The Union Recorder

Local News

February 3, 2013

Ga. House adopts Medicaid financing fix

(Continued)

ATLANTA —

The dynamic left lawmakers fearing re-election attempts cast as either tax-raising politician or as someone who gutted health care. So Deal fashioned Senate Bill 24 as a way to preserve the pot of money and allow lawmakers to say that, at least technically, they didn't vote for a tax.

Nonetheless, legislators kept some control over the details. The final version of the bill states that the Community Health Board — nine appointees of the governor — cannot raise any more revenue from the hospital assessment than is called for in the state budget passed by lawmakers. A second set of changes allows an oversight committee of legislators to block a levy set by the board, with the full Assembly having a say when they are in session. The new structure would expire in 2017.

All states except Alaska use some iteration of the scheme to maximize their Medicaid budgets, and Georgia law already allows the health board to impose a "provider fee" on nursing homes to increase the federal contribution for Medicaid.

Some Democrats, whose party is in the extreme legislative minority, mocked Republicans for refusing to acknowledge the model as a tax. A handful of critics have also argued that the bill is unconstitutional because it raises revenue yet did not originate in the House, as is constitutionally required for tax bills. Most Democrats still voted with Deal and his fellow Republicans.

GOP arguments, meanwhile, sounded much different than what conservatives like Norquist often push, particularly in arguments over federal fiscal policy.

Rep. Matt Hatchett, the governor's floor leader, reminded his colleagues that Deal's administration projected a 20 percent cut to Medicaid payment rates. That was enough, he said, to force hospitals to close and to drive more physicians away from taking Medicaid altogether. Losing that government spending would cause "a ripple effect" throughout local economies, he said, and "would be catastrophic to our already struggling health-care system as we know it today."

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