Category: Healthcare Policy

Updated: Legislature Battles with Autism Issue

An agreement that will allow some children with autism to be covered by insurance has been reached between the chairmen of the House and Senate insurance committee. In a press conference this afternoon at the Capitol, Charlie Bethel and Richard Smith announced that Bethel’s Senate Bill 1 will be merged with House Bill 429 at an 8 AM Senate Insurance committee on Friday. SB1 will be modified in two ways: The annual limit on benefits will be reduced from $35,000 to $30,000, and a sunset provision will be added to the bill such that if the plan announced by Smith this morning is implemented, the mandate in SB1 will end.

Both chairmen expect that the combined bill will easily pass the Senate, and the modified bill should be accepted by the House, which has already approved the non0=amended version. The law would take effect this year.

The proposed .2 cent sales tax would provide benefits for all autistic children up to 18 years old. Before it goes into effect, voters would have to approve a constitutional amendment, presumably in the fall of 2016. Should the voters not approve the tax, the provisions of SB1, which mandates insurance benefits for autistic children up to age 3 would remain in effect.

Original Post:

The possibility of a way to insure or treat children with autism is still alive at the Georgia Legislature, despite several setbacks. An effort to provide insurance coverage to children up to six years old failed during the 2014 session, as the House and Senate could not agree on Rep. Allen Peake’s medical marijuana bill. This year, Peake’s House Bill 1 is awaiting Governor Deal’s signature, while Senate Bill 1, one of the Senate Majority Caucus’s priorities for the session, remains stalled in the House. The bill received a hearing on Monday and remarks by House Insurance Chair Richard Smith afterwards cast doubt on whether the bill would advance.

In a Senate committee hearing, the contents of Senate Bill 1 were substituted into House Bill 162, giving the autism measure another chance at passage. The bill, carried in the Senate by P.K. Martin of Lawrenceville, is expected to be easily passed by the full Senate. The original bill would have set up parameters for insurance companies to conduct internal evaluations in order to ensure compliance with regulations–certainly not a bill of importance enough to set up a major battle with the House.

Meanwhile, Smith has his own idea for providing autism treatment. According to Sandra Parrish of WSB Radio, it would involve voters approving a constitutional amendment authorizing a two tenths of a percent sales tax. The approximately two to three hundred million dollars the tax would raise would provide coverage for all autistic children up to the age of 18.

With four days left in the session, including today, Smith’s bill is unlikely to advance very far this year.

Hope for Ava’s Law

Today is Autism Day at the Capitol and dozens of families are there to raise awareness of Autism Spectrum Disorders (ASD) and persuade their lawmakers to support SB1, Ava’s Law. Sine Die 2014 was devastating to supporters of both the autism and the medical cannabis measures, but the situation this year is – so far – looking up.

Many of the kids at the Capitol today will undoubtedly be wearing shirts that bring attention to ASD and the thousands of Georgia families who live daily with autism’s impact. It’s unlikely that any of the children today are wearing a shirt with the slogan, “I’m a Lil’ Job Killer!” – but that message was implicit when groups like Americans for Prosperity and the Tea Party Patriots recently fought against insurance coverage for ASD in Virginia. Those groups, along with the Chamber and the NFIB, have opposed measures like SB1 in nearly all of the thirty-eight states that have passed such legislation.

Despite the political clout of these groups, GOP support for SB1 appears unified, and advocates for Ava’s Law have every reason to believe that 2015 is their year. SB1 will provide coverage for ASD through age six, critical years for the intensive early intervention that can be life-changing for autistic children.

The majority of children with ASD, however, require treatment beyond age six, which is when they usually enter the public school system. On top of existing per-student annual costs, educating a child with ASD will add around $8,600 to that amount. For this reason, Senator Josh McKoon was right to assert last year that taxpayers would come out on top if SB1 passes.

