The Board of the Georgia Department of Community Health met today, and set rates for the State Health Benefit Plan. James Salzer with the AJC says that the nearly 650,000 state employees under the plan will get reductions in premiums for 2016, in part due to lower than expected expenses in fiscal year 2015, which ended June 30th.

In a series of tweets, TRAGIC, the group of teachers formed last year to protest changes in the health system, notes that plan designs will remain the same, but premium reductions will range from the Blue Cross HMO’s drop of $1.45 per month, to a drop of $21.36 per month for the United Healthcare HMO.

And, the group continued its complaints about high out of pocket costs within the plans.

At the same board meeting, the DCH announced that it will not seek a Medicaid waiver that had been proposed in May, citing costs and a belief that such a plan would not be approved by the feds. Again, from Salzer at the AJC:

[DCH Commissioner Clyde] Reese said federal officials gave strong indications they would reject the state’s plan because state officials couldn’t guarantee they would ultimately agree to fully expand Medicaid, as many states have done under the Affordable Care Act. Reese said the state would have spent about $3.5 million annually to administer the “experiment.”

Another reason the plan might have been rejected was the complaint filed by Rep. Jason Spencer that the legislature would have to approve of the waiver.

Separately, the University System Board of Regents announced that retirees will move from a state-maintained health insurance system to one managed by a private company. Retirees will receive a fixed sum each year to help pay for Medicare co-insurance, or directly for other healthcare costs. From the Athens Banner-Herald:

The typical retiree co-insurance plan will cost less because the risk pool will be much larger in plans offered in a health insurance exchange operated by the Aon Hewitt company, Fedrick said. Even retirees whose medical issues dictate that they choose more extensive plans will only pay a modest amount more than what they pay now, she said.

But only time will tell if that’s so, said Thomas Lauth, president of the University of Georgia Retirees Association.

“That’s the argument. I hope that’s true. Logically, I understand it. But the proof is in the pudding,” said Lauth, the retired dean of UGA’s School of Public and International Affairs.

Under the plan the Regents adopted Wednesday, the University System of Georgia, which includes UGA, will do away with its own self-funded health insurance plan for retirees. Instead, the system will deposit $2,736 next year into a “Health Reimbursement Account” which retirees can use to buy Medicare co-insurance or pay for other medical expenses, including dental costs. Medicare covers 80 percent of most medical costs; coinsurance helps retirees pay for the rest.

The move is expected to save $6.8 million in health care costs for retirees next year. The hoped for savings will increase each year under the plan, up to $19,9 million in 2018.

Back in February, we told you about the ongoing problems at Clayton County’s only hospital, Southern Regional Medical Center. Now, the hospital has gone into bankruptcy, as reported by Georgia Health News.

A media release announcing the filing emphasized that Clayton County’s lone hospital will remain open and operating while Southern Regional Health System officials consider a proposed sale of the medical center to a California-based nonprofit.

Southern Regional said it will fulfill its obligations to its employees and vendors, and continue to deliver high-quality medical care. The organization also said it has obtained a commitment for post-bankruptcy financing.

Last week, Prime Healthcare Foundation signed a letter of intent to acquire the 331-bed Riverdale hospital.

The hospital has become unprofitable due to the large amount of uncompensated care it provides. According to the story 30% of patients had no health insurance. If the sale goes through, Prime Healthcare has agreed to keep the hospital open and offer emergency services for at least five years.

Today marks the fiftieth anniversary of President Lyndon Johnson signing Medicare and Medicaid into law. They were the crowning achievements to LBJ’s Great Society programs designed to eliminate poverty, improve education, and ameliorate racial injustice. House Budget Committee Chair and Georgia’s Sixth District Congressman Tom Price wrote an op-ed published today in IJ Review addressing their viability and the need to preserve them moving forward. Some excerpts:

For about as long as there has been a Medicare or Medicaid program, there has been a vocal opposition to anything approaching a solution that might improve the programs or make them financially sustainable. It is counterintuitive, but favoring the status quo – which is unsustainable and harmful to beneficiaries – is actually considered politically safer than trying to save and strengthen these programs. Then again, common sense has never been particularly popular in Washington.
…
After all, federal spending on health care – Medicare, Medicaid and Obamacare – consumes nearly $1 trillion each year right now. In the years to come, it is projected to approach $2 trillion annually. By 2040, auto-pilot spending on the nation’s health, retirement and economic security programs will account for 76 percent of total expenditures. In other words, Congress will have little to no control over three quarters of the government’s budget – which is phenomenally disconcerting in its own right.
…
Medicare and Medicaid are fifty years old today. If they were American workers, by the time they’d reach retirement age, Medicare would be insolvent.

