Health care typically occupies a large share of the legislation lineup during a Georgia General Assembly session.
Dozens of health-related bills are introduced, promoted or debated, on topics that can range from the prescribing of drugs to an insurance policy’s fine print.
This year, though, many experts say they expect the Legislature to approve no seismic changes in health care, unlike in recent years, when new agencies were created or regulatory structures remade.
One reason is that lawmakers will be working within the confines of a tight budget. Agencies face a 2 percent cut in their budgets, including the new Department of Public Health, which has been hamstrung financially after years of reductions.
Secondly, it’s an election year, when many legislators take fewer chances in embracing bold initiatives — especially tax increases.
Still, every session seems to bring a health care surprise or two. Last year, a bill to help create a health insurance exchange, supported by Gov. Nathan Deal, went down in flames amid opposition from Tea Party members.
The 2012 legislative session begins next week. Among the major topic areas in health care:
The budget for the $6 billion (including federal funds) program is a perennial variable. “Medicaid is always on the table,’’ says Kevin Bloye, a Georgia Hospital Association vice president.
Deal recently restored pay that was to be cut from doctors and other medical providers in the Medicaid program, which covers roughly 1.5 million poor and disabled Georgians.
Yet the Georgia Budget and Policy Institute notes that lawmakers will have to fill existing shortfalls in Medicaid and the PeachCare program for uninsured children. Those gaps amount to more than $200 million in the supplemental 2012 budget, and more than $350 million for the next fiscal year, according to Tim Sweeney, senior health care analyst for GBPI.
Lawmakers borrowed money last session from Medicaid to fill a vast shortfall in the health plan that covers state employees, teachers and retirees, Sweeney says.
Meanwhile, a highly anticipated consultant’s report on a possible revamping of Georgia’s Medicaid program, which is due to the Department of Community Health in mid-January, will command attention from legislators.
Recently, the state of Connecticut eliminated private insurers from the Medicaid program, and there will be some support to do the same in Georgia. But no final decision is likely during the session.
Consumer advocates, meanwhile, will push for a 12-month eligibility period for Medicaid beneficiaries, up from the current six-month limit.
State Health Benefit Plan
As with Medicaid, legislators will discuss continued shortfalls incurred in the State Health Benefit Plan (SHBP), which covers 700,000 people, including state employees, schoolteachers, retirees and dependents.
This year, to correct the financial imbalances, SHBP members are paying double-digit premium increases, and state agencies and school systems are paying more as well.
Also, Georgia has introduced a voluntary switch of thousands of children now covered by the employee plan into PeachCare. Medical provider groups will see reduced payments for treating these children, and that may become an issue during the session.
The idea of a buck-a-pack bump in the cigarette tax is expected to resurface.
Last year, a proposed levy of an additional $1 per pack of cigarettes died after opposition by the Georgia Association of Convenience Stores.
Bloye of the Georgia Hospital Association says, “It’s going to be difficult to pass anything that sounds like a tax.’’ Lt. Gov. Casey Cagle says he’s opposed to a tobacco tax increase.
Georgia’s current tax of 37 cents per pack, though, is among the lowest in the nation, and the proposed increase will gain support from health advocacy groups and health care organizations.
Georgia hospitals pay a “provider tax’’ to help fund Medicaid. While there was some momentum to change that hospital formula last year, another attempt isn’t likely in 2012.
Health insurance exchange
A state advisory panel appointed by Deal recently recommended that Georgia create an exchange for small businesses, and the consumer advocacy group Georgians for a Healthy Future backs a similar marketplace for uninsured individuals.
But it’s likely that Deal himself will have to push an exchange proposal before the Legislature will move forward on one.
Wild cards and other funding issues
• A proposal to make the medical malpractice system more like the worker’s compensation system is expected to be introduced. It’s an idea that would draw intense interest from physician groups.
• A possible budget cut for drug treatment will gain attention as Georgia faces a $20 million reduction in supplemental funds from the federal Temporary Assistance for Needy Families program. The money goes to residential and outpatient programs that help women recover from addictions and keep their children out of foster care.
• The Legislature may hear more about ”balanced billing,’’ a practice whereby a medical provider sends a patient a bill for charges beyond what is paid by a health plan. There was a fiery House hearing on the issue in August.
• The state’s regulatory system of licensing and approving major health care construction projects and programs usually draws some legislative action. But this session, the “certificate of need’’ issue may be dormant.
• Proposed new funding of $10 from ad valorem taxes to help build the state’s trauma care system will be discussed. Georgia’s trauma system is chronically underfunded, and voters rejected a 2010 referendum to raise more revenue for it.
• Consumer advocacy groups will push for new requirements that insurers offer ”child-only’’ policies. Parents purchase these policies when an employer doesn’t offer dependent coverage, or when they can’t buy coverage for themselves due to cost or a medical condition.
But a provision in the federal health reform law created an unintended incentive for insurance companies to stop writing these policies.
“It’s an easy fix, requiring insurers in the individual market to sell these child-only plans as well,’’ says Cindy Zeldin, executive director of Georgians for a Healthy Future. Other states, including Colorado and California, have done it, she says.