Deal, a Republican, outlined his stance in a letter to the U.S. Department of Health and Human Services in which he criticized the Democratic health care plan for what he called its “one-size-fits-all approach” and the financial burdens it places on state governments. The exchanges will allow households and small businesses to buy a private health plan, and many will get subsidies from the government to pay their premiums.
“We believe that a well designed, private free-market approach to small business exchanges could be beneficial to small businesses but the regulations promulgated by your administration take those options away,” Deal wrote to Health and Human Services Secretary Kathleen Sebelius.
Since the U.S. Supreme Court upheld most of Obama’s health care overhaul as constitutional, Deal has strongly suggested that Georgia would not move to implement portions of it. He delayed taking any action on the plan until after the presidential election in the hope that Republican candidate Mitt Romney would win. Georgia Republicans wanted Romney to repeal or eliminate all or part of the law had he been elected.
The federal government will operate the exchanges for states that decline to set them up, so it’s not clear that people buying insurance will see a notable difference at the end of the day. But Deal’s resistance shows the philosophical and political wrangling that surrounds implementation of the Affordable Care Act.
Deal has strongly signaled that he would not move to expand eligibility for Georgia’s Medicaid program, a government health insurance plan for low-income Americans, primarily children. It is jointly funded by the state and federal government. Obama’s health care plan initially required that states expand Medicaid to cover anyone in homes earning up to 133 percent of the federal poverty level. That expansion would add about 620,000 people to Georgia’s current enrollment of 1.5 million.
However, the U.S. Supreme Court ruled this summer that any expansion has to be optional.
“The State of Georgia takes seriously its legal authority over the state’s Medicaid program,” Deal said in his letter. “We will continue to determine eligibility for all individuals seeking Medicaid in our state.”
Other Republicans quickly backed Deal. Insurance Commissioner Ralph Hudgens said in a statement that he hopes federal officials will give Georgia more flexibility.
“However, rather than allowing Georgia to embrace a more competitive private market approach, a Georgia exchange would be subject to the federal law, the mountains of regulations that have been promulgated since its passage, and the regulations that, to this date, have still not been finalized,” he said.
Sen. Vincent Fort, D-Atlanta, has urged Deal to move forward with implementing the law. He said that Republicans complain about the federal government usurping the power of state government, but then refuse to let their states set up a health insurance exchange that can incorporate local ideas or conditions.
“I bet this crowd, when the feds set up the health care exchanges, are going to howl about that,” Fort said.
Fort also said that putting uninsured people in the Medicaid program would decrease the costs that insured patients pay to cover the bills of those who need medical care but lack insurance to pay for it.
“It’s unfortunate that the governor’s chosen to put politics over the need of Georgians,” Fort said.