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Congressional inaction on health programs spurs a scramble in Georgia


Rampant uncertainty over when — or whether — Washington will fund several health care programs of major importance to Georgia is sowing confusion at hospitals, and children’s and rural health care facilities across the state.

Nearly three months after Congress let the broadly popular health care programs expire, Republican leaders do not appear much closer to a deal with Democrats, whose votes they need to advance any bill through the Senate.

The Washington fracas, playing out just days before lawmakers are scheduled to depart for the year, is leaving Georgia health care providers to the poor scrambling over whether they will have enough money to cover critical expenses in the new year.

“I’ve never seen anything like this,” said Dr. Ninfa Saunders, who oversees hospitals and clinics in Macon and other parts of Middle Georgia as the CEO of Navicent Health. Saunders is used to high-wire acts over government funding, but not so many programs at one time. And she did not expect this one to keep playing out so extraordinarily long.

“I never did. Never, never did,” she said. “I really thought when you look at the vulnerable populations, the children, I really thought this would pivot quicker.

“I always thought, I know how to navigate this. When you start dodging too many bullets, one of them is going to hit you and be fatal. You just don’t know which one it’s going to be.”

Sure thing?

Leaders of both parties say they are determined to find a way to fund the Children’s Health Insurance Program, or CHIP — the federal parent to PeachCare for Kids — as well as a constellation of other federal programs that help fund community health centers, rural hospitals and safety-net hospitals.

It just hasn’t happened.

CHIP may be the closest thing in health care to a sure thing in Washington. The beneficiaries are working-class: Their parents have income, just not enough. The patients appeal to both parties. When Democrat Doug Jones won his shocking victory last week in the Alabama U.S. Senate race, he had only one issue to mention in his victory speech: the need to fund CHIP.

For some, the very popularity of the program is beginning to drive deeper worry: If everyone agrees CHIP should pass, why hasn’t it by now?

“We are starting to be very concerned,” said Laura Colbert, the executive director of Georgians for a Healthy Future. “We really thought CHIP was going to be reauthorized — first before the funding expired; then we thought it would take two or three weeks before it got refunded. And now here we are two weeks before the end of December and families are starting to get notices that they’re going to get cut off and states are running out of money.”

That program covers more than 130,000 Georgia children at any given time, and over the course of a year more than 200,000 Georgia kids benefit. It also covers pregnant mothers. The cut to Georgia in the first year is expected to be $427 million, according to the Georgia Hospital Association.

Other programs that expired include the Disproportionate Share Hospital funding program, which goes to hospitals that treat a disproportionate share of the community’s poor. That cut is set to take place unless it’s stopped: a reduction of $36 million in the first year, rising to $145 million within a decade.

Dr. Robert Geller, the chief of pediatrics for Emory University at Grady and Hughes Spalding hospitals, said their no-show rate for child patients had suddenly started to rise after the programs expired, and it is now one-quarter to one-third higher than normal. There’s no proof why, he said, but it’s reasonable to think parents are wary they’re going to have medical bills they can’t pay.

“My personal feeling is that many of these kids are children of hardworking parents that are underinsured, relatively low-income, who don’t have or can’t afford insurance who want to do right by their kids,” Geller said. He stresses that parents waiting until the kid is sick enough to hospitalize is not only tragic but costs more, as well as taking the parent out of the workplace to accompany the kid: “This is not a wise place,” he said.

Josefa Martinez confirms that straight out. She’s a single mother of five. Her two oldest daughters, who work as a waitress and in medical administration, have supported her and her youngest three. Now she works as a cook at a day care center, and her three youngest children, ages 3, 14 and 17, have had PeachCare all their lives.

“For me, for my family, it’s been important” to have PeachCare, she said. “If you don’t have any insurance, you don’t go to the doctor.”

Martinez’s boss, Wande Okunoren-Meadows, added that not giving kids regular care and letting sickness build to days off leads to a host of problems. “If Ms. Josefa is missing work because her kid is sick, guess what? That’s an economic impact. I’ve got no one to cook.”

She added: “I don’t think any of the parents are looking for handouts. All of us can’t be millionaires. All of us can’t make six figures.”

Dwindling funds

PeachCare and other states’ CHIP programs are now running on old money left in the bank. Three states and the District of Columbia are scheduled to run dry imminently, according to the lobbying group MacPac. Georgia thought it had enough money to last until spring, but there is now talk of redistributing states’ money so Georgia would be out in January. At least one state has already sent a cutoff warning notice to families.

Leaders in Washington assure advocates that it really is just politics and the money will come through — if not in time to plan, at least in time to spend. Though several proposals have fallen through over the past three months, another is on deck.

In fact, Congress can move very quickly when it decides to end a cliffhanger, and that still may well happen in the days or weeks ahead.

In the latest proposal, Republicans packaged the program’s renewal with other spending cuts, and Democrats objected. The proposed cuts included trimming some Medicare drug payments and a public health fund at the Atlanta-based U.S. Centers for Disease Control and Prevention. In return, CHIP would be extended for five years and money for safety-net hospitals and community health centers for two.

House Minority Leader Nancy Pelosi, D-Calif., called the latest Republican offer a “nonstarter.”

“How dare Republicans give a permanent, unpaid-for $1.5 trillion tax rate cut to corporations while insisting that a temporary five-year extension of CHIP for 9 million vulnerable children be paid for by ransacking other vital commitments to children’s health,” Pelosi said Friday, referring to some of the GOP’s proposed offsetting cuts.

Publicly, Republicans are holding firm.

“Care for children in need should always, always go beyond party lines,” House Speaker Paul Ryan said.

Privately, though, both sides are talking seriously about the subject, particularly as negotiations over the tax bill come to a close.

“There are a lot of things we need to fix,” said U.S. Rep. Rick Allen, R-Evans, who in September signed onto a bipartisan letter urging House leaders to act quickly to avoid cuts to safety-net hospitals in particular. “I think that’s going to create a real need as soon as we get (the tax rewrite) done to get back on the health care conversation.”

Advocates say their best chance for quick action would be hitching health care language onto the coming spending bill, which must be passed before this coming Friday in order to avoid a partial shutdown.

Ethan James, a lobbyist for the Georgia Hospital Association, is optimistic about that. “Now whether or not that deal falls apart, who knows,” James said. “I can’t predict whether the sun’s going to rise anymore.”

Some say a January resolution is becoming more likely, a timeline that has some stakeholders worried.

Bruce Siegel, the president and CEO of America’s Essential Hospitals, a trade group for safety-net hospitals, said his organization is supportive of the latest effort to fund the programs but is unhappy with the timing and proposed offsetting cuts.

“Relief for our hospitals and their patients cannot wait until the new year,” Siegel said. “These cuts pose an imminent threat that demands immediate congressional action.”

U.S. Sen. Johnny Isakson gets kudos from advocates for his efforts. He signed on as a co-sponsor of a bipartisan CHIP bill in the Senate that would also stave off two years of cuts in funds to the hospitals that handle a disproportionate share of patients who are poor. A spokeswoman said the Republican expects the programs to be extended in the coming weeks.

“Unfortunately, what has historically been an easy pass — everyone from both sides of the aisle has historically recognized the value — we’re seeing it volleyed back and forth this year,” said Erica Fener Sitkoff, the director of the advocacy group Voices for Georgia’s Children, which is particularly concerned about PeachCare. “CHIP needs to stand on its own and pass. We should not be using children’s health care and their lives as a bargaining chip.”

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