November 15, 2000

For more information contact:

Stanley S. Jones, Jr.

404-817-6133

There have been recent happenings under the Gold Dome. 

Party News

The House Republicans have elected Rep. Lynn Westmoreland (he represents District 104, which includes portions of Coweta and Fayette Counties) to become their Minority Leader.  Rep. Westmoreland replaces Rep. Bob Irvin. 

The House Democrats re-elected its Leadership on November 14, 2000.  Rep. Thomas B. Murphy will remain Speaker and Rep. Jack Connell will continue to serve as Speaker Pro Tempore.  Rep. Larry Walker and Rep. Jimmy Skipper will serve as Majority Leader and Majority Whip respectively.  Rep. Calvin Smyre of Columbus will serve as the Majority Caucus Chairman.

Committee News

I.       Joint House and Senate Study Committee on Indigent Care

The Joint House and Senate Study Committee on Indigent Care, created under SR 556, met on November 9, 2000 with Rep. Richard Royal and Sen. Jack Hill co-chairing this committee.  Other members of the committee included; Bob Colvin; Kurk Stuenkel; Larry Sanders; Ron Gay; Ben Harbin; Tom McMichael; Cardee Kilpatrick; Rep. Terry Coleman; Rep. Sistie Hudson and Rep. Mickey Channell.  (Other members of this Committee who were not present include: Sen. Eddie Madden; Sen. Eric Johnson; Sen. Carol Jackson; Sen. Ed Harbison; and Rep. Kathy Cox.)

Two presentations were made at this meeting.  The first presentation was made by the Georgia Hospital Association and the second presentation was made by the Department of Community Health (“DCH” or “Department”).

Georgia Hospital Association

On behalf of the Georgia Hospital Association (“GHA”), Joe Parker explained the various problems of the uninsured and the shortfalls which had been created by the Medicare and Medicaid Systems as well as managed care contracting.  Parker explained that managed care contracts were paying less than full price to the various hospitals.  Further, Parker acknowledged that the Disproportionate Share Hospital (“DSH”) payments in Georgia were the best in the United States.  However, he noted that more intensive treatment created higher costs.  Hospitals have no places to shift the costs burden.  Further, he noted there is a diminishing amount of local financial support by communities for hospitals.  In 1998, more than $700,000,000 (including bad debt) was provided in the form of uncompensated care by Georgia hospitals.  Hospitals are unlike most other businesses as they are required to treat patients regardless of a person’s ability to pay.

Mr. Parker also noted several legislative occurrences which had caused payment changes and/or declines.  In the mid 1980s, a law was passed changing the way in which hospitals  were paid for obstetrical patients.  At the time, payment was based on actual treatments rendered and changes were made to payments on a “per case” basis.  In addition, House Bill 597, which was proposed in 1991, failed to pass. This was apparently an attempt to fund hospitals through local tax dollars.  Also, there have been decreases in the Medicaid dollars paid to hospitals, much of this is due to Balanced Budget Act cuts.

Mr. Parker asked the Committee to :

1)      Endorse the Department of Community Health’s Business Plan for Health which includes recommendations on dealing with the State’s mounting problems of the uninsured;

2)      Assist GHA in locating incentives to get local communities to support hospitals; and

3)      Encourage the maximization of federal dollars coming to Georgia in order to expand Medicaid and Peach Care.

As far as incentives to get communities to help, Rep. Richard Royal and Rep. Coleman agreed that they would not be supportive of any SPLOST (special local option sales tax) legislation for hospitals.  County governments should decide their own share of revenue. Those dollars should be used for capital outlay only.

There were questions raised by the Committee concerning a hospital’s definition of “bad debt.”  Some of this debt might not be pursued by hospitals in collection efforts. 

Larry Sanders, from the Medical Center in Columbus, pointed out that no care is ever denied.  Further, he noted that physicians are resigning from his hospital, as patients cannot pay them either. 

There were also questions about whether employers put up any barriers to employees getting insurance.  Senator Hill asked if premiums on insurance policies are an issue.  He believes that there is some voluntary waiver of the benefits in order for the employees to receive higher salaries.  Should the economy worsen, this could cause an increase in instances where employers give persons additional pay for the waiver of their health care benefits.  One Committee member noted that Georgia requires employers to have liability insurance (and persons to have automobile liability insurance) but not health insurance.

Department of Community Health

Commissioner Russ Toal gave a presentation on behalf of the Department of Community Health.  In his remarks, he noted that Wilbur Cohen, the father of Social Security, was asked why Social Security was financially stressed.  Mr. Cohen noted that, in creating the Social Security System, the Congress then thought that people would live shorter lives.  Thus, their financial assumptions and predictions proved incorrect.

Toal asked the question of who are Georgia’s uninsured?   He noted that 68% of those who are uninsured live in households that are headed by persons who work on a full-time basis.  Many of those work for small employers.  Further, a higher number of uninsured live in urban areas while a higher percentage (based on total population numbers) live in rural areas. 