Many of my conservative friends complain about the country’s $18 trillion national debt, and the estimated $100 trillion of unfunded liabilities. They encourage Congress to do something–cut spending, audit government programs, eliminate foreign aid, and whatnot. Most millennials I talk to don’t believe Medicaid or Social Security will be around when they need them.

Since the GOP took over the House in 2010, discretionary spending has been cut. Conservatives should be proud of that, but should also realize that without fixing entitlements, the spending and debt problem isn’t going to get solved. Yet, there’s no real support for reform from the grassroots of either party. When Paul Ryan proposed changes to Medicare funding, those on the left responded with this, and the Republican base offered no pushback.

At a time when Americans go ballistic over a dead lion, maybe it’s time to consider taking some of that energy to support reforms that can get the country out of the financial bind these entitlements have caused.

The cost of providing insurance and healthcare are the biggest concerns of rural Georgians, according to a survey conducted for the Healthcare Georgia Foundation. 59.9% of those surveyed said that affordability of insurance was a barrier to accessing healthcare, while 53.1% cited the cost of care as an issue. When asked what was the biggest problem with local healthcare, 68.8 of those surveyed cited the cost.

The cost issue outranks other concerns within the healthcare arena. Only 24.8% cited quality of care and 6.4% cited access as the biggest problem with local healthcare. Survey respondents personally experienced issues with lack of insurance (41.9%), lack of doctors (32.6%) and insurance not being accepted by their healthcare provider (28.2%).

In the report accompanying the survey results, the foundation used the two Georgias analogy to compare healthcare in the rural parts of the Peach State with that available in metro Atlanta:

We in Georgia are dealing with older, sicker and poorer people relying on a severely compromised healthcare system. A disproportionate burden of uninsured patients, the shifting healthcare landscape under the Affordable Care Act, healthcare workforce shortages, and an aging rural population are factors compromising the delivery of rural healthcare. If ignored, our healthcare delivery system is at risk of collapsing on the shoulders of these frail rural communities.

Many rural Georgians reside in “medical deserts” where access to affordable, quality healthcare does not exist. The capacity to deliver and sustain the “traditional” model of a healthcare system in a rural community is simply not possible. As long as we continue to rely on such a model of care, there will be winners and losers, including rural Georgians, their families, and their communities.

The survey results appear to bear this out. 27.7% of those surveyed said there was a severe or extreme shortage of doctors in their area, while 59.5% cited a moderate shortage. Attracting more doctors to their community was considered an important healthcare initiative by 80.2% of those surveyed, just ahead of 78.8% citing providing access to emergency care.

Despite predictions that rural healthcare would become an issue during the 2015 Georgia legislative session, it instead was dominated by transportation funding and education reform. In the meantime, at least four rural Georgia hospitals have closed, and an AJC investigation earlier this year pointed towards more problems down the road. During the legislative session beginning next January, the questions of access to healthcare, existing Medicaid funding, and possibly expanding Medicaid as envisioned by the Affordable Care Act could come up.

The Rural Health and Healthcare poll was conducted in February, 2015 by OpinionSavvy of registered Georgia voters. After weighting so that the survey sample measured 2014 voter statistics, the poll of 491 people has a 4.4% margin of error.