Moving beyond the current session, Georgians will continue to benefit if the age cap in SB1 is ultimately eliminated. What other conditions exist that, like autism, are diagnosed by a physician and are treated by medical, psychological, and behavioral specialists, but are denied coverage once a patient turns a certain age? TriCare, the insurance for military families, has no age – or dollar limits – for their autism coverage, and in 2013, Governor Rick Perry signed legislation eliminating age caps for autism coverage in Texas (there’s a not-unreasonable $36,000 annual coverage limit). Many self-insured companies and governments, including the City of Atlanta, the City of Smyrna, Home Depot, and IBM already offer autism coverage to their employees, and providing that coverage hasn’t squelched their growth. The economic benefits to families living with autism, and to all Georgians, are ample reason to support SB1 and the families who have fought for this coverage.

Is the Georgia Latino Vote Shifting to the GOP?

With both Nathan Deal and David Perdue winning with a wide margin, one has to wonder what happened to the Democratic Party of Georgia’s secret weapon, a.k.a. “minority voter turnout”. Did the anticipated voters not show up to the polls? Or did the Georgia Republican Party actually win a significant chunk of the minority voter share? Exit poll statistics of one demographic in particular seems to have surprised many.

From WABE:

National exit polls show Republican Governor Nathan Deal took 47 percent of Latino votes, while Republican Senator-elect David Perdue got 42 percent.

Compare that to the 2010 midterms, when Republicans nationally got about 34 percent of that demographic (Latino voting numbers were too small in 2008, the last time the state had a U.S. Senate race, for reliable polling data).

One could argue that the recent shift in Latino voting trends can be attributed to the Georgia Republican Party’s minority engagement efforts. Leo Smith, the Minority Engagement Director for the Georgia Republican Party is also quoted in the same article:

“When it comes to business opportunities and developing a personal economy, I think that our messaging really resonated,” said Leo Smith, who heads minority engagement for the Georgia Republican party.

Smith says the state GOP did virtually nothing to bring in Latinos in 2010, and looked to change that this time around. He said the party did a lot of outreach with the Latinos this year, speaking with community leaders, talking with Latino media and using Spanish messaging.

Leo Smith may actually be on to something here. A recent PewHispanic study shows that most Latino voters (49%) rate the economy as their number 1 issue, followed by health care (24%) and illegal immigration (16%). It is no secret that the economy was a key issue in the campaigns of Governor Deal and David Perdue. Is the recent Latino surge to the GOP a sign of things to come? Also, is the Republican Party’s fiscal platform enough to attract Latinos their way? Discuss.

1332: Time to Start Planning

There’s been some talk about the ACA this cycle. Some folks have even decided that the ACA is the issue to run on or against for candidates. The ACA has been the subject of some 40ish repeal attempts in the House and countless hours of wasted dialogue. Quite frankly it is here to stay because of simple political math. We aren’t going to see a House and Senate with enough votes to overturn the President’s veto anytime soon. And why would a sitting president sign a law ending his program.

In Georgia we passed HB 707/943 this past session which severely limited the implementation of the ACA in Georgia. I worked for several legislators that were authors and cosigners of HB 707 and did some of the research to determine which programs were affected by the ACA, including reading a good bit of the ACA. We even have a cosigner of the bill now on Peach Pundit.

Even though I did work for several individuals that were very keen on this bill passing, it wasn’t something I was really in favor of. I have benefitted from several provisions of the ACA, and my girlfriend with type 1 diabetes is now able to get health insurance at a cost that is not a mortgage payment. Oh and she doesn’t get a subsidy either.

This all being said, there are some serious problems with the ACA and we should address them. One unique approach that is happening in Arkansas is to take advantage of the innovation waiver provision.

From Governing Magazine:

“But the additional waiver, known as the section 1332 or state innovation waiver, would allow Arkansas and other states starting in 2017 to drop major portions of the law, including the individual mandate or the insurance exchange requirement, if they have a viable plan that maintains at least the same level of coverage at the same cost to the federal government. As long as states can do that, which is no small feat, they can take the federal money they would have received and use it how they see fit.”

