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What state politicians are doing to try to fix the world of health care
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Rep. Lee Hawkins, R-Gainesville, takes a question from the audience Thursday, Dec. 12, 2019, during the annual Eggs & Issues breakfast at the Lanier Technical College Ramsey Conference Center. - photo by Scott Rogers

Understanding medical costs upfront was a common theme in health care public hearings held by the state this fall — and one that may play out as an issue in 2020 under the gold dome.

“I think the cream that rose to the top is identifying opportunities to develop a price transparency model in the state of Georgia,” Lt. Gov. Geoff Duncan’s told The Times in an interview last month, speaking of the Task Force on Healthcare Access and Cost meetings.

“Any other industry that operated like this would be shut down.”

Basically, “if you go to have a medical procedure done, you have no idea how much that’s going to cost until you get home and wait a few weeks to go to the mailbox,” Duncan said.

Patients “want to have the highest quality and the lowest price,” he said. “With modern-day technology, we should be able to empower every single patient in the state — if they want to — to be able to make decisions based on those two parameters.”

The task force hearings may trigger legislation in the 2020 General Assembly starting in January, Duncan said.

Lives on the line

This special weeklong series explores how cost and bureaucracy stand between local residents and their health care. Times reporters pored through the latest Community Needs Health Assessment, conducted numerous interviews with those in the local health care industry and those affected by it and examined the latest efforts by state government and politicians to remedy problems in our health care system. The entire series will be available online at gainesvilletimes.com/livesontheline.

And then there are pending Georgia waiver requests addressing health insurance access and Medicaid changes. 

To fulfill the Patients First Act passed by the legislature this year, Gov. Brian Kemp is proposing that uninsured adults in Georgia who make no more than the federal poverty level would qualify for Medicaid assistance if they spent at least 80 hours a month working, volunteering, training or studying. They would also have to pay monthly premiums.

The federal poverty level is just under $12,500 for an individual.

Georgia is one of 14 states that have not fully expanded Medicaid under the Affordable Care Act. Kemp’s office has said full expansion would cost Georgia taxpayers more than $1.5 billion in the first five years.

The state plans to seek a 90% match from the federal government for its more limited expansion. That would make the cost to Georgia $10 million in the program’s first year; otherwise, it would be $36 million.

The governor’s office projects this expansion will cover more than 52,000 people in its fifth year.

Supporters of a full Medicaid expansion have estimated that would cover roughly 500,000 Georgians. 

The health insurance request — referred to as Georgia Access — is for a waiver under the Affordable Care Act, which would allow residents seeking insurance through the ACA marketplace to opt out of the federal portal and instead use brokers or buy directly from insurance providers.

Public comments, which were allowed until Dec. 3, were provided to the state’s Board of Community Health.

And they have varied from support to staunch opposition. 

Speaking in support at a Nov. 19 public hearing in Gainesville, Deb Bailey, executive director of governmental affairs for the Northeast Georgia Health System, said, “We are grateful the state recognizes too many of its working, low-income citizens do not have access to or are unable to afford health care coverage.”

Heather Breeden, representing the National Multiple Sclerosis Society, is concerned about the work requirements excluding some people with MS from benefiting from the plans. The application “includes so many barriers to coverage that we know that only a small fraction of uninsured, low-income individuals living with MS will gain coverage,” she said.

Duncan’s task force, meanwhile, is aiming to “pinpoint improvements that can be made to tackle the cost and access burdens to health care across Georgia,” Duncan said.

The task force looked at price transparency, data and technology use and employer opportunities.

“We have one final executive session with our task force … to gather opinions of the group,” Duncan said. “We believe that will generate some meaningful legislation.”

One key issue is “balance billing” or “surprise billing,” when patients get a bill from a provider who turns out to be out of network with their insurance company — such as one who performed part of a procedure at a hospital.

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Dr. Bart Kimbrell interprets an MRI scan of a brain recently at the Northeast Georgia Medical Center. - photo by Scott Rogers

Emergency department doctors, anesthesiologists, radiologists and pathologists negotiate their own contracts with the health system, so a patient’s insurance plan might not be one they accept.

Legislation concerning the issue “is something we need to come to fruition,” said state Rep. Lee Hawkins, R-Gainesville, during a legislative preview breakfast, Eggs & Issues, held Thursday, Dec. 12, by the Greater Hall Chamber of Commerce. “Surprise billing is really something that’s hurting our population.”

He added: “This in-network, out-of-network is a changing landscape.”

State Rep. Emory Dunahoo, R-Gainesville, “I just think (billing) should be a lot more simple than it is. I look forward to the transparency — coming to that goal.”

Hawkins said he’s also considering legislation concerning prescription drug costs.

“Being a dentist for 40 years, I’ve been very involved in health care, dental and medical, and too often I hear (that people) cannot afford their prescriptions,” he said.

Specifically, Hawkins would like to see “more price transparency in drug costs … and I’m very committed to help our hometown pharmacies survive the economic challenges they have.”

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