Jessica linked to it in the Morning Reads and this was in this morning’s Peach Pundit Daily:

The Coming Battle Over Certificate Of Need. – Two Cartersville ob/gyns filed suit Tuesday to overturn the state’s health care regulatory process, saying it restricts competition and is unconstitutional. Drs. Hugo Ribot and Malcolm Barfield are challenging the Georgia Certificate of Need program, a complex set of regulations governing the creation and expansion of medical facilities. The Certificate of Need process has long been controversial because hospitals often use it to challenge competitors’ proposed projects. It has also pitted doctors against hospitals in battles over building surgery centers. The physicians’ lawsuit, filed in Fulton County Superior Court, is believed to be the first such litigation seeking to overturn the state’s entire Certificate of Need, or CON, program, said Glenn Delk, an Atlanta attorney for the physicians. This is one to watch.

According to the Department of Community Health website:

The Certificate of Need (CON) program is intended to achieve three goals: (1) to measure and define need, (2) to control costs, and (3) to guarantee access to healthcare services. Georgia began reviewing health care projects in 1975 under Section 1122 of the 1972 Social Security Act Amendments and Georgia’s CON program was established by the General Assembly in 1979 (O.C.G.A. Title 31, Chapter 6).

A report by the Mercatus Center takes a different view:

While CON programs were intended to limit the supply of health care services within a state, proponents claim that the limits were necessary to either control costs or increase the amount of charity care being provided. However, 40 years of evidence demonstrate that these programs do not achieve their intended outcomes, but rather decrease the supply and availability of health care services by limiting entry and competition. For policymakers in Georgia, this situation presents an opportunity to reverse course and open the market for greater entry, more competition, and ultimately more options for those seeking care.

Hopefully this lawsuit will encourage a discussion about Certificate of Need and whether or not changes to the system are needed. I would suggest changes are needed. Of course, if the Doctors win, change will come.

Editor’s Note: This OpEd was written by former First District Congressman and Senate candidate Jack Kingston.

The Affordable Care Act may be remembered as one of the most disastrous pieces of legislation in modern history. It’s bad for patients, it’s crushing small businesses with more than 20,000 pages of regulations, and it does nothing to address the real problems in our healthcare system like the cost of treatments or access to care. I voted against the Affordable Care Act, I voted to repeal it more than 40 times, I fought to defund and dismantle it, and I strongly believe it must be repealed.

Disappointingly, after Thursday’s King vs Burwell ruling, it’s clear that the Supreme Court is playing favorites by defending and practically rewriting certain laws in order to protect them from legitimate challenges. Thus, Obamacare appears to be the law of the land unless Republicans win the Presidency in 2016, hold onto our majorities in the House and in the Senate, and unite behind a legitimate alternative to keep Americans healthy but protect our freedoms.

That’s the sad truth, at least for another 18 months.

An equally sad truth— and one that says a lot about the times we live in— is that by upholding Obamacare, Chief Justice John Roberts and the five associate justices in the majority probably just saved the Republican Party. Politically.

If the Court had ruled that those who purchase insurance through the federal exchange are not eligible for the same subsidies as those who purchased through state exchanges (as the law objectively and undeniably reads) most exchange enrollees would lose their subsidies and many would not be able to afford to stay on their plan. This puts Republicans in Washington in a very precarious spot.

If we try to address the issue by transitioning these enrollees off of the subsidies, our base would, appropriately, have none of it— prolonging spending related to Obamacare is a concession to the law’s legitimacy.

On the other hand, if we did nothing in response to the ruling, the nanny-state press would have had a field day. I can see the headline now: “Soulless Republicans kicking poor people out of insurance exchanges.” No matter how unwarranted the attack, the coverage would be disastrous for Republicans in an already difficult 2016 election season, where the Presidency appears to be a coin flip and Republicans will be defending 24 seats in the Senate to the Democrats’ 10.

So, while it is clearly a huge loss for conservatives that this law stays in place, politically, the party may actually be better off.

If this is what it takes to stay in the majority, is it worth it?

Sometime in the next week, the Supreme Court will announce its decision in the case of King vs. Burwell. ScotusBlog covers the case here. The question being decided is whether government subsidies can go to people who purchase insurance via the federal exchange rather than one operated by a state. A decision against the subsidies would affect many in Georgia, however at the federal level, there is no announced plan to deal with the problem.