Given the already rampant distaste for the ACA amongst Georgia politicos (talking heads, bureaucrats, elected officials, and party leaders) it may behoove us as a state to look into this option. Some states will likely go with a more blue option, others more red meat.

Taking advantage of the 1332 provision, Georgia would be able to remake many provisions of the ACA. We’d presumably be able to get rid of various mandates as long as we met certain federal requirements. We’d also, presumably, be able to coerce more price transparency between providers and insurance companies. There’s a whole laundry list of options that Georgia could utilize to reform the ACA, and 1332 is the route to take.

The ACA is the law of the land regardless of your opinion on it. We had HB 707/943 last session which was a great red meat politics kind of bill, but it doesn’t do much to make Georgia better off than it was before. We’ve still got a couple years before this provision would be able to be fully utilized by Georgia, but we should start looking into it this coming session so we can be ready to lead and show what sort of innovation a state can have.

Autism Coverage Gets a Thumbs Up In the Senate

Both the Georgia House and Senate have been passing bills originating in their respective chambers, preparing for Crossover Day on Monday. In the Senate, Senate Bill 397 passed by a vote of 51 to nothing.

If passed in the House and signed into law, the bill would require insurers to provide coverage of autism spectrum disorders for children up to six years old. Georgia would become the 37th state to provide some form of autism insurance coverage.

Roswell Senator John Albers, who introduced similar legislation last year, is a strong proponent of autism insurance coverage. In a statement, he said,

Senate Bill 397 is a step in the right direction toward providing children like Ava Bullard with the appropriate care and treatment. The majority of states already have a funding mechanism in place for Autism; therefore, the adoption of this bill is crucial to making Georgia a more attractive destination for both businesses and families.

We are on the right side of ‘right’ and building treasures in heaven with this bill.

Meet the Puppeteers Behind the Patient Compensation Act

Last week, Peach Pundit featured posts supporting and opposing Senate Bill 141, the Patient Injury Act. In a nutshell, the proposed legislation would attempt to reform the way medical malpractice litigation is handled in Georgia. Instead of a jury trial, a new Patient Compensation System and an accompanying Patient Compensation Board would determine payouts when a doctor makes a mistake.

This post isn’t going to debate the pros and cons of the legislation. Instead, it will document how money and influence are trying to get the bill passed.

Because the Patient Injury Act, also known as the Patient Compensation Act, affects several high-powered groups, including doctors, trial lawyers and insurance companies, there is lots of behind the scenes activity going on.
Read more

Georgia Legislators Go For A #Constitutional Option

The tenth amendment to the US Constitution has been bantered back-and-forth among a lot of conservatives as “the solution” to fix problems stemming from the federal government. The South Carolina legislature has taken the first steps to “gut Obamacare” in their state. Now Georgia is following South Carolina’s lead:

State representative Jason Spencer (R-Woodbine) along with three other representatives will be holding a press conference on Monday, Dec. 16 to discuss the proposal.

“The bill’s main thrust is to prohibit state agencies, officers and employees of the state from implementing any provisions of the Affordable Care Act, leaving implementation entirely in the hands of the federal government, which lacks the resources or personnel to carry out the programs it mandates,” said Rep. Spencer in a press release.

Based on the long-standing legal principle, the anti-commandeering doctrine, the legislation is on strong legal grounds. In four major cases from 1842 to 2012, the Supreme Court has consistently held that the federal government cannot “commandeer” states, requiring them to enforce or expend resources to participate in federal law or regulatory programs.

[Judge Andrew] Napolitano noted that the plan was not only legal, it would be highly effective. “If enough states do this, it will gut Obamacare because the federal government doesn’t have the resources … to go into each of the states if they start refusing.”

I’m not a constitutional expert/scholar/unicorn, nor do I claim to be. I don’t know if this will work, but perhaps it will. Not to be pessimistic, but I don’t see this as being a priority for the leadership in either chamber.

