A season stuffed with Georgia health care developments

The week before Christmas usually isn’t packed with health care news. ‘Tis the season for health care experts – and journalists – to ease off the gas and prepare for the holidays.

Not so this year.

Friday alone brought some major developments in Georgia.

The afternoon began with a state board’s expected passage of Gov. Brian Kemp’s plan to add uninsured Georgians to the Medicaid rolls.

BD’s main warehouse in Covington. Credit: Rockdale Citizen

Next came news that a company that does medical supply sterilizing in Covington agreed to the state’s terms on containing emissions of cancer-causing ethylene oxide at its nearby warehouse in the suburban Atlanta city.

But BD also acknowledged it has a second warehouse in Covington – a development that the state declared was a violation of its October consent order.

The afternoon concluded with news of a possible breakthrough in contract negotiations between Anthem, the state’s biggest health insurer, and Gainesville-based Northeast Georgia Health System. The contract between them had ended Oct. 1, leaving consumers in the lurch.

All of that followed a federal court decision Wednesday on the constitutionality of the Affordable Care Act – a ruling that left many people puzzled as to where the case goes from here.

Medicaid waiver

The board of the Department of Community Health approved the state’s Medicaid waiver proposal. That moves the Governor’s Office a step closer to submitting the proposal, along with another one involving the health insurance exchange, to the federal government for approval.

The waiver process allows for the public to submit comments on proposals, and most comments on the Medicaid waiver called instead for Medicaid expansion under the Affordable Care Act (ACA). Those criticizing the waiver plan argued that expansion would cover more Georgians at a lower cost.


Georgia’s Republican leadership — in the Legislature and the governorship — has long opposed expansion. And Community Health’s Blake Fulenwider said expansion is actually prohibited by the language in the waiver legislation passed by the General Assembly this year.

The Kemp plan would add low-income uninsured Georgians to the Medicaid program, provided they meet requirements on working, job training, community service or being in school.

Community Health board member Mark Trail, a former state Medicaid director, asked whether a person in active treatment for mental health or substance abuse problems could be allowed an exception in order to gain coverage. Fulenwider said the waiver proposal would not allow those people to get coverage unless they met the other eligibility criteria.

“I hope that as we progress with this, that we would give active consideration to that’’ possible exception, Trail said.

Here are Kemp’s arguments for the method he has chosen. 

Warehouse emissions

State environmental regulators Wednesday announced a surprising development in Georgia’s ethylene oxide controversy.

It involves high emissions of the cancer-causing gas in Covington, but not at BD’s sterilizing facility, which has drawn scrutiny for months. This time the concern is about the company’s nearby warehouse, where sterilized products are stored to undergo “off-gassing.”

The state Environmental Protection Division (EPD) said that because of those levels, BD was operating a facility without an air quality permit. The company told EPD that the estimated fugitive emissions from the warehouse were 5,600 pounds per year. Current law requires that facilities with a potential to emit greater than 4,000 pounds a year of ethylene oxide have a permit and install emissions controls.

Gov. Kemp called the warehouse results “highly concerning.’’

BD agreed Friday to EPD terms outlined in the agency’s “notice of violation.’’ The company will take immediate steps to decrease the amount of products in the distribution center, and also conduct air monitoring at the nearest residential area and nearest school, as well as within the warehouse. It said it would develop plans to reduce the fugitive emissions at the facility.

But another surprise came Friday when EPD said the company told the agency for the first time of a second warehouse in Covington.

“As part of today’s agreement, BD will be conducting air monitoring at this warehouse,’’ the state said. Failure by the company to identify this facility and evaluate its emissions is a violation of the October consent order with the state, EPD said.

BD said it isn’t aware of any facility in the nation like its distribution center that requires a permit for purely fugitive product emissions.

Northeast Georgia vs. Anthem

A protracted battle over an insurance contract is showing signs of easing.

Thousands of Georgians with Anthem insurance have been out of network for the past three months when visiting hospitals and other facilities run by Gainesville-based Northeast Georgia Health System (NGHS).

Northeast Georgia Medical Center

Since the last contract ended Sept. 30, NGHS has been spending millions of dollars to ensure patients aren’t hit with out-of-network costs for visiting its physicians and hospitals. But that arrangement will run out at the end of this month.

Two powerful members of the Georgia General Assembly announced Friday that Anthem and Northeast Georgia were “close to an agreement in principle’’ on a new contract.

Senate President Pro Tempore Butch Miller (R–Gainesville) and Rep. Terry England (R–Auburn), chair of the House Appropriations Committee, said in a joint statement that they’ve been told the two side “are diligently working in good faith toward an agreement. The parties have documents in hand that are moving towards a deal.’’

Northeast Georgia runs hospitals in Gainesville, Braselton, Winder (in England’s district) and Dahlonega.

Consumers in those areas have faced a tough choice during open enrollment periods: whether to sign up for an Anthem health plan and lose network access to those hospitals, or choose another health plan with Northeast Georgia as a network provider.


The Affordable Care Act

The federal appeals court ruling that struck down the ACA’s requirement that people have health insurance left key questions about the fate of other provisions of the law, such as coverage for pre-existing conditions, the Associated Press noted.

The decision Wednesday by the 5th U.S. Circuit Court of Appeals in New Orleans sent the case back to federal district court Judge Reed O’Connor, who had declared the entire law invalid because there is no longer a tax penalty on people without insurance. (Congress ended the tax penalty a couple of years ago, halting enforcement of the insurance requirement.)

It will now be up to Judge O’Connor to figure out what parts of the ACA should survive.

Georgia is one of a coalition of states that is challenging the constitutionality of the 2010 law, which is sometimes called Obamacare.

“Once again, the courts have agreed with what we already knew – the cornerstone of Obamacare is unconstitutional,” said Georgia Attorney General Chris Carr. “Now, we need to get back to work and do it the right way. Congress, the states and the private sector must seize this great opportunity to fix the mess created by Obamacare and do right by the American people.”


Democratic attorneys general, defending the ACA, are weighing whether they want to appeal the case directly to the Supreme Court, which twice before has upheld the law.

Laura Colbert of the consumer group Georgians for a Healthy Future said the appeals court ruling “only serves to prolong Georgians’ uncertainty about their access to quality, affordable health care.’’

Nothing will be resolved soon in the court case, said Bill Custer, a health insurance expert at Georgia State University.

The appeals court ruling “is a bizarre punt’’ on resolving the basic legal challenge, he said.

Custer pointed out that much of the Kemp waiver initiative – especially the proposal involving the health insurance marketplace – is directly tied to the continued existence of the ACA. So the Georgia opposition to the law seems contradictory, he said.

“One hand is trying to fight what the other hand is trying to do,’’ he said.