The fate of the GOP’s effort to repeal and replace Obamacare is in grave doubt. That doesn’t mean health reform is stuck in Georgia.
While House Republicans argue and negotiate, one man sits in his office ready and able to authorize as bold a plan as Georgia’s leaders can conjure. As it happens, he is quite familiar to them.
When Roswell’s Tom Price moved from Congress to the executive branch as secretary of health and human services, he instantly gained the power to reshape much of the way health care works in this country, regardless of what becomes of Obamacare. Ironically, it’s Obamacare that gives him that ability.
The law Republicans are now trying to undo left many decisions up to the office Price now occupies — by his count, the law says “the secretary may” or “the secretary shall” more than 1,400 times. It also gives Price’s department the authority to grant the states waivers to the law’s requirements for health plans offered on their insurance exchanges, and that’s where this gets interesting.
Between that authority and a similar waiver provision in the original 1965 Medicaid law, the federal government can choose to give states wide latitude in how they run federal health programs. The Obama administration was fairly restrictive when it came to granting that latitude. The Trump administration, with Price at the point, is expected to be far more generous.
The upshot is Georgia can finally pursue the kinds of reforms of Medicaid and Obamacare exchange plans that would help rationalize our health-insurance marketplace. No one has yet tested the boundaries of what HHS under Price may allow, but from what I’ve heard Georgia should shoot for the moon.
We’re talking about combining Medicaid dollars with grants for housing assistance (from Ben Carson’s Department of Housing and Urban Development) and job training to provide down-on-their-luck but able-bodied Georgians a chance to rebound and move into, or back into, self-sufficiency.
We’re talking about subsidizing high-risk individuals in the exchange — primarily those with expensive pre-existing conditions — to lower premiums for everyone else. (Maine is often mentioned as an example of how to do this right.)
We’re talking about finding ways to ensure the subsidies Washington makes available either help working Georgians afford at least a catastrophic insurance plan or, if they don’t use the money, are shifted toward the hospitals that perform uncompensated care.
We may even be talking about asking for a portion of the federal money that would have gone toward expanding Medicaid — not all of it, and not the state’s matching funds, with the idea being that taxpayers at both levels of government would save money — to help pay for all of this.
In short, we’re talking about using the tax dollars already going to health care for reforms that would actually help cover more people and lower costs. For too long, we’ve been spending those dollars in ways that raise costs, which leads to fewer people being covered.
If ever there was a time to combine conviction with expertise to the benefit of Georgia’s health consumers, it’s now, with Price at HHS and Nathan Deal (who chaired a key health subcommittee while in Congress) as governor. Let’s see what’s possible.