The General Assembly is back in session, and health care is on the minds of lawmakers. It’s the first session in a post-Roe v. Wade Georgia. The assembly’s return comes as the Biden administration seeks to wind down the federal emergency pandemic response, putting the majority of responsibility into the hands of state governments and the private sector.
Capital B Atlanta spoke with experts and lawmakers who spend lots of time advocating for health policy in the state’s capital about the issues being talked about the most.
Medicaid expansion
Expect the fight for Medicaid expansion to continue in 2023. Georgia is one of 12 states that has not expanded Medicaid under the Affordable Care Act, which would allow those whose income is at or below 138% of the federal poverty line to qualify. On Jan. 13, House Minority Leader James Beverly introduced HB 38, legislation aimed at expanding Medicaid coverage. In general, for Georgia, eligibility currently extends to patients at or below 133%.
According to a 2021 study from Kaiser Family Foundation, the majority of patients on Medicaid in Georgia are Black.
Beverly, who has his own medical practice in Macon, says a lack of Medicaid expansion creates a financial deficit for hospitals. Without Medicaid, he said, hospitals basically give out free care for those who can’t pay, and it can lead to delays in treatment for the state’s sickest patients.
“The reality is when you don’t [expand Medicaid], about 500,000 Georgians go without health care, and these are Georgians … who really don’t have health insurance,” he said. “So what happens when they get sick, they go to the emergency room, and that then drives the cost of everybody else’s health care up.”
In addition to leaving thousands of local patients uninsured, advocates also say hospital closures — including the shuttering of Atlanta Medical Center South’s emergency room and Atlanta Medical Center in Old Fourth Ward last year — are the result of Republican lawmakers and Gov. Brian Kemp’s refusal to expand Medicaid.
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“A lot of these issues that we’re dealing with here in our state — whether it be access to mental health services or our completely unacceptable rates of maternal mortality — Medicaid expansion could really help move the needle on those issues,” said Leah Chan, the senior policy analyst at the Georgia Budget and Policy Institute.
Some steps have been taken to expand Medicaid, but detractors say they aren’t enough. Among them are Kemp’s partial expansion that covers those below the poverty line as long as they’re working 80 hours per month. The Biden administration sued the state over Kemp’s proposed work requirement, but a federal judge sided with Georgia and allowed it to proceed.
Medicaid Loss
More than 18 million nationwide people could lose their Medicaid coverage beginning in April if the COVID-19 Public Health Emergency ends as scheduled.
In 2020, the PHE required the state to keep people on their Medicaid coverage without having to recertify. In turn, the federal government footed the bill for the coverage costs. Kemp, alongside other governors, asked the Biden administration to end the public health emergency, alleging that it was a factor in destabilizing state economies.
“The PHE is negatively affecting states, primarily by artificially growing our population covered under Medicaid (both traditional and expanded populations), regardless of whether individuals continue to be eligible under the program,” the letter, signed by Kemp and 24 other governors, states.
Beverly worries that for patients covered under the PHE, an unwinding of their benefits could create problems for the Georgia Department of Community Health and jeopardize the chances for low-income people to get back on the Medicaid rolls.
“There’s $0 in the budget right now to address that,” Beverly said. “How do we communicate to these folks that this is what’s going on?”
In anticipation of the forthcoming loss and its impact on the DCH, Beverly filed HB 37 on Jan. 13. The legislation calls for ways to smooth the transition for patients and the department. The bill calls for a call center to handle questions for Medicaid beneficiaries, distributing notices about the potential loss in coverage, and for the DCH to determine people’s eligibility before simply terminating their coverage.
Abortion
Georgia is one of many states in the Southeast that has stringent abortion laws. Last year, the 11th U.S. Circuit Court of Appeals ruled the state was allowed to enforce HB 481, which banned abortion after fetal cardiac activity is detected, typically around six weeks of pregnancy — before most realize they’re pregnant. Georgia does allow exceptions in the cases of incest and rape, but a police report must be filed.
Last November, a Fulton County Superior Court judge ruled the law, passed in 2019, was unconstitutional since it was passed while Roe v. Wade was still in effect. The Georgia Supreme Court ruled to temporarily keep HB 481 in place.
Black people receive 65% of abortions in Georgia, despite being a third of the population.
“The general consensus from Republican leaders … is that ‘We are confident that the bill will stand up to legal scrutiny, so we’re not going to worry about passing other serious abortion bans at this time,’” said Megan Gordon, a lobbyist for the Feminist Women’s Health Center.
The Georgia Life Alliance added an anti-abortion bill to its 2023 agenda that was defeated last year. The Women’s Health and Safety Act would have limited restrictions on telehealth abortion care, which allows women to have virtual doctor visits and skip over the tests — blood, ultrasound — common during in-person checkups. The proposal is still one of the organization’s legislative priorities in the new year. Nothing has been filed yet to defeat the use of telehealth, but Gordon said she’s keeping a watchful eye for it.
Mental health and substance abuse
In July 2022, the late speaker of the House, David Ralston, introduced the Mental Health Parity Act. The legislation requires that all health care providers offer mental health coverage in line with other medical conditions.
The state’s Behavioral Health Reform and Innovation Commission, which reconvened shortly after the passage of the Mental Health Parity Act, released a new report that Chan says will likely inform any mental health legislation that comes this session. The commission was formed in 2019 to review the effectiveness of the state’s behavioral health system.
In addition to mental health concerns, Chan says they are also looking at how the state plans to address substance abuse. According to the state attorney general’s office, from 2019 to 2021, Georgia saw a 61.9% increase in drug overdose deaths. Opioids, specifically fentanyl, have led to the increase. In fact, fentanyl-related overdose deaths increased over 232% over the same period.
“A hot topic there … is this issue of the workforce,” Chan said. “We have this increasing demand for mental health services and substance use disorder services, and you can see in the data, we have rising rates of drug overdoses in our state.”
The commission recommended that the workforce shortages be addressed through “a multipronged approach,” to address both short- and long-term solutions. Part of that, Chan said, is expanding community-based practices that have been proven to assist with treating people with mental health and substance abuse disorders.
Many of the bills don’t yet have a dollar figure. Kemp recently released his 2023-2024 budget proposals to the GA, which includes health funding. The new budget goes into effect on July 1.