Of course, a lot members of the General Assembly read our fine blog, so it could suddenly pop up on the radar if there’s enough buzz among the Republican caucus in both chambers. It is an election year after all, and the Obamacare #failwhale will probably be on the minds of primary voters in May.  No doubt a lot of anti-incumbent candidates will harp on this while campaigning. I just hope Charlie’s liver is up for the debate on this #constitutional option as it winds its way through the whirlwind that will be the 2014 legislative session.

McKoon’s Star Rising

Senator Josh McKoon (R – Columbus) has been appointed to serve as chairman of two committees created during the 2013 session: the Senate Expungement Reform Study Committee and the Senate Select Alternative Funding for Medicaid and other Health Care Federal Funding Study Committee. In layman’s terms, one committee will study the state’s process for expunging criminal records and the other will examine the effect of federal health care funding on the state budget.

McKoon was also appointed as a member the Joint Study Committee on Mental Health and School Violence.

Findings and proposed changes will be presented by December, 2013.

Hope and Change Costing Georgia

From the Friday news dump comes this little gem:

Residents of states that refuse to set up health insurance exchanges under Obamacare are set to be hit with higher premiums under new rules announced by the Health and Human Services Department.

Insurance companies will be charged 3.5 percent of any premiums they sell through the federal exchanges, the department announced Friday.

And insurers are likely to pass that surcharge on to clients, leading to higher premiums.

The WaPo attempts to spin the wording soften the blow a bit, by calling the exchange surcharge a “user fee.” But wait, isn’t that Newspeak for tax?

Matt Ramsey Big Winner, Rising Star.

In the waining hours of the 2011 Legislative Session, Representative Matt Ramsey (R-Peachtree City) found himself at the Speaker’s Rostrum with the gavel in his hand managing the business of the House. Speaker Ralston was busy getting pictures with the day’s Pages and as they say the show must go on. I commented to one of my seat mates that we were looking at this Legislative Session’s biggest winner.

Two of the highest profile pieces of legislation passed this year (dealing with illegal immigration (HB87) and the ability to purchase insurance policies sold in other states (HB47)) were navigated successfully through the Legislature by Matt Ramsey. Both bills elicited passionate opposition in the House from the Democrats but I suspect both poll reasonably well among Georgians of both parties. More importantly HB47 and HB87 were well thought out pieces of legislation. Ramsey listened to everyone who had something to say and tried to assuage their concerns as much as he could without violating the core ideals of both bills.

As you all know the debate over illegal immigration was a contentious one. There were protesters at the Capitol numerous times this year including last night. Yesterday one of our colleagues placed an article on our desk that called Ramsey a liar. The Speaker had it removed for violating House rules. There were many days when it looked like HB87 was dead. In fact moments before the Senate took the bill up again last night it looked to be dead. Yet not once did I hear of Ramsey losing his temper. In all the public statements I read and radio interview I heard him give, never did I hear him say anything that hurt his cause or embarrassed the Republican caucus. He gave his opposition no “locker room” quotes, and believe me on an issue like illegal immigration, with passions running high, that is quite an accomplishment. Matt Ramsey, on one of the most controversial issues facing our State, gave the people what they deserve: a thoughtful debate that didn’t inflame passions or play to the lowest common denominator. HB87 is a case study on how our political process should handle controversial issues.

Conservatives who were worried the House would suffer with the loss of conservative stalwarts like Tom Graves should really get to know Matt Ramsey.

Peaches for Thought: Obamacare, Early Voting, and an Unlikely Alliance

Today’s “fresh political pickins from the Peach State”:

1.) Coming off a bitter campaign, Governor Deal and former Governor Barnes have forged an unlikely alliance over a good cause: ensuring that spouses of state employees killed in the line of duty are able to continue health coverage under the state’s plan. Read more

HB 23 is Crazy.

Rep. Mary Margaret Oliver (D-83) sponsored HB 23 that would allow children as young as 14 to refuse medication their foster parents and doctors say they need.

