What the Kemp budget has for health care — and what it doesn’t


Extension of Medicaid coverage for women who have given birth. Higher compensation for doctors serving the poor in Georgia. More money for rural health care.

In many ways, health care is getting a boost in Gov. Brian Kemp’s budget.

Kemp’s proposed budget calls for a record $30.2 billion in government spending next year. High-profile items include $5,000 pay raises for state employees, $2,000 bonuses for teachers and a $1.6 billion tax refund for Georgians.

State tax collections — boosted by federal pandemic relief funds sent to Georgians — have increased since mid-2020, and those revenues have risen further as the economy has recovered, the State reported. AJC. The state has accumulated a record surplus.

Democrats would like to see more of the surplus spent on state programs than Kemp is proposing. They point out that amid the health care features in his budget, there is no sign of extending coverage to hundreds of thousands of uninsured Georgians through Medicaid.

In his state of the state address on Thursday, the governor made no mention of Georgia’s proposed federal Medicaid waiver, which the federal government recently approved broadly while rejecting its work requirement.

He also said nothing in the speech about expanding Medicaid, which is outlined in the federal Affordable Care Act (ACA) and has been passed by most states over the past decade. The expansion adds more low-income people to the Medicaid rolls.

Kemp and his fellow Republicans who control Georgia’s government have repeatedly rejected the Medicaid expansion, citing its cost. Last year, Congress approved new financial incentives for states to continue expanding, but that hasn’t eased the resistance here.

The rate of people without health coverage in Georgia is 13%, the third highest in the United States.

Beverly comments on the budget. Photo credit: Georgia Recorder

“The governor has failed our health, our state and our economy. The money is on the table to expand health care to 500,000 Georgians and it has been there for years,” State House Minority Leader James Beverly (D-Macon) said after the speech. governor.

State Sen. Gloria Butler (D-Stone Mountain) said of Georgia’s surplus, “The first thing that would be on my list is to expand Medicaid.”

One health care proposal that is expected to draw support from both political parties is Kemp’s request to expand Medicaid coverage from six months to 12 months for women in the program after giving birth.

Extending coverage could help reduce Georgia’s high maternal mortality rate. Pregnancy-related death rates among black women in Georgia are three to four times higher than among white women, the Georgia Budget and Policy Institute noted.

Hearings on Kemp’s budget will take place this week at the General Assembly.

Reinsurance and ‘attestations’

In his Thursday speech, Kemp touted competition and lower prices from the Georgia Health Insurance Exchange, which was created by the ACA — a law, ironically, that Republican leaders have consistently condemned.

A Georgian waiver pushed by the Kemp administration includes creating a reinsurance program that caps costs for exchange health insurers who have large numbers of expensive medical cases. Reinsurance has been shown to reduce foreign exchange premiums in other states. Other factors, including enhanced discounts imposed by the Biden administration for exchange customers, were cited in the premium cuts.

Kemp gives an annual state of the state address. Photo credit: GPB

Kemp’s tax plan includes $15 million to create a new exchange setup in Georgia, which would be handled by private insurers and brokers. This device, which for Georgian consumers would replace the device operated by the federal government health.gov website, has so far not been approved by federal health officials, who question its effectiveness and cost.

The budget also proposes additional spending for mental health and developmental disability services, though experts say the money won’t close key funding gaps in those care systems.

To strengthen Georgia’s healthcare workforce, Kemp requested $1 million from the University of Georgia system to expand nursing programs to support up to 500 students per year for five years, and funds for the Georgia Technical College System to add up to 700 nursing students. .

His plan would also invest $2.5 million for 136 residency spaces and allocate $1 million to Mercer University to address rural doctor shortages.

“Doctors and nurses are in short supply across the country, but especially in rural Georgia,” Kemp said.

The fiscal year 2023 budget includes an additional $85 million for physicians through improved Medicaid provider rates and the elimination of an unusual “attestation” requirement.

This rule “has been a huge problem for us,” said Dr. Hugo Scornik, a Conyers pediatrician who is president of the Georgia Chapter of the American Academy of Pediatrics.

The roots of the problem go back to when the ACA increased pay rates nationwide for primary care physicians treating Medicaid patients. To obtain the salary increase, doctors had to “certify” in the years 2013 and 2014 that they practiced in pediatrics, family medicine or internal medicine and that they were certified by the board. The reimbursement increase was funded entirely by federal dollars.


ACA wage increases were phased out in late 2014. Beginning in 2015, the Georgia Medicaid program, with state funding, reinstated higher pay rates for certain patient reimbursement codes. medical visits, then added more the following year. But doctors who had not certified in 2013 and 2014 were not eligible for this new salary increase.

As a result, some vendors “have been paid less than they should be,” Scornik said last week. “They have like a scarlet letter on their chest.”

The end of the attestation rule, if enacted, “will put all vendors on a level playing field,” Scornik said.


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