State Sen. Jason Carter (D-Decatur) recently announced that he is running to become governor of Georgia, attempting to follow in the footsteps of his grandfather Jimmy Carter, who was governor of the state from 1971 to 1975.
Carter sat down this week with GHN to discuss a range of health care issues, including the Affordable Care Act, the criticism of the State Health Benefit Plan, and the financial struggles of rural hospitals.
(GHN is also reaching out to Gov. Nathan Deal for a similar interview on health care topics.)
Here is the Carter interview:
Q: What are your thoughts about House Bill 990, which would require legislative approval for any expansion of Medicaid in Georgia?
A: I think it’s essentially a political bill. If you examine the bill by looking at the problem that it’s attempting to solve, it’s very difficult to discern what the Legislature believes that problem to be, other than they’re worried that I’m going to get elected governor . . .
The politics are real and I think are at the forefront of it. I think the thing that’s amazing to me is that the governor would agree to give up the ability to respond in an appropriate way to the situation that’s there, to operate the state government as an executive. And I think that’s part of a pattern that this governor’s leadership style has been essentially one of passing the buck on important issues. And I think that’s a problem. This bill is indicative of that pattern.
Q: You’re in favor of Medicaid expansion?
A: What I believe is that we have to look at this problem critically. I think expansion should be on the table … and make sure those folks [eligible for coverage] can get either private insurance on the exchanges or get a Medicaid-like expansion — it all has to be on the table. I think we will do one of those things if I’m elected governor.
Q: Are you going to make expansion and health reform issues in your campaign?
A: There are sort of two sides to this coin. What you’re talking about on some level is, what are the politics of it? And on another level, what’s the moral value, or what’s the correct policy option?
I’m not sure what the politics are, but I’m going to do what I think is right, no matter what.
I think that it makes economic sense for our state to ensure that we draw down our tax dollars and bring them back to Georgia to improve the health options that our citizens have, to improve the economics of our hospitals, to inject a giant amount of money into the economy.
The jobs impact of taking the billions of dollars back and not rejecting our own tax dollars is huge. Plus, it ripples out to having more productive, healthier citizens.
My impression thus far of the governor’s campaign is that they’re going to talk about “Obamacare” a lot. I think [with] the national dialogue on Obamacare, there are going to be books written about it. It has become whatever it has become as this political animal.
The bottom line is the Affordable Care Act [Obamacare] was passed by Congress, signed by the president and affirmed as constitutional by the Supreme Court. It is the law of the land, no matter what.
What has happened in my view is what we’ve seen in Georgia is that all the Washington politics about Obamacare have been imported. It doesn’t matter if I support 100 percent of the Affordable Care Act or not. There are things I would change, there are things the president would change. The question we have to confront as governor, is what’s best for the state, given the federal law.
This governor came from being in Congress for two decades and can’t let go of the Washington politics, and wants to use Georgia’s tax dollars and Georgia’s health and sacrifice it on this Washington politics altar of Obamacare, and say, we are not going to do this because of Washington politics, instead of looking at this, and say, what makes sense? We have to look as governor at what’s best for the citizens of Georgia.
To me, it is examining the best way to do an exchange, rather than just rejecting it. [Georgia, like a number of other states, lets the federal government run its exchange.] And examining the best way to take the health care dollars and reduce the size of our uninsured population.
Q: Can you comment on the argument that expansion will cost the state too much money?
A: What’s interesting to me about this rhetoric about the federal government is that it’s pick-and-choose. We don’t like Obamacare because Obamacare is unpopular. That’s pure politics. We like deepening the Savannah Harbor with federal dollars because, well, that is popular.
Georgia today under the current leadership is one of the most dependent states on the federal government in the country, and yet we sit here and blast the federal government all day, while we grow more and more dependent on it. Half of the time we’re begging for federal dollars.
I think we have to strengthen our state government in ways that make sense. We have to invest in the future. To the extent that we’re going to participate or not participate in federal programs, we need to look at what they are doing for our state. Are we investing in our future? Are we getting stronger? When we build roads, when we invest in our infrastructure, when we deepen the Savannah port, I think those things strengthen our state. I think it strengthens our state by injecting billions of dollars into our health care system to reduce the size of our uninsured population. Those things are investments in our future that don’t make us more dependent on the federal government.
We pay our federal tax dollars in Georgia, yet we’re going to try to pick and choose based on politics when we get the benefits of those tax dollars? That doesn’t make sense.
Q: There was another rural hospital that closed in Georgia last week – Lower Oconee Community Hospital in Wheeler County. That makes four to close in Georgia in two years. What are your thoughts on that issue?
