Georgia May Just Say No

By Mike King

With a month to go before the 2010 session of the Georgia General Assembly convenes, a leading Republican lawmaker has already staked out what the state party’s position on any health care reform measure coming out of Washington will be: Georgia wants no part of it, says state Sen. Judson Hill (R-Cobb County).


Hill, one of the chief proponents of market-based, non-government health reform measures in Georgia in recent years, has pre-filed legislation (SR 794) for the 2010 session that would do three things. It would provide Georgia residents a right to obtain coverage through a private insurer, allow them to buy health care services with their own funds directly from doctors and hospitals and be free not to buy insurance or participate in a particular health plan. All these rights would need to be secured with an amendment to the Georgia Constitution.


Of course they would all run counter to the comprehensive reform bills now being debated in Congress, which would require most individuals to have health coverage and most large employers to provide it or face taxes for their failure to do so. If approved, Hill’s proposal would do next to nothing to make coverage more affordable or accessible. It would instead showplace Georgia as a state that prefers to have one in four of its working age population go without affordable insurance coverage rather than bowing to the federal government.


The measure comes directly from the playbook of the American Legislative Exchange Council, a conservative advocacy group. The Council is working in about 20 states to get legislatures to pass state constitutional amendments designed to thwart the national effort.


Even though the amendment may stand no chance of being enacted – there is little likelihood it would survive a court challenge – the effort is indicative of how the GOP-dominated General Assembly is likely to respond to Washington’s reform proposals. If what comes out of Congress in any way allows states to “opt out” of specific provisions – the establishment of a public insurance option in a state-administered insurance exchange, for instance – you can pretty much bet that Georgia will head for the door.


Historically, Georgia – like other southern states – has never embraced health care programs coming out of Washington. The state has one of the most restrictive Medicaid programs for the poor on the books, despite the fact that federal taxes pay nearly two-thirds of its cost. While other states were expanding eligibility for their children’s health insurance programs, Georgia’s Speaker of the House took to the bully pulpit a few years ago to condemn PeachCare for Kids as an “entitlement” and tried to remove more working-class families from the program. Even though, again, federal dollars finance most of the program – and parents pay premiums for their kids’ coverage – he almost succeeded in gutting it.


Even now, with Washington agreeing to foot more than 90 percent of the bill for expanding Medicaid under the reform effort in the first years, state leaders have decided to whine about the additional costs rather than concentrate on the significant benefit the reform brings with it – providing as many as 400,000 more Georgians access to affordable care.


Hill and his cohorts don’t see it that way, of course. They’d prefer less regulation of the health insurance industry in Georgia; they tout high-deductible plans combined with tax-exempt health savings accounts as a better answer; tax breaks for small employers who offer insurance to their workers, and they want companies to be freed of mandated benefits. (At least they did before the national GOP decided that it was better politics to claim that scientific concerns about the effectiveness of mammograms and other cancer screenings will inevitably lead to “rationing” under a government-run plan).


These and other ideas Hill and the Georgia Republicans have put forth over the years are not illegitimate and are offered with the best of intentions. But they are woefully anemic and have done nothing to control costs or reduce the number of Georgians who are without insurance. (Medical costs and insurance premiums are far outdistancing inflation and the number of Georgians without insurance has gone steadily up – 1.8 million now, or nearly 25 percent of the adult population between 18 and 65, according to a September estimation from the U.S. Census Bureau.) The ideas from the state GOP may be worth trying but they would only effectively work as part of a more comprehensive approach – the kind being debated right now in Congress.


That’s the tone the state should adopt as it awaits Washington’s final decisions. Unfortunately, with Hill’s first volley it appears that we will start the 2010 session with a just-say-no approach to meaningful health reform in Georgia.


Mike King is a retired journalist who specializes in writing about health policy issues. He also serves as editor and administrator of the Healthy Debate blog.

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