enroll people in private insurance,” he later said.
At the very least, Hufstetler’s speech, which startled even Democrats, was inconvenient to the chief resident of the state Capitol’s second floor.
The next day, the governor would tell a gathering of rural legislators that he would back a plan allow rural hospitals in south Georgia – which are gasping for cash that could come their way under an expansion of Medicaid – to reduce the services they offer as a way of cutting expenses.
For many health care centers, the only other alternative is to shut down. Four rural hospitals have closed in the last two years. The Department of Community Health recently advanced $800,000 to a small hospital and nursing home in Fort Oglethorpe, Ga., so that it could make payroll.
The singularity of Hufstetler’s comments might be hard to understand, unless you’ve sat through a dozen or so Republican gatherings. There is a playbook, and unwavering opposition to Obamacare is at the very top of it.
Right now, when it comes to Medicaid expansion, Hufstetler stands alone among Republicans in the state Capitol. “I can’t think of anybody else,” said Matt Caseman, executive director of the Georgia Rural Health Association – who quickly declared his sincere and deep appreciation for Deal’s efforts to help rural hospitals.
As for Hufstetler, he will survive in the Legislature at least through 2016.
“I haven’t really had any negative reaction to this. I think it helps that in my eight years on the county commission, we lowered taxes six times,” Hufstetler said. “The people in my district know my record as a fiscal conservative.”
Perhaps more important, Hufstetler’s speech came after qualifying closed – he has no opposition in 2014. He might be fearless, but he’s not stupid.