State task force looks to close gaps in AHCA
The federal healthcare bill that passed to the Senate includes new tools and new challenges for Georgia officials.
Georgia’s Health Care Reform Task Force continues to push ahead, despite the uncertain fate of the federal repealand-replace bill that passed the U.S. House on Thursday and moved on to the U.S. Senate.
The panel of state senators appointed by Lt. Gov. Casey Cagle is charged with coming up with ways to improve the quality of care available to residents and control the cost of coverage. Its next meeting is set for May 15.
“It is the intent of the committee to have legislation ready by January,” said Sen. Chuck Hufstetler, R-Rome, an anesthetist at Floyd Medical Center who is one of the five appointees.
The American Health Care Act provides new tools and new challenges, and is probably not yet in its final form.
“What passed in the House ... it’s my opinion that the Senate is going to drastically change it,” Hufstetler said.
Northwest Georgia Congressman Tom Graves was unavailable for an interview last week. But in an emailed statement the Ranger Republican said he strongly supports the House version of the AHCA.
“Importantly, it continues to protect people with pre-existing conditions from price-gouging, and they cannot be denied coverage,” Graves said. “What’s new is that each state can take its own approach.”
A Kaiser Family Foundation study from December 2016 — “Pre-existing Conditions and Medical Underwriting in the Individual Market Prior to the ACA” — estimates 29 percent of Georgians under the age of 65 have health problems that could have made them uninsurable before Obamacare, the Affordable Care Act, became law.
The report’s estimate of 1.7 million people includes those who currently have coverage through an employer or public plan but would be uninsurable if they lost it.
Under the AHCA, insurers still would have to offer coverage, but could charge up to five times what healthy people would pay.
The new bill provides an additional $1.6 billion a year for five years to help set up high-risk pools to offset the cost.
Hufstetler said that provision of the healthcare plan is likely to be problematic.
“Eight billion dollars won’t be enough to cover it,” he said. “And if we have to keep putting money in, there won’t be savings anymore.”
Cutting costs
A Congressional Budget Office report was not available when the House passed the AHCA, but independent analyses estimate the bill cuts an average of $84 billion a year from Medicaid while providing the states with block grants.
However, it also eliminates some taxes, such as an assessment on medical equipment sales, and provides — instead of subsidies — age-based tax credits ranging from $2,000 a year for those under 30 to $4,000 a year for people over age 60.
“So it’s only saving about $25 billion, which I don’t think justifies the loss of coverage for 700,000 Georgians,” Hufstetler said.
The task force is using an estimate from Bill Custer, director of the Center for Health Services Research and an associate professor in the Department of Risk Management and Insurance at Georgia State University’s J. Mack Robinson College of Business.
“We’re looking at Medicaid waiver programs to fill in the gaps, like Mike Pence did in Indiana,” Hufstetler said, referencing the former governor who is now vice president.
As the group sets parameters, Hufstetler said there will be a focus on requiring recipients to get preventative care because real savings will come from heading off debilitating conditions.
“Controlling things like hypertension, obesity and smoking will eliminate a great portion of costs later,” he said. “We also think these people need to have some skin in the game, like a small co-payment and a penalty if they go to the (emergency room) for primary care.”
A healthy state
Members also want to ensure there is mental health coverage. Hufstetler said studies show people living with mental health problems also have higher physical healthcare costs.
He emphasized that a healthy workforce is crucial to the economic health of the state.
The task force’s assignment to create patient-centered policies has three main goals: enhancing residents’ quality of life, enabling productive workers, and doing it in a cost-effective manner. They’re goals Hufstetler thinks the Senate will aim at in rewriting the House version of the AHCA.
“The House bill has taken money out of healthcare and given tax cuts to wealthier Americans. That doesn’t improve health in this country,” he said. “And until we improve health in this country, we’re simply pushing money around from one pot to another.”
The task force will hold several meetings around Georgia this summer, including in Rome, to get input from residents in the different regions.
And as it meets, the federal rules will likely change.
The House ACHA also removes the Obamacare requirement that everyone have coverage, and its restriction against insurance companies setting lifetime and annual caps on benefits.
Graves said a lot of work has gone into finding the right balance between lifting federal mandates and protecting people with serious health challenges.
“This is about rescuing Georgia families who have been suffering for years,” he said.