Georgia leaders face decisions on health law changes

By Carrie Teegardin, AJC staff writer

As many states are hunkering down to plan the details of their role in the nation’s health care overhaul, Georgia’s newly elected leaders must decide how to implement a sweeping law that they strongly oppose.

While state officials can’t modify the law, Georgia’s new governor, insurance commissioner and attorney general — who are all Republicans — will influence how the law works in Georgia. Democratic lawmakers worry that Republican opposition to the Patient Protection and Affordable Care Act will prevent the state from making the necessary plans to implement provisions they say many Georgians desperately need.

Even experts who oppose the law say it’s smart for Georgia’s new leadership to plan for the law as passed. Otherwise, they say, they risk being forced to take what Washington devises instead of using the influence they have to shape what Georgia consumers end up with.

“States shouldn’t sit around waiting for a miracle to happen with the House and Senate passing repeal and the president signing it,” said David Merritt, an expert on health policy at Newt Gingrich’s Center for Health Transformation. “Folks need to plan that this is reality.”

The act asks states to play a significant role in managing many provisions of the new law.

That includes the opportunity to design and run a new online health insurance marketplace — called an “exchange” — where consumers would shop for coverage and learn about government programs that could help them pay for coverage. The law also asks states to implement a dramatic expansion of the Medicaid program, which provides health insurance to low-income people.

Twenty states, including Georgia, are interfacing with the law in another way: They are challenging its constitutionality in a pending federal lawsuit.

Georgia’s new insurance commissioner, Ralph Hudgens, and the state’s new attorney general, Sam Olens, will play important roles in the state’s handling of the federal law, and both are critics of the law.

But Gov.-elect Nathan Deal will orchestrate Georgia’s strategy and is expected to take a hands-on role in the state’s health care matters — including its response to the new federal law.

Before his resignation from the U.S. House this year, Deal served as the ranking Republican on the health subcommittee of the House Committee on Energy and Commerce. Deal also opposes the law.

“You’re talking about somebody who at one point in time was one of the most powerful people in the nation when it comes to health care policy,” Deal spokesman Brian Robinson said.

He said the governor-elect offers “a wealth of institutional knowledge and leadership ability on health care.”

The strong opposition to the health care law by Georgia’s key elected leaders concerns some who say the state’s consumers need the help extended by the law. Statewide, an estimated 1.9 million Georgians — about 20.5 percent — lacked health insurance last year, according to the U.S. Census Bureau.

“I get calls from people every day who can’t get insurance, and these are working families,” state Rep. Pat Gardner, D-Atlanta, said.

Gardner acknowledged that the new law is not perfect, but she said a comprehensive change was needed to address serious problems that piecemeal legislation has not been able to fix.

“The election is over,” Gardner said. “Let’s leave the rhetoric behind and look at what is best for the people of Georgia.”

State Sen. Nan Orrock, D-Atlanta, said Georgians value provisions of the law enacted already, which include the ability to add adult children up to age 26 to a parent’s policy, the elimination of lifetime caps on insurance plans and the closing of gaps in Medicare’s drug benefits.

“Suing to block this law would mean losing the reforms that Americans want and that Georgians want,” she said.

Deal opposes the law based on its public cost, its mandate that most Americans get health coverage and a Medicaid expansion that he fears will prove costly to states, Robinson said. But Deal does favor creation of high-risk pools and setting up a way for small businesses to band together to get a better deal on insurance coverage.

Deal’s influence on any changes in the new law will be limited to the influence he has on the U.S. Congress.

“Obviously the state cannot overrule federal mandates,” Robinson said, “but no governor is better prepared to deal with the new reality than Nathan Deal.”

Deal will likely make one crucial decision: whether or not Georgia will design and run its own online insurance exchange or whether it will punt that responsibility to the federal government. The exchanges, scheduled to be up and running in 2014, will be used primarily by people who do not have insurance through an employer.

Georgia’s current leadership has already declined some opportunities offered under the law.

The overhaul gave states the authority to run their own high-risk insurance plan for consumers with pre-existing conditions. But Georgia is among 23 states that opted to have the federal government run their plan.

Georgia was one of five states that declined to apply for a grant to help states improve their review of health insurance rates, a decision made by Insurance Commissioner John W. Oxendine.

Georgia, however, did apply for a federal grant to study the health insurance exchanges that are a critical part of the law, according to the governor’s office. And early planning for setting up a Georgia-run exchange already has begun.

Merritt, of the Center for Health Transformation, said working on the design of the exchanges is particularly important for states. He said most states, especially conservative states such as Georgia, would prefer the results of setting up their own insurance exchange since some approaches are heavily market-driven and others rely more on government control.

Attorney General Thurbert Baker refused to lead a state legal challenge of the federal law, so Gov. Sonny Perdue proceeded without him. Olens, the former Cobb County Commission chairman who will take over the office in January, said he will strongly support the effort.

The lawsuit challenges whether the federal government can require individuals and employers to buy health insurance. “It’s a vital constitutional issue,” Olens said.

Hudgens will be the state’s first new insurance commissioner in 16 years when he takes over Oxendine’s office in January.

The insurance commissioner regulates the licensing of insurers and agents and has the authority to investigate complaints and review some of the rates charged for health coverage.

Hudgens said he opposes most of the elements of the federal legislation, but he has not determined how he will try to influence the state’s role in implementing the act.

He said he will attend a meeting of state legislators who oversee insurance matters this month to understand what will be awaiting him when he takes office. “I’m going to come away from there with a lot more education on what needs to be done and what has to be done,” he said.

Orrock, the state senator, said while many states are working hard to prepare for the new law, Georgia has focused its efforts on challenging the law and turning down opportunities from Washington to run programs.

“To have Georgia’s political leadership turning their back on this health care reform act is not going to be in the best interest of Georgians,” she said.

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