Few things stir up lawmakers more than somebody trying to get bureaucrats to do something the General Assembly rejected, and that's just what some legislators say the politically-connected Cancer Treatment Centers of America just did.
Now there is talk of special legislative committees and lawsuits to stop the company from getting the right to go after more well-insured Georgia patients.
"You can't do 180 House members and 56 senators that way without there being repercussions," said Senate Health & Human Services Chairwoman Renee Unterman, R-Buford. "It doesn't work that way."
The Department of Community Health board last week gave tentative approval to a rule change that would allow the company to shed its in-state patient cap. In doing so, the Atlanta Journal-Constitution reported, it reignited a decade-long war between Georgia's hospitals and the national cancer treatment chain, which has a huge stable of well-connected lobbyists and a track record of generous giving to elected officials.
The decision gives the company the chance to get around elected officials, who stalled its bid to remove the cap during the 2015 session. The company said that it is unfair to Georgia patients to have to turn them away.
Other hospitals counter that if the company wants to see more Georgia patients, it should go through the same process they face if they want to expand. They also contend that the company cherry-picks patients with the highest-paying insurance coverage while leaving other hospitals to shoulder the burden of care of Medicaid and other indigent cancer patients.
Georgia typically requires hospitals to go through a stringent "Certificate of Need" process that is intended to prevent an oversupply of health care facilities and to control costs. But in 2008 the General Assembly allowed Cancer Treatment Centers of America to open the Newnan facility without going through the process because it was touted as a destination hospital that would draw patients to Georgia. As such, lawmakers limited it to 50 beds and required that at least 65 percent of its patients come from out of state.
The DCH board's decision to change that kicked off a public comment period. A final vote is scheduled for November.
For its part, Cancer Treatment officials said little publicly about the DCH board's actions.
"We remain committed to working with our public officials to increase access to the highest quality cancer care available, " its statement statements said.
Gov. Nathan Deal's office said it knew about the vote but didn't take a side.
The company’s executives helped organize a fundraiser for Deal in Newnan last fall during his re-election campaign. Deal collected $12,500 from Cancer Treatment executives Sept. 23 after attending a ribbon-cutting at their Southeastern Regional Medical Center.
After the DCH board vote, lobbyists for other hospitals talked of lawsuits to stop any rule change.
However, lawmakers could beat them to the punch.
A seldom-used law would allow the health committees of the House and Senate - with a two-thirds vote - to stay a rule change. The committee could also just decide to send the DCH board a message letting them know they object to the rule change. Typically agencies take the hint. After all, the General Assembly votes on their budget every year. Unterman, by the way, is also vice chairwoman of the Senate Appropriations Committee.
Since the DCH board isn't expected to vote until November and the General Assembly reconvenes in January, any rule change might have a short shelf life even if the health committees don't have a special meeting before then.
All this might seem like inside baseball, but certificate-of-need issues and fights over who can provide what medical services are highly charged and highly expensive battles every legislative session. Millions of dollars are at stake for health care companies and providers. Many of the top statehouse lobbyists are engaged by one side or the other, and suitcases full of campaign checks are doled out by those involved.
Cancer Treatment Centers are going up against some deep-pocketed players. The Georgia Hospital Association and Georgia Alliance of Community Hospitals have contributed about $2 million to state lawmakers, legislative candidates, state leaders and party political action committees over the past decade, according to disclosure reports reviewed by the AJC. Deal and his political action committee collected more than $50,000. Lt. Gov. Casey Cagle's campaigns have gotten almost $87,000.
Many Republican lawmakers say they aren't big fans of CON laws regulating services that businesses like hospitals can provide. But they are even less of a fan of bureaucrats changing rules that the General Assembly didn't vote to change.
"Why do we have CON laws if you can circumvent the law?" Unterman asked. "Why should you give CTCA an exception? Why are you picking and choosing winners?"
That "winners and losers" argument is similar to the one made by Unterman's colleague, Senate Majority Leader Bill Cowsert, R-Athens, recently when he raised questions about the General Assembly's decision this year to approve a $10 million state tax credit for a developer to build a luxury hotel on the Savannah River. It's the same issue Democrats frequently raise when Republicans file a host of tax-break bills aimed at specific companies or industries each year.
Unterman said other specialty hospitals are ready to enter Georgia if they don't have to worry about the certificate-of-need law.
"If you want a free-for-all, we'll have a free-for-all," she said.
Some of Unterman's colleagues are sympathetic to CTCA.
"I think if any of these facilities want to expand to treat more patients and make people better, the Legislature needs to get out of the way," said Rep. Chuck Martin, R-Alpharetta, whose mother was treated at a CTCA facility.