The power of a name at the center of Medicaid debate

The first step on the road to wisdom, Confucius declared thousands of years ago, is to call a thing by its proper name.

Republicans in Washington have taken the Chinese philosopher’s advice to heart, and are now engaged in a debate over whether an increase in federal revenue can correctly be labeled a tax hike. Anti-tax guru Grover Norquist says yes. U.S. Sen. Saxby Chambliss says no.

A Georgia version of this name game – no less intense than the one in D.C. — is already percolating. Two-and-a-half years ago, the state Legislature passed what came to be known as “the bed tax” – a levy on Georgia’s hospitals used to leverage federal dollars and prop up the state’s Medicaid program.

It expires next year. Gov. Nathan Deal, House Speaker David Ralston and soon-to-be Senate president pro tem David Shafer all agree that without it, there will be hell to pay.

But a bed tax? They’ve never heard of it. “Medicaid assessment fee,” says Ralston. “Provider fee,” the governor told a reporter. “The financing plan,” texted Shafer. Because if it is indeed a tax, then few Republicans will touch it and one of next year’s most important legislative battles will be over before it’s begun.

Briefly, here’s how it works: Hospitals pay a 1.45 percent fee, levy, mandatory donation or tax – take your pick – on net patient revenue. Slightly less if the hospital also provides trauma care. Last year, the state used the collected $215 million to draw down an additional $590 million in federal Medicaid funds that are used to provide health care for the state’s poor.

Money collected from the hospitals is returned according to how much Medicaid service they provide. So hospitals with low rates of lower-income patients lose out.

Without the fee/tax, Medicaid payouts would shrink to the point that many hospitals, particularly in rural Georgia, would have to close, advocates say.

Lawmakers will assemble in January to formally debate the issue. “Without it, we’re going to be hard-pressed to maintain the quality of care and to provide the payments to the provider community that we’d like to see,” Deal said recently. The governor said extension of the Medicaid provider fee “seems like the most logical” alternative.

“If we do not renew the financing plan, our only options are to divert general funds to Medicaid or substantially reduce reimbursements to medical providers,” said Shafer, the future leader of the Senate. “There is no easy choice.”

Said Ralston last week: “I’m not sure that doing nothing is an option.”

Lobbying is already underway, and has taken a particularly ruthless form. In late October, tea party activists Debbie Dooley and Julianne Thompson, were invited to a tour of Children’s Healthcare of Atlanta at Egleston – CHOA has been the largest Medicaid provider in the state for the last five years.

A bird’s-eye explanation of why the Medicaid funds were needed included the hospital’s heart-breaking neo-natal unit, where early-arriving, unfinished babies are nursed into full-sized miracles.

The tea party pair said they weren’t swayed by the sight. “We’ve been around the block several times. So we knew going in that they had a motive,” Dooley said.

“Most of our activists are currently opposed to the bed tax, but we’re still getting more information,” said Thompson.

David Tatum, vice president of governmental affairs for Children’s Healthcare, said he’s conducted 22 such tours since June – for state lawmakers, their staff, and tea party leaders. The neo-natal unit has been getting a workout.

“It’s impactful,” Tatum admitted.

Republican leaders in the Capitol have pressed hospitals to come to an agreement on an extension of what Tatum personally likes to call “the Medicaid finance program.”

Many hammers exist to encourage them. Last week, Ralston raised the possibility that the Legislature might review the non-profit status claimed by many hospitals – and raise Medicaid matching funds that way.

But the biggest hurdle for an extension of the Medicaid program/fee/assessment/tax is the fact that the Legislature is far more conservative than it was in the spring of 2010. Tatum figures that 70 of 236 state lawmakers will be new to the debate. Forty-three were elected just last month.

Most of the newbies are Republicans who consider themselves part of the tea party revolt. They include state Sen. Josh McKoon, R-Columbus, who was elected in 2010 – after the Medicaid levy on hospitals was already in place.

He will oppose the extension of what he considers a tax. “I oppose the bed tax for the same reason I support the governor on his decision to refuse the Medicaid expansion,” McKoon said. Both would rely on additional – and borrowed – federal funds, he said.

McKoon said he is ready to fill a $300 million to $400 million gap that will result by cutting an already vastly trimmed state budget. “As I understand it, there was a very clear and public assertion that this was going to be a temporary measure,” the Columbus senator said.

Keeping that promise is as important as getting the name right, he said.

