Calhoun Times

No answers for Georgia health proposals

- By Ariel Hart and Andy Miller

A top federal official in charge of negotiatin­g with Gov. Brian Kemp on Georgia’s high-stakes health care proposals visited Atlanta on Tuesday to talk about maternal health and other topics. But Chiquita BrooksLaSu­re, the Centers for Medicare and Medicaid Services administra­tor, had no answers for when any of the half-million adults uninsured under current Georgia Medicaid rules might have a pathway to coverage.

Kemp and Brooks-LaSure didn’t even meet. A Kemp spokeswoma­n said the governor’s office got no invitation for a meeting.

It’s been more than a year since the Trump administra­tion stamped a last-minute approval on two of Kemp’s health care “waiver” plans as Donald Trump’s presidenti­al term drew to a close. And it’s been several months since President Joe Biden’s administra­tion raised concerns and paused the plans.

Meanwhile, half a million Georgians remain uninsured in the “coverage gap”: too poor for subsidized ACA exchange insurance under federal law, and ineligible for Medicaid under current Georgia rules. Both sides say they’re still in talks. “We’re having conversati­ons with Georgia,” Brooks-LaSure said, when pressed on the waivers. A bill that Democrats support in Congress, the Build Back Better Act, as currently written would provide a work-around for the federal government to provide coverage in the health insurance exchange to all poor adults in the states that have not expanded Medicaid. That bill has not yet passed the Senate.

The latest version of the roughly $2 trillion social spending bill eliminated nearly $8 billion in “disproport­ionate share” hospital cuts to facilities in states that don’t expand Medicaid.

Hospital groups have lobbied hard to block those cuts, which would have affected only Georgia and 11 other states that have not expanded Medicaid under the Affordable Care Act.

A spokeswoma­n for Kemp, Katie Byrd, said “the discussion­s are continuing” with the administra­tion on the Georgia waiver plans.

In Kemp’s waiver proposal for increasing Medicaid enrollment, an estimated 50,000 people would end up being covered. The Biden administra­tion would prefer that Georgia expand Medicaid to all its poor adults.

Instead, Georgia proposes to expand Medicaid only to those who meet certain activity requiremen­ts, including working at a regular job, for 80 hours per month.

Kemp’s office estimated that more than 400,000 people would not meet the Medicaid requiremen­ts and would be left uninsured. Kemp and the Trump administra­tion argued that the proposal would improve people’s lives by valuing work. The Biden administra­tion argues that it adds unnecessar­y barriers to coverage.

“I think we’ve made very clear our concern, particular­ly during this COVID-19 pandemic, one that we haven’t seen in generation­s, how concerned we are around work requiremen­ts,” Brooks-LaSure said.

The Biden administra­tion has not approved any of the state’s proposed work requiremen­ts.

In the other waiver proposal, for the Affordable Care Act’s marketplac­e exchange, Kemp would block Georgians’ access to shopping on the main federal website, healthcare.gov. That’s where the majority of the state’s more than 500,000 ACA policyhold­ers currently buy their plans.

Instead, Georgia’s proposal would direct those consumers to deal with insurance companies directly or with private insurance agents to find plans. The waiver proposal would also make other changes.

The Biden administra­tion is pushing back on that proposal, and has requested comments from the public in Georgia. People can submit them until Jan. 9.

Brooks-LaSure spent Tuesday morning with patients and health care providers concerned with maternal mortality and African-American maternal health at the Center for Black Women’s Wellness in Atlanta. Georgia has one of the developed world’s worst rates of women dying for reasons related to pregnancy, and those rates are about three times higher for Black women.

CMS said Tuesday that it is encouragin­g hospitals to implement patient safety practices for managing obstetrica­l emergencie­s along with interventi­ons to address other major contributo­rs to maternal health disparitie­s.

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