A: It is a major crisis for a community when a hospital closes. Lower Oconee in Glenwood had 100 employees and 25 beds. The problem in a community like that when a hospital closes is not just that you’re losing health care options and not just that you’re losing jobs. The economic impact a hospital has in a community like that is gigantic. It also ripples out beyond that. If it takes 30 or 40 minutes to get to a hospital from that spot, it’s harder to put a factory or mill there. You’ve got someone operating a nail gun, you have someone operating a piece of machinery, and you’re nowhere close to a hospital. It makes it more difficult. Those things about rural Georgia and rural hospitals are incredibly important to me and to those communities.
We have to find a way to make those hospitals economically viable and sustainable. One piece of that, I believe, is to use our federal tax dollars that we’ve already paid that are waiting for us to reduce the size of the uninsured population. That uninsured population is just a giant hole in [hospitals’] budgets.
We have to find ways to have sustainable economic models for those hospitals going forward. It’s not just reducing the uninsured population. It’s also finding an appropriate mix of services that are going to work in those areas. I understand there are ways to approach that issue through the regulatory environment. It doesn’t have to be to open up [the certificate of need rules]. I think we can explore regulatory solutions. We haven’t seen that yet from this administration. This being an election year, as soon as we start talking about things, the administration has acted. Hopefully we’ll see some of that in a short period of time.
Q: The health plan that covers state employees and teachers has come under sharp criticism since changes were launched in January. What’s your view of this situation?
A: First of all, I’m on that same health plan. I not only heard complaints from citizens, but complaints from my wife. A very important constituent (laughs) . . . [Both Carter, as a state legislator, and his wife, a teacher, are eligible for the state health plan.]
I believe that we have to have options — more options than we have now. I think the outcry from teachers and others has been intense and powerful. And you saw, all of sudden it’s an election year, and we’re seeing a huge amount of responsiveness from the governor’s office. The flip-flop on whether we needed to use the reserves from the State Health Benefit Plan is not shocking, it’s just politics as usual.
We’ve spent $100 million out of the reserve fund as an attempt to placate the anger. It doesn’t actually solve the problem. We’re going to continue to hear from a great number of people, led in part by the teachers, that this is not enough. We’re talking about real options that need to be there.
The State Health Benefit Plan is a symptom of a much deeper-seated problem, which is the current leadership of our state doesn’t believe they need to take care of those teachers. They don’t have a respect for the work that gets done, and the desire to recruit and retain and support the best possible workforce that they can.
I think one other aspect of the current leadership’s ideology that is indicated by this decision is they don’t run the state with the belief that it can succeed as an entity. They’re so against “government” as a concept that they don’t believe in its success. If that’s true, you’re running a multi-thousand-employee entity with serious morale problems, with disrespect for the employees. . . . You end up with decisions like this that result in a backlash.
Q: Medical marijuana is an issue that seems to have come out of the blue, yet there’s momentum in the General Assembly to allow its use for children. Do you have a position on that?
A: I agree with you that it was an interesting and surprising development, given the makeup of the Legislature. I think the fact that it was a very conservative Republican from Middle Georgia who has led the charge is interesting.
But I personally tend to be a libertarian on things like this. . . . If you have a carefully crafted piece of legislation that’s going to minimize the unintended consequences, then I wouldn’t have a problem getting on board with it.
When you talk about the health outcomes for the kids that they’ve been discussing, you have to put those facts first, and whatever ideology there is, second, or not at all.
Q: Is health care going to be a big part of your campaign?
A: Part of a campaign is meeting people where they are.
Health care is an undeniably important part of our policymaking. The state government has a huge impact on the health care industry and the health care of its citizens. There are major problems that we’re confronting. There’s no doubt in my mind that it will be an important, crucial part of my governorship.
How the campaign plays out is too hard to know.
Q: Anything you want to add about health care?
A: I think it’s important that people get good information about the health care policy discussions because it’s so opaque.
If I buy a car muffler, I know exactly what it costs. If you go get an MRI, I haven’t found anyone who tells me how much it costs.
Q: The prices could vary by hundreds of dollars.
A: Not only that, but to different patients. Having a good, well-informed discussion about it is really important.
Q: Can the state do anything about making health care prices more transparent?
A: Yes, I think that the state can do that. Part of the problem is that [there is] so much volatility into the system with the staggered rollout of the different parts of the Affordable Care Act, we have to take a minute so see where that’s going to go. We don’t know what it’s going to do to costs.
But once we settle in, and understand what the [impact of] the federal law is going to be, I think there’s a variety of things the state can do, certainly from an informational standpoint. It’s not easy, but I do think transparency is one of the things that almost always helps.