- By Jim Galloway, Political Insider

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27 comments Add your comment

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December 5th, 2012
6:33 pm

A tax is a tax, like lipstick on a pig at the end of the day a tax is a tax and a pretty pig is still a pig.
shady DEAL a ralston never meet a tax they did not like or steel a tax from people least likely to not have the money.
Crooked Nat and the legislature will tax a sick person for going to the hospital, and take tax money to build a football stadium for a billionaire.

Crooks I tell ya.

Recall them all

another comment

December 5th, 2012
6:44 pm

It is amazing that the unattractive poodle ladie with the home perm, and crew that are anti abortion, do not want to pay for these permies when they are delivered alive with catistropic costs. They want to walk away and call everyone else name like irresponsible, lazy etc…. Many of these early deliveries would have been abortions if we did not have the Crazies. Or course the Pro Life crowd does not want to pay for the care of these babies. They don’t want to pay the Millions of dollars of ICU care. They don’t want to pay the Millions of dollars of special needs care. They don’t want to pay for the Special Ed cost in the Public School. They don’t care that the Special Education Mandates that they don’t fund, then take up all of the money for the Regular Education and above level students in public School. They will just put their kids in private school or home school them.


December 5th, 2012
7:14 pm

another comment
“It is amazing that the unattractive poodle ladie” Well said!

I wonder which neo-natal unit, they would want their new early arriving CHILD or grand child to be in?

Hummmmmm Easy guess.

When SHADY ,” Deal said recently. The governor (loosely used term) said extension of the Medicaid provider fee “seems like the most logical” alternative.

Loosely interpreted All i have to do is rubber stamp it. Might get a few $$ for my stamp…

An observer

December 5th, 2012
7:38 pm

It is a tax, but it does seem reasonable to extend it. If all hospitals serve medicaid patients, then no hospital comes out ahead or behind. It seems reasonable that all hospitals would want to serve medicaid patients since payment is guaranteed by the government.


December 5th, 2012
7:45 pm

The fee/tax mandated from the hospital to the state goes for Medicaid only, and is redistributed according to need. Collecting in this way, only to pass out later, just seems like a gimmick to get more federal $$. Higher costs will only be passed on to the consumer/insurance company. Nothing is free. SOMEBODY pays for it.


December 5th, 2012
7:48 pm

$Thats Deal-Dough$


December 5th, 2012
8:28 pm

Voters in Washington and Colorado last month made those the first states to decriminalize and regulate the recreational use of marijuana.Nevertheless, some people planned to gather at 12 a.m. Thursday to smoke up beneath Seattle’s Space Needle. Others planned to party outside Hempfest headquarters in Seattle.

If Georgia’s leaders had spine just think of the tax money we could raise and after all the political pocket lining, there might be enough left to support medical care in GA.
Just think a legal cash crop for the South

To quote double now “$Thats Deal-Dough$”


December 5th, 2012
8:30 pm

A home perm is called a *permie* if it is unattractive and if it is so unattractive that the lady looks like a poodle and has to go to a hospital where she will suffer irreparable damage and morph from looking like a poodle to looking like a cat and that is called a catistrophe or something but if she promises that from now on she really really likes abortions and will not send her kids to private school or home school them then the judgmental democrat who insulted her in the post above will say she likes her well enough–just like Obama likes Hilary.

Look before I leap...

December 5th, 2012
9:05 pm

Excellent illustration of the typical conservative thinking.
They seem to be all about keeping an embryo alive when there is virtually no public cost, but once the embryo is born and funds are needed to provide care, they run for the hills.


December 5th, 2012
9:22 pm

Conservatives believe life begins at conception and ends at birth. Very old, still true


December 5th, 2012
9:52 pm

God deliver us from the Tea Baggers and the so-called “Christians” who want people to die if they don’t have insurance. Where in God’s name are we heading as a society? Jesus is looking down and crying.


December 5th, 2012
10:28 pm


December 5th, 2012
10:59 pm

The Teabags and so-called Christians are easily influenced, shallow thinkers. They view political issues in the same vein as sporting events. They prefer the mindless, primal behavior exhibited at college football games. Empathy, like matters of science, requires way too many thought processes.

Tom mitchell

December 5th, 2012
11:30 pm

As a practical matter, it behooves Georgians to get as much money from the Federal Treasury as possible, less the Yankees and left-coaster States will get it all. This so-called “bed tax” is not a tax, it’s just a way to help Georgia get as much Federal money as possible into he State Medicaid program. The idealists from the GA Tea Party can pontificate all day long about the evil of taking Federal money, but in practical terms, if Georgia doesn’t get the Federal money it will just go to some other State. Gov Deal needs to get practical and be as conniving as all the other Governors in the country.


