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Kemp celebrates waiver win, but pivot by White House may complicate things

  • April 3, 2019
  • Comments Off on Kemp celebrates waiver win, but pivot by White House may complicate things
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By Andy Miller, Georgia Health News

The state affirmed Wednesday that it will
pursue its waiver plan despite the Trump
administration’s renewed bid to eliminate
the Affordable Care Act – the federal law
under which at least part of the Georgia
plan would be carried out.
“We have regular contact with federal officials,
and they continue to encourage us
to submit waivers,’’ said Candice Broce, a
spokeswoman for Gov. Brian Kemp. “We’re
going to keep moving forward with our game
plan.’’
She made the statements to GHN at a
signing ceremony for the Kemp-backed Senate
Bill 106, which authorizes the waiver effort.
It passed the Georgia House this week.
The newly enacted legislation has two
parts. One waiver would involve adding people
to the Medicaid rolls. The other would
allow Georgia to revise the set-up of the
state health insurance exchange, created by
the ACA for people who don’t have coverage
from employers or government programs.
Each would require federal approval.
But in a new court filing, the U.S. Justice
Department has argued that the ACA, also
known as Obamacare, should be invalidated
in its entirety. That includes provisions protecting
millions of Americans with pre-existing
health conditions. The White House arguments
came in conjunction with a lawsuit
against the ACA filed by 20 state attorneys
general, including Georgia’s Chris Carr.
President Trump suggested that Republicans
should embrace a new congressional
battle over health care policy ahead of the
2020 elections, according to the Washington
Post.
“Let me tell you exactly what my message
is: The Republican Party will soon be known
as the party of health care,” Trump told reporters
before a Tuesday lunch with GOP
senators. “You watch.”
The Justice Department filing to eliminate
the ACA came the same week that Georgia
Republicans were celebrating the passage of
Senate Bill 106.
At the signing ceremony Wednesday,
Kemp called the bill’s passage a “historic
moment.’’
“Insurance premiums are too high, the
number of doctors is too low,’’ Kemp said,
also citing the financial struggles of rural
hospitals and medical outcomes that fall at
the bottom of national standards.
“We have decided to abandon the status
quo,’’ he told a crowd at the Capitol. “We will
craft innovative, flexibility options within
the Medicaid program and the Affordable
Care Act.’’
“We will address Georgia problems [with]
innovative Georgia solutions.’’
The goals are to lower premiums and
ensure access to quality health care for all
Georgians, Kemp said.
Democrats in the General Assembly
fought the waiver legislation, arguing that
a full Medicaid expansion — which under
the ACA is an option for states — would
cover more Georgians at a lower cost than
the Kemp proposal would. But with Republicans
holding strong legislative majorities,
the vote was not close in either chamber.
Kemp’s plan is to cover people at up to 100
percent of the federal poverty level, whereas
regular expansion gives Medicaid to people
at up to 138 percent of poverty. At full expansion,
the federal match is at 90 percent
under the ACA. At the poverty level, the
match is expected to be the normal 67 percent,
though Trump administration officials
say they may consider the higher match figure.
The waiver plan appears to run counter to
the renewed White House effort to erase the
ACA.
Kemp’s private insurance waiver seeks to
change the rules in the individual market,
which is dominated by the ACA’s exchange,
said Bill Custer, a health insurance expert
at Georgia State University. And even the
effort to increase Medicaid enrollment could
involve the ACA, he added.
Custer said that if the Medicaid part of the
waiver seeks a 90 percent federal match, as
under a full Medicaid expansion, it would
involve the ACA. If the state is just seeking
a regular 67 percent match under a standard
Medicaid member increase, the state
doesn’t need a federal waiver, he added.
A federal judge in Texas last year invalidated
the entire law, including its expansion
of Medicaid and subsidies to help many lowand
middle-income people buy insurance.
The ACA remains in effect while that judgment
is appealed to higher courts.
The appeals process can take a long time,
and Custer said he considers it’s unlikely
that the whole health law will ultimately be
thrown out.
The Justice Department initially said that
only parts of the ACA, including its protections
for pre-existing conditions, should be
struck down. But on Monday, it expanded
its attack to say the whole law should be
eliminated.
Republicans in Congress failed in 2017 to
push through their longtime goal of repealing
the ACA, but Congress did effectively
scrap the law’s tax penalty for people who
do not have health insurance, the New York
Times noted. The suit contended that the
absence of a real tax penalty rendered the
law’s “individual mandate” — the requirement
that most Americans have insurance
— unconstitutional.
Without a requirement to purchase insurance,
the states argued, the law could not
then insist that insurance companies cover
pre-existing medical conditions and a suite
of other “essential health benefits,” such as
maternity care and prescription drugs, the
Times reported.
Democrats have seized on the Trump administration
action to re-inject health care
into the political debate.
The Associated Press reported that according
to AP VoteCast, a nationwide survey of
more than 115,000 voters in last year’s midterm
elections, nearly 4 in 10 Democratic
voters identified health care as the most
important among a list of key issues, including
immigration, the economy and the
environment. A Quinnipiac University poll
released Tuesday found 55 percent of Americans
supporting the improvement but not
the replacement of the nation’s health care
system.
Georgia House Speaker David Ralston
(R-Blue Ridge) attended the signing ceremony
and said afterward that the Legislature
still would have the opportunity to affect
whatever waiver plan is devised.
Senate Bill 106 would appear to give Kemp
the authority to craft the Georgia plan, and
not have to get the General Assembly’s approval.
Ralston also said he strongly supported
the drive for reform of the state’s certificate-
of-need (CON) system, which regulates
the construction and expansion of health
care facilities and the introduction of new
medical services.
Rep. Matt Hatchett, a Dublin Republican,
‘‘has done an amazing job’’ leading the fight
for CON reform, Ralston told reporters.