House Speaker David Ralston said the Georgia House of Representatives took an important step Friday when it passed a bill to allow the state draw more than $450 million in federal money for Medicaid next year.
"We stepped up and made the hard call today," Ralston, R-Blue Ridge, said after the vote.
The bill, which will now goes to Gov. Nathan Deal for signature, continues a hospital provider fee to hospitals, but moves the authority to create and assess a fee to the board of the Department of Community Health. The Senate approved the legislation Jan. 17. The current fee, nicknamed the "bed tax," is charged by the General Assembly and expires in June.
The bill passed the House 147-18, with Reps. Emory Dunahoo and Lee Hawkins, both Gainesville Republicans, voting yes. Rep. Carl Rogers, R-Gainesville, was absent due to a family emergency.
Rep. Timothy Barr, R-Lawrenceville, voted no. He could not be reached for comment Friday to discuss his vote.
Several supporters of the House bill stepped up to advocate for it amid concerns that lawmakers would lose control of the fee by relinquishing oversight. Matt Hatchett, R-Dublin, who introduced the bill as one of Deal’s floor leaders, said it makes sense for the Department of Community Health to administer the fee because it already does that for nursing homes. The General Assembly will control the fee through the appropriations process, he said.
Other representatives said the legislation was a revenue bill that should have started in the House.
"I’m disappointed in the way this has come about," said Dunahoo, who voted to approve the bill. "It should have started in the House, not the Senate. You can’t break rules and I won’t stand for them being broke again."
Majority Leader Larry O’Neil, R-Bonaire, said the bill was a continuation of the original revenue bill the assembly passed in 2010 that created the fee. Hawkins said he had conversations with fellow members who had constitutional concerns, but many of his colleagues voted "yes" in the end.
"They just want to make sure we’re doing everything by the constitution and we should," Hawkins said. "I agree with them. I just felt like this was constitutional."
Some lawmakers said the bill was structured in a way that enabled lawmakers to approve on the fee without voting directly for a tax increase. Rep. Brian Thomas, D-Lilburn, said the approach indicated a lack of political courage of the General Assembly to do its job. Sometimes it takes money to solve a problem, he said.
"I’m concerned that we’re doing a bit of ducking and dodging here," Thomas said. "We didn’t get elected to play dodgeball."
Hatchett echoed a main argument of Deal’s that letting the fee expire would cause hospitals to close and require cutting Medicaid reimbursement payments by 20 percent. Medicaid payments to hospitals will rise by nearly 12 percent to offset the state fee, which can be lowered, but can’t be raised more than what lawmakers put in the budget. The state faces a nearly $700 million Medicaid funding shortfall for the fiscal 2014 budget.