As a somewhat new Georgia senator, I am still learning about how our political system works, and I have some thoughts about the general climate in the Legislature that opens today. I also have a somewhat unique perspective on healthcare issues filtered by my background as an orthopaedic surgeon and business leader.
The 2019 session will be very interesting due to the large number of new legislators and the new leadership of our government, including the constitutional officers. As a senator, my new “boss” is Geoff Duncan, President of the Senate, and our new Senate leadership will be working closely with Gov. Brian Kemp and his team. Like every 40-day session, there will be a constant tug of war on many fronts. Relationships are key and the atmosphere is generally collegial.
Many bills are nonpartisan and party lines come into play on a minority of issues. Additional areas of tension are:
Rural vs. Urban
Local vs. State Control
House vs. Senate
Executive vs. Legislative Branch
A balancing act is required to work toward solutions that are good for constituents in individual districts as well as the state.
Issues that will come into play on the healthcare front include:
Certificate of Need- there is a longstanding debate about regulation of medical facilities and whether CON is worthwhile. The subject comes up every year and there have recently been several study committees dealing with this conversation. It is very likely that there will be some loosening of the CON law and the debate will potentially be very contentious.
Waivers- Although a full expansion of Medicaid is unlikely, there seems to be a growing appetite for federal 1115 waiver development to increase coverage and allow for innovation. There appear to be at least two waiver proposals in the works and these will require legislative input although the actual development would be done by the Department of Community Health. Another type of waiver deals with private insurance and would go through the Department of Insurance. This type is called a 1332 and would allow development of programs such as reinsurance to make our individual market more competitive.
Rural hospitals- There continues to be a lot of concern about the health of our rural hospitals. A tax credit program has been created and this may be expanded this year. “Microhospitals” were authorized last year so that hospitals in smaller communities can change their business model. Rural broadband is important so that telemedicine can have an increasing role in rural areas.
Insurance issues- Choice and cost continue to be a big concern, especially in the market for individuals and small businesses. New models are needed to give consumers more choices. Direct Primary Care would allow patients to privately contract with physicians for in-office services (outside of insurance). Prior authorization continues to be a concern for patients and physicians and STEP therapy legislation will likely return this session. “Surprise” billing for out of network services is an ongoing issue that will come back this year along with transparency. Transparency is a goal that is important and also difficult due to the complexity of insurance contracts. The federal government has new regulations that were effective January 1 requiring hospitals to post their prices; however, it is going to be difficult to make this “user-friendly” for consumers.
Mental Health- More attention is being given to mental health as a factor in many situations, including healthcare, criminal justice, substance abuse and school safety. More funding was allocated last session and Governor Kemp has supported increasing school counselors for early intervention.
Marijuana- Cultivation and dispensing are under discussion since our current law allows use of THC oil for various conditions but federal law does not allow transport across state lines. Many are concerned about the negative results in other states that have done full legalization from a public safety standpoint.
Education, taxes, voting machines and many other issues will be discussed. I would highly recommend that you get familiar with our legislative website, legis.ga.gov. On the site you can track bills, search for legislation, find your representatives, follow committees and watch live or archived recordings of most proceedings in the chambers and committees.
Serving in the Legislature is both a difficult job and a great honor. Please feel free to contact me or visit the Capitol. My email is kay.kirkpatrick@senate.ga.gov and my office phone is 404-656-3932.
Sen. Kay Kirkpatrick represents east Cobb County and a part of Sandy Springs.
