A wide range of health care woes face Georgia Legislature this year

When the state Legislature meets again this month, it will have no shortage of work on health care.

The past year’s headlines say it all. Slices of Georgia are in a full-on health care crisis: Premiums higher than a mortgage payment. Insurance networks for 2018 that suddenly exclude all of a family’s doctors. An opioid epidemic; rural hospitals going bankrupt; the uninsured poor; their unpaid emergency room bills.

But how much it can do, and how much it will do, are up for discussion, especially in an election year.

Legislators from both the House and the Senate spent much of the past year running committees devoted to issues surrounding health care, including the rural-urban divide. Their findings include the need for broadband access in underserved areas to facilitate “telehealth” service

Ethan James, a vice president at the Georgia Hospital Association, chuckled ruefully when asked whether the upcoming statewide elections, including a governor's race, would complicate getting legislation done (as did every other advocate interviewed for this story).

“As much as any other barrier or challenge, probably,” he said. “But again, that doesn’t mean we don’t have work to do.”

House Speaker David Ralston told reporters Thursday that “we have elections every two years in this state.”

“So if we’re going to take off every other year for people to run for office,” Ralston said, “then maybe we just not ought not to have a session during an election year.”

One issue that may cross chamber and election lines is money to deal with the opioid crisis.

The chairwomen of the Legislature’s two health committees, Sen. Renee Unterman, R-Buford, and Rep. Sharon Cooper, R-Marietta, have suggested a need to support funding for behavioral health programs to deal with the addiction epidemic ravaging the state.

“I don’t do the budget,” Cooper said, “but I think anything we can do to help with finding more options would be a plus.”

Ralston, on Thursday, agreed that “we may get to that point,” citing the “devastating” crisis unfolding in his North Georgia district.

The state’s health care problems and gaps usually have an impact on each other, like a collection of dominoes that knock each other down. Addicts who can’t afford treatment may burden the emergency and hospital systems with unpaid health scares. Then hospitals wind up deeper in debt.

Washington hasn't helped the provision of health care here: No one knows whether hundreds of millions of dollars in delayed funding for Georgia's poor kids, their hospitals and clinics is actually going to come, or when, or whether it might fall victim to federal infighting.

In the meantime, even long-standing established hospitals are getting hit. Houston Healthcare, in the home county of state luminaries such as Sonny Perdue and Sam Nunn, has just had its credit rating downgraded to three notches above junk.

So first on the agenda for patients’ and caregivers’ lobbyists is one unsurprising thing: money.

Some are hoping the Legislature will step in to fill the federal funding gaps to pay for uncompensated patient care. Many are hoping that one way or another, the Legislature this year will lay the groundwork for the governor to work with the Trump administration to get medical coverage to allow more of the state’s poorest adults to pay their bills.

When the Affordable Care Act went into effect, it said states would expand Medicaid to cover the poorest adults. But then conservative states such as Georgia decided not to do that, leaving those people without any coverage. While traditional Medicaid expansion remains off the table among Georgia leaders, there is talk of applying for a "waiver" that could allow Georgia to launch a pilot program to better tailor Medicaid to the state's needs. If done in a particular way, that might end up adding 600,000 people to the state's Medicaid rolls. Or a waiver could be done in a way that just tinkers at the margins.

Ralston was not encouraging about getting one done this year. But he didn’t rule out expanding coverage. “I have generally supported the concept of Medicaid waivers,” he said. “I’m not locked into a view of being opposed if it added people to the rolls or being supportive of adding them. At the end of the day we have to pay for these things.”

Two issues that are guaranteed to see discussion, if not success, speak to a shortage of medical providers.

In the study committees that dealt with rural issues, a consistent subject was the need for access to broadband internet. Officials hope that doctor visits by internet can take the place of some of the state’s slipping health care access. However, it would take a lot of money to build out broadband statewide.

Another issue is the perpetual fight over state legal limits on who can build a new hospital or health service. Such limits are called “Certificate of Need” requirements, or CON. Private companies are constantly pushing to eliminate or weaken CON. On the other side of the fight, established hospitals push to keep CON in place, maintaining that the companies just want to cherry-pick away the profitable services and leave regular hospitals deeper in the hole with money-losers. In addition, they say, no company wants to start up service where it’s needed in a poor, rural area — they want to go where paying patients are, where there’s usually already access to care.

Any of these issues may be hamstrung by election-year politics. But they may also be aided by it, said Jimmy Lewis, a health care consultant, especially as politicians in a statewide race vie for rural votes.

“Something’s going to happen because somebody wants to run on it,” Lewis said.

“How successful it will be depends on how successful politico A is in sticking it to politico B.”

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