December 6th, 2012
12:51 am

Tom, that money ISN”T FROM THE FEDERAL GOVERNMENT, it is from TAX PAYERS. Stop knocking the Tea Party until you understand that the sub-50% of Americans paying taxes are sick of this nonsense.

Get rid of it. Stop the excuses.

The real problem is that we had to introduce this to cover up for other things. We pay out far too much to hospitals as it is, and don’t tell me that money is all going to neo-natal care units or other very positive things. Propping up fat-cat board members who make millions for about 3 weeks worth of work is the problem. We can’t force it to stop, but we certainly should not continue to prop it up with fake fees that syphon money from tax-payers right into fat-cat pockets.


December 6th, 2012
12:56 am

@lana, you sad pathetic fool. You obviously knew nothing and continue to know nothing about uninsured people and emergency medical care. You really should invest some time into reading and learning instead of listening to the biased media.

I will let you do the work. Hopefully this post will make you question your own statement and actually put a little effort into being less … media-informed.

Hiram, Lana’s post proves that the real lemmings are not the Tea Party members, and your follow up proves you are every bit as ignorant. Well done.

David Hoffman

December 6th, 2012
3:49 am

No other industrialized representative democracy on Earth has this problem. We are the only one with such a badly functioning health care financing system.

South GA Food Taxer

December 6th, 2012
8:04 am

I said it before and I’ll say it again, we NEED these hidden fees. Taxes are tough enough to vote on with the Tea Partiers wipping everyone up into a frenzy every time one comes up for a vote. The least we can do is keep these fees that the public pays little attention to. Without them, government ain’t going to function. The problem with my party right nw is that they don’t see this common sense and think you run government like a business. You don’t, and these “business republicans and their Tea Party buddies are going to bankrupt us.

Buckhead Boy

December 6th, 2012
8:06 am

Oliver Wendell Holmes, Sr. said, “I hate paying taxes. But I love the civilization they give me.” Steve, maybe you and your Republican Tea Party ilk could do with a little less hating and a little more loving?

nathan's political arsonist

December 6th, 2012
8:20 am

this state is sad, where do all these idiots come from? mckoon? are they bleeding in from alabama?

Bob Loblaw

December 6th, 2012
8:23 am

Why on Earth is Children’s Healthcare giving a crap about what those two women think? It’s apparent that none of our leader’s particularly care about their opinion. You think showing Debbie Dooley and Julieanne Thomson a sick premature baby is going to make them want to give up their soapbox? Child, please.


December 6th, 2012
8:42 am

To expand on your premise, what level of expertise do either of these women bring to any aspect of Public policy?
Rather than attracting lazy reporters and involvement in losing political campaigns, I cannot identify any area of expertise or successful enterprise between them.
The ‘bed tax’ needs to remain.
For profit hospitals are what needs to GO.

Wallis the dog

December 6th, 2012
8:46 am

Nice balanced column, Mr. Galloway.

This McKoon fellow sounds like a sensible thinker.


December 6th, 2012
9:03 am

Yes it is a tax.
and, there is no such thing as a free lunch.
You get what you pay for.
So — let’s pay for it and move on. Those who voted for the anti-abortion legislation have to vote to provide needed medical care — unless, of course, they aren’t sincere about protecting life.

reagan conservative

December 6th, 2012
1:09 pm

@Bob, Boss Hog type elected officials like Speaker Ralston might not care what these two ladies think, but conservative voters do and so do other elected officials if they are smart. I live in Doug McKilips district and I was definitely swayed by the fact I received a robo call from one of the ladies supporting Regina Quick. Changed my vote to Ms. Quick and I do believe she pulled off an upset.

It is pretty clear that these ladies are getting under the skin of people like Bob and honested and that makes me think even more of the two. They are government watch dogs and as long as we have elected officials like Speaker Ralston and Nathan Deal, we need watch dogs. In fact, we need many more of them.

Bob, honested, which corrupt elected official do you work for?

reagan conservative

December 6th, 2012
1:26 pm

While we are talking about endorsements, I was very disappointed to see the tea party endorse Chip “the hotel man” Rogers and Tom Graves. Glad to see Rogers is leaving the Senate and would like to see even more leave the House where Boss Hog rules the roost.