Toal noted that he does not want the State of Georgia to be the insurer of last resort.  Therefore, there is a need for both public and private initiatives to solve the problems as well as obtaining additional federal funds.

Toal also noted that the indigent care load is not carried equally around the State.  He stated that those providers that wanted access to the State Health Benefit Plan and the Board of Regents Plan are those that do not fully participate in the provision of indigent care.  He believes that there needs to be some form of enforceable expectation (in order to participate).  He also noted that the Certificate of Need playing field was not level.  There are not-for-profits which also do not carry their fair share of the indigent care load.  The payment of additional dollars to those carrying a bigger load of indigent care is already being accomplished through the Indigent Care Trust Fund.  Further, if a hospital is connected to a teaching facility, that hospital gets additional dollars.  Also, rural facilities get additional dollars.  More than two-thirds of the hospitals which participate in the Indigent Care Trust Fund are rural hospitals.

Commissioner Toal noted that the Department is working with the Governor on the Medicaid budget.  The Department has asked for a Medicaid rate adjustment for hospitals. The Department is also working with the Governor on hospitals that qualify as DSH hospitals.  Finally, DCH is also working on the whole problem of the uninsured with the Governor.

Toal noted that pharmacy costs are increasing at approximately 24 percent on an annual basis.  Thus, the State cannot keep asking for an additional $100,000,000 annually to keep up with these costs.  He noted that HMOs, around the State, are also experiencing increased pharmaceutical costs.  HMOs have experienced pharmacy cost increases between 18 and 20 percent on an annual basis.  As a result, the Department of Community Health believes that the Pharmacy Benefit Manager ("PBM") may help with these rising pharmaceutical costs.

Rep. Coleman asked some questions about the need for DSH hospitals to offer obstetrical services.  He believes that, if the Certificate of Need requirement on that issue is loosened, that would be somewhat beneficial.  It causes him concern that obstetrical services are not treated as a basic service.  Thus, he believes the State should encourage obstetrical delivery (normal cases) for those hospitals in order that they can participate in DSH payments.

Toal explained that, if a hospital meets all the criteria except for not having two obstetricians, the State may actually create a second group or class of hospitals other than DSH hospitals.  This second group of hospitals would also be handled through the Medicaid program.  As for obstetrical services, the Department of Community Health does not wish to do any harm to the State’s regional perinatal system. Further, it was noted that obstetricians usually gravitate towards the Level Two (perinatal) facilities.

There was also some discussion about Critical Access Hospitals (“CAH”) and their ability to receive additional funds. Rep. Channell asked some pointed questions on CAH facilities.  Apparently, in the budget documents which were passed in the 2000 Session, the Legislature sent a clear message to improve the financial health for those rural hospitals that were “CAH Eligible.”  Further, those hospitals were to be paid some additional dollars through the CAH budget item.  The CAH hospitals which are actually designated facilities are getting additional dollars.  Channell’s question concerned other “eligible hospitals” and the fact that they should also be getting dollars.  He has learned that some of the CAH “eligible” facilities are not getting additional funds.  Commissioner Toal noted that the Department of Community Health was basically reviewing all of those hospitals and making independent calls on whether those CAH hospitals are “eligible” to receive funds.  Apparently, the Department of Community Health sent questionnaires to CAH “eligible” hospitals to see if they were actually willing to make “changes” in order to get these dollars.

Further, the Department believes that it might be able to get additional philanthropic support.  Thus, it may propose to change the Indigent Care Trust Fund statute in order to allow such philanthropic dollars be added to the fund.

Ms. Cardee Kilpatrick raised the question of whether there were enough obstetricians to cover the entire state.  Toal noted that the Georgia Board for Physicians’ Workforce has done an excellent job in documenting where the physicians are located and the distribution problems.  Further, Certificate of Need is a bigger issue and very prescriptive.  Toal stated that this could be both good and bad.  As the State has not dealt with the uninsured problem, it must have Certificate of Need.  Thus, there is no interest in amending the Certificate of Need statute until the problem with the uninsured is addressed.  He also noted that while Certificate of Need was a problem, the Certificate of Need law was created in 1982 and is somewhat difficult to administer due to the fact that times have changed.  Further, Commissioner Toal explained that some changes may be proposed concerning the State’s Certificate of Need statutes in the 2001 Session.  These changes to the current statutes would deal with the Governor’s new cancer initiatives.  No other information was given as to what the cancer initiatives might involve.

Toal also noted that the Indigent Care Trust Fund might be an additional way in which to help emergency medical service efforts around the state.  Also, the Committee asked whether other states were looking at the uninsured issues.  According to Toal, other states were looking at the problems associated with the uninsured, but no state had put together such a broad report.  Colorado, Vermont and Rhode Island have been working on issues surrounding the uninsured.  Georgia has also been looking at what has failed in other states.  DCH found that Florida, California, Iowa and Washington have experienced difficulties in what each proposed to solve  the problems.  Also, Georgia does not want to see another situation like what occurred with the TennCare Program; that program is now running a $10,000,000 deficit.

