WOODBINE, Ga. — State Rep. Jason Spencer has fought the Affordable Care Act as hard as anyone in the Georgia General Assembly.

Spencer, a Woodbine Republican, was a driving force behind passage of a bill that requires legislative approval for expansion of Medicaid in Georgia under the 2010 federal health care law. He also pushed legislation that forbids Georgia from running its own insurance exchange under the ACA. (Georgia, like most states, has a federally run exchange.)

Now Spencer, a physician assistant, is raising questions about a plan proposed by Grady Health System that would request a special Medicaid “waiver” to cover more uninsured Georgians.

The proposal is not part of the Affordable Care Act, but Spencer sees the waiver plan as a potential pathway to Medicaid expansion in the state.

This year’s General Assembly approved the state’s potential request for a Medicaid waiver in the fiscal 2016 budget. But Spencer cites a May 22 letter from Daryl Robinson, counsel to the state attorney general, that says the General Assembly may not amend provisions of general law through an appropriations act.

The line item in the 2016 budget allowing a waiver process “does not constitute proper authority,” Spencer told GHN on Wednesday. “Whoever slid that into the budget was misinformed.”

Spencer has written Clyde Reese, commissioner of the state’s Department of Community Health, informing him of the opinion from the attorney general’s office. Spencer’s letter was also signed by state Reps. David Stover (R-Newnan), Scot Turner (R-Holly Springs) and Michael Caldwell (R-Woodstock).

Reese told reporters earlier this month that he did not believe separate legislative approval was needed for a waiver request, saying the budget line item allowing the waiver constitutes General Assembly approval already.

DCH spokesman Jeremy Arieh declined comment on the Spencer letter Wednesday.

After an agency board meeting in May, Reese said Gov. Nathan Deal “has asked us to work on” the waiver request.

Community Health would determine if the plan is feasible and who the potential participants will be, Reese said. “I’d like to get back to the governor [with an analysis of the plan] within a month,” he added.

He said he did not foresee a waiver program starting earlier than July 1, 2016.

The new coverage program would be kicked off through an “1115 waiver,” an experimental plan that the feds approve to give states flexibility to improve their Medicaid programs by using a new approach.

The Grady plan focuses on using federal matching Medicaid dollars to help set up lot sites that would give coverage to the uninsured, then manage their care and potentially improve their health.

Grady in Atlanta, Memorial Health in Savannah, and a small group of rural hospitals are seen as the initial sites in the coverage plan, which has generated much interest within the state’s health care industry.

Grady officials declined comment Wednesday on the legislators’ letter.

Spencer said Wednesday that it would take passage of a separate bill or action by the Legislature to enable the state to pursue the Grady plan. That could not occur till next year’s General Assembly, except in the unlikely event that legislators are called back in a special session.

He told GHN that a waiver “could open the door to have the federal government coerce the state to expand Medicaid.”

Spencer cited the case of Florida, where Gov. Rick Scott has accused the federal government of trying to force the state into expanding Medicaid to 800,000 Floridians in exchange for federal aid for hospitals.

“Obtaining Section 1115 waivers can be problematic [and can] lead to eventual Medicaid expansion either through coercion from the federal government or by means of political expediency, not on the merits of the policy,” the May 26 letter to Reese stated. “Therefore, proper debate and authorization of a Section 1115 waiver must occur.”

The letter concludes, “We the undersigned will actively oppose and seek legal remedies to prevent efforts from the Department of Community Health to pursue a federal Section 1115 waiver without the proper consent and authorization from the General Assembly . . . We have already been in contact with legal counsel to stop any such waiver should your department proceed in pursuing additional Section 1115 waivers without proper legislative approval.”

Spencer said Wednesday that to address the problem of uninsured Georgians, he advocates a system whereby consumers and medical providers can negotiate prices. “Then you can have real price transparency,” he said.

“The current reimbursement structure perpetuates price inflation in health care,” he said.


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