As Kemp Celebrates Waiver Win, White House Pivot May Complicate Things

The state affirmed Wednesday that it will pursue its waiver plan despite the Trump administration’s renewed bid to eliminate the Affordable Care Act – the federal law under which at least part of the Georgia plan would be carried out.

“We have regular contact with federal officials, and they continue to encourage us to submit waivers,’’ said Candice Broce, a spokeswoman for Gov. Brian Kemp. “We’re going to keep moving forward with our game plan.’’

She made the statements to GHN at a signing ceremony for the Kemp-backed Senate Bill 106, which authorizes the waiver effort. It passed the Georgia House this week.

The newly enacted legislation has two parts. One waiver would involve adding people to the Medicaid rolls. The other would allow Georgia to revise the set-up of the state health insurance exchange, created by the ACA for people who don’t have coverage from employers or government programs. Each would require federal approval.

But in a new court filing, the U.S. Justice Department has argued that the ACA, also known as Obamacare, should be invalidated in its entirety. That includes provisions protecting millions of Americans with pre-existing health conditions. The White House arguments came in conjunction with a lawsuit against the ACA filed by 20 state attorneys general, including Georgia’s Chris Carr.

President Donald Trump suggested that Republicans should embrace a new congressional battle over health care policy ahead of the 2020 elections, according to the Washington Post.

“Let me tell you exactly what my message is: The Republican Party will soon be known as the party of health care,” Trump told reporters before a Tuesday lunch with GOP senators. “You watch.”

The Justice Department filing to eliminate the ACA came the same week that Georgia Republicans were celebrating the passage of Senate Bill 106.

At the signing ceremony Wednesday, Kemp called the bill’s passage a “historic moment.’’

“Insurance premiums are too high, the number of doctors is too low,’’ Kemp said, also citing the financial struggles of rural hospitals and medical outcomes that fall at the bottom of national standards.

“We have decided to abandon the status quo,’’ he told a crowd at the Capitol. “We will craft innovative, flexibility options within the Medicaid program and the Affordable Care Act.’’

“We will address Georgia problems [with] innovative Georgia solutions.’’

The goals are to lower premiums and ensure access to quality health care for all Georgians, Kemp said.

Democrats in the General Assembly fought the waiver legislation, arguing that a full Medicaid expansion — which under the ACA is an option for states — would cover more Georgians at a lower cost than the Kemp proposal would. But with Republicans holding strong legislative majorities, the vote was not close in either chamber.

Kemp’s plan is to cover people at up to 100 percent of the federal poverty level, whereas regular expansion gives Medicaid to people at up to 138 percent of poverty. At full expansion, the federal match is at 90 percent under the ACA. At the poverty level, the match is expected to be the normal 67 percent, though Trump administration officials say they may consider the higher match figure.

The waiver plan appears to run counter to the renewed White House effort to erase the ACA.

Kemp’s private insurance waiver seeks to change the rules in the individual market, which is dominated by the ACA’s exchange, said Bill Custer, a health insurance expert at Georgia State University. And even the effort to increase Medicaid enrollment could involve the ACA, he added.

Custer said that if the Medicaid part of the waiver seeks a 90 percent federal match, as under a full Medicaid expansion, it would involve the ACA. If the state is just seeking a regular 67 percent match under a standard Medicaid member increase, the state doesn’t need a federal waiver, he added.

A federal judge in Texas last year invalidated the entire law, including its expansion of Medicaid and subsidies to help many low- and middle-income people buy insurance. The ACA remains in effect while that judgment is appealed to higher courts.

The appeals process can take a long time, and Custer said he considers it unlikely that the whole health law will ultimately be thrown out.

The Justice Department initially said that only parts of the ACA, including its protections for pre-existing conditions, should be struck down. But on Monday, it expanded its attack to say the whole law should be eliminated.

Republicans in Congress failed in 2017 to push through their longtime goal of repealing the ACA, but Congress did effectively scrap the law’s tax penalty for people who do not have health insurance, the New York Times noted. The suit contended that the absence of a real tax penalty rendered the law’s “individual mandate” — the requirement that most Americans have insurance — unconstitutional.

Without a requirement to purchase insurance, the states argued, the law could not then insist that insurance companies cover pre-existing medical conditions and a suite of other “essential health benefits,” such as maternity care and prescription drugs, the Times reported.

Democrats have seized on the Trump administration action to re-inject health care into the political debate.

The Associated Press reported that according to AP VoteCast, a nationwide survey of more than 115,000 voters in last year’s midterm elections, nearly 4 in 10 Democratic voters identified health care as the most important among a list of key issues, including immigration, the economy and the environment. A Quinnipiac University poll released Tuesday found 55 percent of Americans supporting the improvement but not the replacement of the nation’s health care system.

Georgia House Speaker David Ralston, R-Blue Ridge, attended the signing ceremony and said afterward that the Legislature still would have the opportunity to affect whatever waiver plan is devised.

Senate Bill 106 would appear to give Kemp the authority to craft the Georgia plan, and not have to get the General Assembly’s approval.

Ralston also said he strongly supported the drive for reform of the state’s certificate-of-need (CON) system, which regulates the construction and expansion of health care facilities and the introduction of new medical services.

Rep. Matt Hatchett, a Dublin Republican, ‘‘has done an amazing job’’ leading the fight for CON reform, Ralston told reporters.

Andy Miller is editor and CEO of Georgia Health News