There are no dull, uneventful years in health care.

It’s too big an issue for consumers, state government and businesses, and has a huge effect on the economy of a state.
This year could see considerable action on a variety of health care fronts.

Let’s start with the Affordable Care Act.

Like it or not – and many people don’t – the health reform law is still the biggest thing going in health care in the state. Its provisions have altered the landscape of the medical system.

The Georgia General Assembly passed laws last year to place obstacles to ACA implementation in the state. One prohibited the state from expanding Medicaid without legislative approval. Opponents of expansion say it’s too costly overall.

Advocates’ campaign for Medicaid expansion has gone nowhere in Georgia. Some Republican governors, including critics of the ACA, have accepted expansion in their states. But Gov. Nathan Deal has stood firmly against it here.  And last year Deal easily defeated a pro-expansion Democrat.

So will Medicaid expansion get a more favorable hearing this year? Given recent events, the idea might sound far-fetched. But political support for expansion could grow, especially if there is continuing financial trouble for Georgia hospitals. Expansion is a boon for many hospitals because it helps cover the expense of treating otherwise uninsured patients. (In states that have expanded Medicaid, hospitals have reported a surge in revenues.)

The rural health care crisis will continue to grip Georgia in 2015. 

Georgia has seen four rural hospitals close in the past two years. Rural Georgia also has major shortages in primary care physicians. Will there be meaningful changes to help sustain rural health care this year, or will access to care in these areas continue to erode?

The ACA also gave primary care doctors a pay bump for treating Medicaid patients, but that raise ran out Jan. 1. Will the Legislature follow the lead of other states and continue the Medicaid pay hike for these doctors?

Link-ups in the hospital business 

Hospitals in Georgia face a rocky path ahead. Financially, many of them are struggling, even in urban areas such as Columbus. It’s the most difficult financial times ever for hospitals, the Georgia Hospital Association says.

To buttress their positions, some struggling hospitals are seeking alliances and partnerships with bigger, more profitable health systems. Will this trend accelerate in the coming year? Who will partner with whom?

Meanwhile, hospitals are expected to defend the state regulatory apparatus against attempts by physician groups looking to operate doctor-owned multi-specialty surgery centers. This certificate-of-need battle is expected to heat up in the Georgia General Assembly.

Another hospital issue to watch is the continuing contract standoff between Grady Health System and Blue Cross and Blue Shield of Georgia, the dominant health insurer in the state. How it will be resolved could have ripple effects with other hospitals in the state, as Blue Cross continues to gain market share.

Children’s health issues figure to take a prominent profile when the Legislature convenes. A push for to allow children with seizure disorders to be treated with medical marijuana already has gathered momentum. Experts say that unlike last year, a bill to allow cannabis oil for children and other patients will probably pass the 2015 General Assembly.

The Legislature is also expected to tackle child welfare reform, in the wake of egregious cases involving the abuse and neglect of children. What to watch for is whether the state can end the large backlog of cases and fill the job vacancies of DFCS workers, so that caseloads will shrink to more manageable levels.

Protecting the public

The uproar over Ebola in the U.S. has quieted considerably over the past month or so. The Atlanta-based CDC is heavily focused on containing the disease in West Africa, and that effort will get much attention and resources during this new year.
Less certain is whether Ebola will have a major effect within our state, other than Emory University Hospital treating some patients who contracted the virus overseas.

Public health officials and hospitals will battle the flu epidemic that has hit Georgia and many other states. In Georgia, there have been of 12 flu-related deaths since Oct. 1, with adults 65 and older accounting for most of them. The impact of the flu during these winter months could strain the health care system in the state.

Consumer health 

Many consumers in Georgia will start 2015 with health plans that contain higher deductibles than ever. That means lots of folks will be paying substantial sums out of their own pockets for medical care early in the year.

How will consumers handle this financial load? Will there be more transparency in the pricing of medical services, so that people can comparison-shop before they get an MRI or other procedure?

Another thing to watch is whether health insurers continue to pare down their networks of physicians and hospitals, narrowing the choices of providers for consumers.

Meanwhile, in Washington . . . 

The U.S. Supreme Court made Medicaid expansion optional for states… Almost five years after its passage, the Affordable Care Act is still going through the legal process. The U.S. Supreme Court will decide later this year whether most of the ACA health care exchanges now in operation are illegally giving subsidies (in federally run exchanges).

If it says they are, the situation with exchanges may be thrown into chaos. That’s especially true for Georgia, which would have to switch to running its own exchange to maintain the subsidies, something that it is forbidden by state law to do.


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