Health care reforms: A matter of life or death
Should the state continue to require a certificate of need for new hospitals and other health care facilities? The issue is under consideration in the General Assembly once again in what has become an annual battle between established hospitals and legislators bent on reforming the regulatory system that restricts the opening of new facilities.
At the same time, the lawmakers are considering Gov. Brian Kemp’s controversial proposal to extend insurance coverage to more uninsured Georgia residents through Medicaid expansion. Thus, the stage is set for full-scale debate over how to improve the state’s health care programs.
Year after year the politically powerful Georgia Alliance of Community Hospitals, the Georgia Hospital Association and their allies have defeated legislative efforts to change or abolish the certificate of need program. This time around, they are faced with House Bill 198 which would eliminate CON. A companion bill, SB 74, has been introduced in the state Senate. Significantly, neither bill would remove the CON requirements for longterm care facilities.
Under the certificate of need program, when a new medical facility is proposed, the state has to certify that the need is not being served already by other hospitals. Such applications are usually opposed by existing hospitals which contend that CON is essential to keeping them sound financially. On the other hand, proponents of proposed new facilities say they are unfairly prevented from providing a choice to patients. If the pending legislation is approved, health care costs should come down, says Rep. Matt Brass, R-newnan, the lead sponsor of SB 74. Incidentally, the trend across the country is against CON with 15 states having eliminated such systems. Is it handwriting on the wall for Georgia? Not necessarily.
Enactment of the proposed reforms, says Georgia Hospital Association executive Ethan James, would permit “unchecked growth of multi-specialty ambulatory surgery centers and other facilities that would seek only to cherrypick the well-insured patients, leaving our hospitals to stand alone in the service of the more medically complex and uninsured patients,” according to a report by Georgia Health News. Yet while the hospital community “strongly opposes” eliminating the CON process, James appears open to compromise, saying: “We can support a thoughtful and measured modernization of CON, but we object to repealing the entire state health planning process.”
Gov. Kemp’s proposal on Medicaid would provide coverage for more uninsured Georgians, a major shift in the state’s approach. Heretofore, expansion of Medicaid, which has been pushed by patient advocates and medical provider groups, was not done on the ground the state could not afford to do so. The governor also wants to strengthen the state’s health insurance exchange under the Affordable Care Act. To help with federal waivers of Medicaid rules so that Georgia can create its own plan, Kemp included $1 million in his budget for a consulting firm to help get the waivers.
Kemp has run into strong opposition from Democrats who want to just expand Medicaid without a special Georgia plan. There’s also criticism from fellow Republicans who favor some requirements for recipients under any Medicaid expansion. For example, Rep. Ed Setzler, R-acworth, says it should not be a free benefit. In his view: “I think we want to create incentives for able-bodied adults to be as productive as they possibly can be and contribute as much as they possibly can. Creating conditions in which people who are employed want to stay employed is important.”
The debates over health care reform affect every citizen of this state. Our lawmakers must devote the most careful and thoughtful consideration to all sides of these issues, giving due weight to the views of their constituents, the citizens of Georgia — because health care can be and often is a matter of life or death.
We urge the people to be active participants in these debates.
Let your legislators hear from you.
Columnist Don Mckee is the editorial page writer for the Rome News-tribune.