Also, Rep. Channell noted that the Balanced Budget Act (“BBA”) Relief, being considered by the United States Congress, was of grave concern.  He encouraged this Committee to encourage its Georgia delegation to get the United States Congress to act on the BBA Relief proposal.  As a result, the Committee asked that a resolution be drafted to encourage Georgia’s Congressional delegation to take action on this initiative.

There will be three additional committee meetings.  Further, the Committee asked that if anyone had suggestions, those suggestions should be made in writing.  The next meeting will be in Camilla on December 14th followed by a meeting in Statesboro on December 19th.  It plans to hold its last meeting on January 2, 2001.  The Committee also plans to have the Department of Insurance and the Consumer's Insurance Advocate at one or more of these meetings.

II.                Joint House and Senate Long-Term Care Study Committee

On November 14, 2000, this Committee, chaired by Rep. Jack West and Sen. Harold Ragan, met to discuss Recommendations proposed by one of the Subcommittees of this Committee.  This Committee has been charged to address issues surrounding workforce shortages (nurses as well as allied healthcare professionals). 

Recommendations put forth by the Home Health Subcommittee suggested the following:

1)                 Continue the work of the Committee by allowing it to survive the “sunset” date of December 1, 2000.  Many of the members of the Subcommittee felt that the issues were to important to put something hastily together.  Thus, it wishes to study and investigate what other states have done on this issue (using best practices).

2)                 Standardize the services provided across the programs (the State’s six waiver programs such as CCSP, Source, ICWP, etc.) and provide for adequate reimbursement for those services.

3)                 Pay additional reimbursement to providers who provide benefits to their direct care workers (the Recommendations suggest that a minimum percentage of a company’s full-time staff should be established).

4)                 Standardize basic worker requirements across all programs and create a personal care aide registry (similar to the Certified Nursing Assistant Registry).

5)                 Pay additional reimbursement to providers for serving “difficult” consumers (those who have behavior issues, special needs children, etc.).

6)                 Encourage the State to create an ad hoc committee for recruitment of long-term care service workers and other purposes (build career ladders, develop training for healthcare managers, etc.)

The Committee did not vote on these proposed Recommendations but will take these up at a later date.

III.             House Study Committee on Ovarian Cancer

Rep. Dorothy Pelote, Rep. Carolyn Hugley and Rep. Rene’e Unterman hosted meetings on November 13 and14, 2000 at the Capitol to discuss the issue of ovarian cancer.  Various presentations were made:  Ms. Carol Steiner with the Department of Human Resources’ Cancer Control Unit; Dr. Janet Bobo with the Center for Disease Control and Prevention (Epidemiology Section); Dr. Julie McCarty with Kaiser Permanente; Dr. Laverne Minsah a gynecologic oncologist; and Ms. Ginger Ackerman Smith with the Georgia Ovarian Cancer Alliance.

Various statistics were introduced about cancer generally as well as ovarian cancer.  There are 780 reported cases of ovarian cancer in Georgia this year.  It is estimated that 330 women in Georgia will die in the year 2000 from ovarian cancer.  This is the fifth deadliest cancer in women (lung and bronchus, breast, colon and rectum, and pancreas are the top four). Nationally, 23,100 cases will be found in the year 2000 and there will be 14, 000 deaths.  The survival rate is that 50% women diagnosed will survive an additional 5 years (it was pointed out that the quality of life for these five years would be less than great).  Caucasian women are at higher risk for disease.

More women over the age of 65 are at risk.  Also, more women who have a family history of this disease are more likely to contract the disease.  The reproductive history of a woman plays a significant role in whether a woman will get this disease (apparently, a woman who becomes a mother at an early age is less likely to contract the disease).  Women who have been exposed to ‘talc’ are at higher risk.  There is also a possible link to the disease with a woman’s consumption of milk products.  A female who has taken oral contraceptives for five years is less likely to get the disease.

Currently, there is no accurate test or screening tool for the disease.  Transvaginal ultrasound and a test known as CA 125 (a serum test) are used for screening.  The Centers for Disease Control and Prevention is not promoting any test/screening.  There are research projects underway to improve symptom detection and recognition of the disease at the University of Alabama at Birmingham and the University of Texas.  Also, the University of California – Los Angeles is collecting cancer tumor data. 

Testimony was given about the importance of educating women about the disease.  Also, women must be encouraged to talk to their healthcare professionals and explain all symptoms and family history.  Further, the doctors who testified explained that some of the most severe problems deal with diagnosing the disease once it has reached either Stage III or IV.  The later the stage of diagnosis, the more difficult the treatment and less likelihood for remission.

The Georgia Ovarian Cancer Alliance is asking for $350,000 in order to fund an educational program for women.   This program would inform women about the symptoms and facts of the disease.  It envisions a “speaker’s bureau” consisting of advocates from the ovarian cancer community, medical professionals, and member of appropriate State government to deliver the program to women’s groups, employee groups, religious groups, social and civic groups, hospital health educators, senior groups, and others.

This Committee will host its next meetings in Savannah on December 4, 2000.