49-2-33 Part 1, Section A states:
(B) A process for obtaining written informed consent from the child’s legal
guardian and the child, if he or she is age 14 years or older, in advance of the
child starting psychotropic medication;

(E) Requiring documentation of the child’s assent or objection to psychotropic medications if the child is under 14 years of age;

Written consent from the CHILD.

Rep. Oliver, according to her bio, has no real experience in the behavioral physiatric needs of juveniles. Sure, she has been on some committees, sponsored some bills related to children, and is a lawyer who teaches Child Law and Policy, but she went to school to be a lawyer, not a doctor or a physiatrist. Yet, she sponsored this bill alone according to the filing records.
Read more

ObamaCare shrinking insurance market in Georgia

What has ObamaCare done to Georgia? Bob Vineyard explains:

Since March when Obamacrap was signed in to law we have seen the following changes in the Georgia health insurance market. (Other states have had similar issues, but I am only familiar with Georgia health insurance plans).

All but two health insurance companies have withdrawn from offering maternity benefits.

Only a handful of companies will still write “child only” health insurance plans.

As of this date, it is almost impossible to find a rate for children’s health insurance if they are under age 19 and you are looking for coverage to be effective on 9/23/10 or later.

Some companies have either withdrawn from offering major medical business or are dropping hints they will be out of that market in 18 months or less.

Many have already indicated higher premiums for the 4th quarter of 2010 and later, especially on children under age 19.

Companies are starting to push limited benefit plans as “more affordable” alternatives to true major medical insurance.

Several companies have introduced new plans with stripped down benefits in an attempt to make their product look more appealing.

Drug formulary’s are changing, so the drug that is covered under your plan now may not be covered in the future.

Doctor and hospital networks are shrinking in an effort to further control costs but also has the effect of limiting access to a wide range of medical providers.

Given all this, why is Obamacare so great for the consumer?

This doesn’t even get into the impact on the state’s budget, which Roy Barnes alluded to recently. When ObamaCare was passed back in March, supporters talked about how it was under a trillion dollars, which is not true once you add the cost of the “doc fix” (that was removed from early versions of the proposal to bring the cost down). The CBO did not measure impact to health insurers, who are seeking premium increases to pay for ObamaCare’s mandates, and state budgets.

Another Word Before You Leave Town, President Obama…

A federal judge today dismissed your Justice Department’s motion to dismiss Virginia’s case against Obamacare.

Georgia is part of a 20 state lawsuit using a similar defense, that the federal government does not have the constitutional power to enact many if not most of the parts of Obama’s heath care reform initiatives. The judge rules that it is an open constitutional question:

While this case raises a host of complex constitutional issues, all seem to distill to the single question of whether or not Congress has the power to regulate – and tax – a citizen’s decision not to participate in interstate commerce. Neither the U.S. Supreme Court nor any circuit court of appeals has squarely addressed the issue.

If I did this correctly, you can read the decision here. For now, consider the constitutionality of Obamacare officially under review.

Ralston & Perdue To Senate: Try Again

Over the holiday weekend, frustration from the Governor and the House at the measures the Senate had to add to the Hospital Bed Tax to secure passage began to boil over. Travis Fain has statements from both the Governor and Speaker indicating their displeasure here, noting that Ralston has ruled the Senate passed version “not germane”, thus keeping the House members from voting AGAIN for a tax hike, only to have the Governor ultimately veto the package.

The blame from both inside the Senate chamber as well as from the House and Governor appears to be pointing toward Lt. Governor Casey Cagle, who the Gov and House think may not have been dealing in good faith (or has promised something he can’t deliver). Meanwhile, there are rumblings from inside the Senate about displeasure with the Lt. Gov putting them on the hook to vote for a tax hike that many privately do not support.

Weird things tend to happen in this state after showdowns like those of last week – and during Master’s week. This one deserves some close attention. We’ll see if the “Spring Break” allows tempers to cool, or for the forces of opposition to organize.