The state Senate passed legislation Thursday that would facilitate the renewal of the hospital provider fee, after soundly rejecting a bid to tie the bill’s approval to Georgia expanding its Medicaid program.
As envisioned by the 2010 federal health reform law, Medicaid expansion would add more than 600,000 lower-income Georgians to the program. Senate Democrats offered the amendment to allow the provider fee to fund expansion of the Medicaid program. The amendment failed on a party-line vote, 36-18.
The overall Republican-backed provider fee bill passed easily, 46-9, after more than two hours of feisty debate.
Earlier in the day, in his annual State of the State address to lawmakers, Gov. Nathan Deal reiterated his decision not to expand Medicaid.
In the same speech, the governor emphasized his support of the hospital fee legislation.
The Senate bill would transfer the assessment from the Legislature to the state’s Medicaid agency, the Department of Community Health. The current assessment is due to expire at the end of June. Without replacing those funds, the state Medicaid program would have a financial hole of more than $400 million to fill, beyond a current shortfall of a similar size.
As of the end of Thursday’s proceedings, the fast-tracked Senate Bill 24 was the first and only bill taken up by the state Senate this year, and the first bill passed in either of the chambers this year.
Passage of the measure in both chambers would allow Republicans not to have to vote directly on the provider fee.
The fee, sometimes labeled a “bed tax,’’ has been opposed by anti-tax activists. A nationally known leader of that movement, Grover Norquist, publicly warned Georgia legislators to let the fee die. But many Georgia Republicans who generally take a tough line on taxes, including Gov. Deal, don’t think the state can do without the fee.
So far, Deal has stood firm against Medicaid expansion. And the lead sponsor of the legislation, Sen. Charlie Bethel (R-Dalton), said before the final vote that Medicaid expansion ‘‘is not the direction the state of Georgia is going.’’
Under expansion, the federal government would pay 100 percent of the cost for the first three years, and 90 percent thereafter. But the feds can’t compel any state to expand its Medicaid program, the Supreme Court said last year in its ruling on the health reform law.
Advocates of expansion say the federal funds are incentive enough. “We ought to take this money,’’ said Sen. Vincent Fort (D-Atlanta), who sponsored the expansion amendment.
If the state rejects the move, Fort argued, Georgia taxpayers would be paying for other states to expand. “Georgia will be subsidizing’’ other states, he said. “We ought to do the right thing.’’
He noted that Arizona Gov. Jan Brewer, a Republican who has frequently clashed with President Barack Obama’s administration, recently decided in favor of expansion.
But Deal, in his State of the State address, said, “I did not judge it prudent to expand the eligible population of an entitlement program by adding an additional 620,000 new enrollees since our state is already spending approximately $2.5 billion in state taxpayer funds annually.
“Even without expanding the eligible population base, we expect our Medicaid rolls to grow by an additional 100,000 individuals. This new population of Medicaid recipients, along with other mandates of Obamacare such as the extension of the time between the review of eligibility, will raise our Medicaid costs by nearly $1.7 billion over the next 10 years.”
Another amendment to the provider fee bill would have placed the aged, blind and disabled individuals covered by Medicaid into HMO-like organizations. The care management organizations now cover children and pregnant women in Medicaid, and children in PeachCare.
Sen. John Albers (R-Roswell), sponsor of the amendment, said it would save money and improve quality of care. The amendment was overwhelmingly defeated.
The one amendment that did pass would direct the Department of Community Health not to raise the fee percentage higher than the Legislature decides is appropriate.
Earlier, Democrats questioned the legality of even proposing the provider fee legislation in the Senate. “I feel it is a revenue bill. It should be started in the House,’’ said Senate Minority Leader Steve Henson (D-Tucker).
And Sen. Steve Thompson (D-Marietta) said the bill would transfer the fee authority to a “non-elected body’’ in Community Health, whose board and commissioner are appointed by the governor.
Bethel, though, noted that Community Health also handles a similar fee for nursing homes. And he recited a litany of state agencies that have the power to levy fees.
Deal, in his address, called health care a ‘‘foundation block’’ for Georgia, along with education, public safety and economic development.
His budget, he pointed out, contains an additional $2 million to increase the number of health professionals practicing in the state, following the funding of extra residency slots last year.
The budget continues funding for accountability courts, including those dealing with drug offenders and people with mental illness.
Deal also said he supports a boating safety bill. He mentioned a crash on Lake Lanier last year that killed two young brothers and resulted in a man being charged with homicide and boating under the influence. “If you’re too drunk to drive an automobile, you’re too drunk to drive a boat,’’ the governor said.
The health budgets contain some funding cuts, including a Medicaid reduction in reimbursements of 0.75 percent to providers other than primary care doctors, hospitals, hospices, rural health clinics, and federally qualified health centers.