Early in January, the Republican leadership in the General Assembly declared the door was shut this year on any bill to set up a...

Early in January, the Republican leadership in the General Assembly declared the door was shut this year on any bill to set up a health insurance exchange in Georgia.

The decision surprised many, because an advisory committee, appointed by Gov. Nathan Deal, had recommended in December that such an online insurance marketplace for small businesses be created.

Deal’s spokesman cited the uncertainty over the fate of the federal health reform law as a reason to wait. The law, also known as the Affordable Care Act, requires that health insurance exchanges be operational in the states by 2014, but it could be overturned before that happens.

“With the Supreme Court set to issue a landmark decision on Obamacare [the reform law] this spring, the governor does not want to move forward until the court has ruled,” Deal’s spokesman, Brian Robinson, told Georgia Health News last month.

But Rep. Pat Gardner (D-Atlanta), a member of the exchange panel, sees no need to wait. She has introduced an exchange bill anyway.

‘‘It’s pretty clear to me that the business community believed we need to help small business, regardless of the Affordable Care Act,’’ she says.

Gardner is the lead sponsor of HB 801, which would create the mechanism for an exchange for small businesses and one for uninsured individuals.

She acknowledges that her bill has little to no chance of moving anywhere. She speculates that lawmakers’ fear of Tea Party opposition has killed momentum for legislation.

The Tea Party is a loosely knit movement, but legislators agree it was the force that killed the exchange bill favored by the governor last year.

“I think people were afraid of being attacked on this issue in their upcoming campaigns,’’ Gardner says.

The governor’s advisory committee, in its report recommending an exchange for small businesses (though not one for individuals), found that ‘‘Georgia’s small businesses expressed a strong interest in a free-market-driven insurance marketplace that would facilitate employer defined contribution arrangements and employee choice.’’

A panel member, Julianne Thompson, state coordinator of the Tea Party Patriots, notes  a subcommittee that she joined has created a free-market proposal that the group is advocating with lawmakers.

“With regard to a state-based exchange to satisfy the mandate of Obamacare, no, I do not support one being implemented in Georgia. I support only a free market-based approach,” Thompson says.

Still, Gardner says, “There are lots of Republicans who believe in” the exchange concept.

One prominent Republican, state Insurance Commissioner Ralph Hudgens, has voiced support, saying recently that an exchange could act as a ‘‘superagent’’ for individuals seeking coverage.

Small business owner Jimmy Childre, a member of the advisory panel, said last year that developing a new health insurance marketplace is worthwhile, no matter what the Supreme Court decides.

An exchange could provide multiple health plans for people to choose from, unlike the slim choices offered now to a small business and its employees, said Childre, who is also the CEO of a Sandersville hospital.

 

Some states hedge their bets

Georgia is one of 26 states fighting in the courts to overturn the federal reform law, with the state’s Republican political leadership united in opposition to the overhaul.

Several advocates of a go-slow approach agree with Deal that there is too much uncertainty about the future of the health reform law. The high court, when it rules later this year, could uphold the entire law, declare parts of it unconstitutional, or declare all of it unconstitutional.

If the reform law is upheld and fully implemented, the federal government will step in and run exchanges in those states that don’t establish and operate their own.

Other states, meanwhile, are forging ahead on creating exchanges, though with limited results.

A recent Robert Wood Johnson Foundation report prepared by the Urban Institute found that only 14 states plus the District of Columbia have made legislative progress toward creating an exchange. Another 21 states have demonstrated interest, and 15 have made little headway, the report said. Georgia is included in the latter group.

Brett Graham, a managing director at Leavitt Partners, a consulting firm working with states on implementation of the law, told Kaiser Health News recently that while some states are aggressively moving forward, ‘‘at the other end are states that say, ‘no way, no how, we’re not doing it.’ Montana, Texas, Louisiana, Florida, they are not going to build it and they’re playing a game of chicken.’’

‘‘They’re waiting for the Supreme Court’’ to kill the health law, he said.

But Kaiser Health News has reported that even some states that are part of the Supreme Court challenge are moving forward: Colorado, Washington and Nevada have created exchanges.

And several states, including Minnesota and Iowa, are working on plans for an exchange without having passed authorizing legislation.

Concept is not radical or new

To create a workable exchange, “a great deal of planning must be done in insurance departments,’’ says Bill Custer, a Georgia State University health insurance expert.

“If you wait till the Supreme Court rules and after the election, you’ll have to really scramble to catch up,’’ Custer says.

The idea of a health insurance exchange has kicked around since the 1970s, under a term called ‘‘managed competition,’’ and has been embraced at times by leaders of both political parties, Custer says.

‘‘At the end of the day, if you want to have a private market [health reform], you come to an exchange idea,’’ he says.

Under the health reform law, states face a federal deadline of Jan. 1, 2013, when they are supposed to present their exchanges to the federal government for certification.

Gardner fears Georgia will be left behind. She says she’s frustrated by the difficulty in even getting a House hearing on the bill.

“I have no regrets,’’ she says. “I’ll take whatever flak comes my way. I believe in it.’’


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Andy Miller

Andy Miller is editor and CEO of Georgia Health News

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