What we do see are some actions that nibble away at the Affordable Care Act, along with a statement from Senator Johnny Isakson calling for an Obamacare replacement in light of a projected increase in insurance costs by 38% and the possible decision by the court
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Last week, the House considered two bills that would limit, but not eliminate the health care law. One bill, HR 160, would eliminate the 2.3% medical device tax that was put in place as part of the ACA. The house vote was 280-140 in favor of eliminating the tax. Democratic Congressmen Hank Johnson and John Lewis were the only two members of the Georgia delegation to vote against the measure, which now heads to the Senate.

Republican Congressman Tom Price, who has authored an alternative to Obamacare, issued a statement following the vote:

Patients all across America are losing the ability to access the highest quality care for many reasons. One of those reasons is the extraordinary increase in costs. Embedded in Obamacare are more than 20 different taxes on Americans and American businesses. The medical device tax is one of the more destructive to the quality of health care. It takes resources away from pioneering research and the development of lifesaving treatments, and it raises the cost of medical care. Repealing this tax is a necessary step in moving toward a patient-centered health system where patients, families and doctors have access to affordable, innovative health care choices.

The other measure under consideration in the house is HR 1190, which would eliminate the Independent Payment Advisory Board (or “Death Panels,” in Sarah Palin parlance. The IPAB would have the ability to set Medicare reimbursement rates independently on its own, and it has been criticized for being exempt from congressional oversight. The House began consideration of this measure last week, and a voice vote appeared to approve the measure, but a request for a recorded vote meant that final passage is delayed until this week.

Meanwhile, Senator Johnny Isakson took to the Senate floor last week to oppose the Affordable Care Act, calling for a new health care system that would be better for Americans and the country’s economy. From his speech:

There’s a limit to what government can do to try to fit a square peg in a round hole. The Affordable Care Act is a square peg that for six years we’ve tried to fit in a round hole that doesn’t exist. It’s time we… took into consideration the American people, the taxpayers, the patients and physicians and did what’s right… Let’s allow [the American people] to have a choice of insurance policies that once they buy them, they can keep them, and a system that doesn’t mandate increases but instead encourages competition and quality.

We’ve got to see that we build a bridge from where we are today to a future of better health care, more accessible health care and more affordable health care. If the court throws out the subsidies on the Affordable Care Act, we need to first of all do no harm. We need to see to it that nobody… arbitrarily loses insurance that they planned on. We need to see to keep the promise President Obama made and never kept.

You can watch Isakson’s entire speech below the fold. Read more

Last night, the U.S. Senate passed a bill that permanently enshrines into law a budgetary gimmick known as the “Doc Fix.” Back in 1997, Congress enacted legislation intended to keep Medicare solvent by defining a “sustainable growth rate” for payments to physicians. The measure was supposed to slow the rate of medical inflation, but in practice, it kept payments so low, doctors were unwilling to take on patients.

As a result, congress has annually passed a workaround that provided additional funds to pay doctors above what the sustainable growth rate would allow. This bill, known as the doc fix, was off budget, and typically was paid for using borrowed funds. That kept the entitlement looking good on paper. The current doc fix bill expired last night, and Congress decided to eliminate the charade, and fund Medicare properly.

However, the bill providing for a permanent extension would cost government $141 billion over the next decade, and the bill did not provide for a spending offset from other areas to keep the measure budget neutral. Senator Mike Lee of Utah proposed an amendment that would require the spending offsets, which failed, 58-42, despite needing only 50 votes to pass. Among the Republicans voting against the amendment was Georgia Senator David Perdue.

On final passage of the measure, however, Perdue was one of eight senators to vote no. Others, according to The Hill, included presidential candidates Ted Cruz (R-Texas) and Marco Rubio (R-Florida), along with Lee, Ben Sasse (R-Neb.), Tim Scott (R-S.C.), Jeff Sessions (R-Ala.) and Richard Shelby (R-Ala).

Had the Lee amendment passed, the bill would have had to go back to the House. That would have meant an immediate 21% cut in doctor payments, which would have lasted until the House and Senate could agree on offsetting cuts.