Georgia Tipsheet

The National Republican Congressional Committee is celebrating the third anniversary of the passage of the Affordable Care Act much the same way it passes any day in which the sun rises in the east: attacking John Barrow.

It also inadvertently redistricted the blue dog to a state on the opposite end of the county.

“With the third anniversary of President Obama’s infamous health care law right around the corner, New York’s hard-working families are wondering — does John Barrow still support ObamaCare?” a hastily-proofed Friday afternoon press release reads.

In truth, New Yorkers probably couldn’t pick Barrow out of a lineup of seersuckered southerners.

Similar releases targeted a dozen other vulnerable Democratic incumbents, including New York’s Tim Bishop, whose home state wasn’t scrubbed before his southern colleague’s name was substituted.

President Obama signed the legislation, which the U.S. Supreme Court largely upheld last session, into law on Mar. 23, 2010.

- James Richardson

Gov. Nathan Deal said Friday that Georgia would not create its own insurance exchange, a key element of the president’s recent health care reforms, because the financial burden would be too great for the state to shoulder.

In a letter to Health and Human Services Secretary Kathleen Sebelius Friday, Deal criticized the law’s “one-size-fits-all approach” and said his administration would not be a party to the mandated marketplaces.

“I remain committed to common sense health-care solutions that empower consumers to take responsibility for their own health, motivate the private sector and drive efficiencies for consumers, employers and governments alike,” Deal says in the letter. “I continue to hope that we might finally engage in a serious conversation about restoring meaningful flexibility to states around health care programs.”

In a separate statement, the Republican governor said he would now allow the appropriation of state revenues for a project that is “state-based in name only.”

“We have no interest in spending our tax dollars on an exchange that is state-based in name only,” he said. “I would support a free market-based approach that could serve as a useful tool for Georgia’s small businesses, but federal guidelines forbid that. Instead, restrictions on what the exchanges can and can’t offer render meaningless the suggestion that Georgia could tailor an exchange that best fits the unique needs of its population.”

Friday was the last date by which the state could notify federal officials whether it would establish the exchange.

Even though Deal decided the state would not create the exchange itself, the health care law still requires one, so the federal government will now assume that responsibility.

Deal’s letter also said the state would maintain its own guidelines for Medicaid eligibility.

The federal law originally required states to broaden their enrollment protocols lest they face stiff funding penalties, but the penalty provision was stripped when the U.S. Supreme Court weighed in. Now the expansion is only optional.

“The State of Georgia takes seriously its legal authority over the state’s Medicaid program,” Deal warned Sebelius in the letter. “We will continue to determine the eligibility for all individuals seeking Medicaid in our state.”

- James Richardson

U.S. Rep. Phil Gingrey said Thursday he had resigned to the unlikelihood of a full repeal of the president’s health care reforms, even as he said his party remained committed to the tedious work of dismantling it piecemeal.

“It would be pointless, in my opinion, to have a vote on repeal of PPACA, but we know enough egregious aspects of the law that can and should be repealed, and very likely–well, somewhat likely, I should say–in a bipartisan effort,” Gingrey said yesterday.

House Republicans have voted to repeal the law more than 30 times, each measure failing when it reached the upper chamber. But those bleak dynamics have apparently sunk in.

Gingrey, a doctor from Marietta, said his GOP colleagues would only force another ceremonial vote for “messaging” purposes.

“I don’t think we will have a vote on full repeal unless really it’s a messaging vote,” he told reporters. “I think we should concentrate on our efforts to try to repeal the most egregious parts.”

- James Richardson

Gov. Nathan Deal has just one week to determine whether Georgia will establish an insurance exchange and enroll in an optional federal program that would swell the state’s Medicaid roster by more than 600,000 new patients.

The health care reform law passed in 2010 required states to broaden eligibility guidelines for Medicaid enrollment lest they faced stiff federal funding penalties. But the U.S. Supreme Court recently ruled that Congress lacked the authority to withhold funding from those states that rejected the expansion effort, effectively neutering the provision.

The decision triggered a chain reaction among Republican governors vowing to not participate, though Deal remained mum for some two months before telling reporters in late August he didn’t have “any intention of expanding Medicaid.”

Deal reaffirmed that position again this week, arguing the associated costs of the expansion–it’s estimated the program would mean a $4 billion tax burden over the next decade for Georgians–would be too great for the already cash-strapped state to absorb.

But the governor has been less clear on whether or not he would establish an online health care marketplace. If Deal refuses to honor the provision, which went untouched by the court in its recent decision, the federal government is required to create the exchange.

Deal told reporters this week he has made a decision, but said he would not publicly disclose it until first notifying federal health officials.

The deadline for both decisions is November 16.

- James Richardson

Republicans were quick to pile on Georgia Democrat John Barrow for his vote Wednesday against a full repeal of the nation’s controversial health care reforms, the thirty-third such effort by House Republicans to scrap or scale back the measure.

Wednesday’s largely symbolic repeal effort notched five Democratic votes, but Barrow, who voted against the original bill in 2009 and again in 2010, was not among the defectors. Instead, the National Republican Congressional Committee said, Barrow has reconciled to the reality that he’s politically inseparably from President Barack Obama.

“Barrow must figure since he can’t run away from Obama he might as well embrace his health care disaster,” NRCC spox Andrea Bozek said in an afternoon statement noting that Wednesday’s vote was not the first time Barrow had held the party line on the health care law. “Georgia families understand that in order to repeal ObamaCare they must repeal John Barrow.”

When the Supreme Court last month affirmed the constitutionality of the individual mandate as a tax, the legislation’s most controversial aspect, Barrow criticized the reforms as “flawed” and stressed that he previously voted against the measure both in committee and on the House floor.

Yet when offered the opportunity to repeal the legislation he had thrice voted down, one of the Republicans angling for the opportunity to square off with the Georgia Democrat said, Barrow kowtowed to progressive interests.

“Congressman Barrow continues to ignore the wishes of 12th District voters by voting against repeal of ObamaCare,” Wright McLeod said in a press statement. “He’s not interested in representing us, and that is everything that is wrong with Washington, D.C. today.”

Barrow’s vote today will only further animate Republican cracks at characterizing Barrow as a reliable partisan who once boasted he worked “hand-in-hand” with the president.

- James Richardson

A pair of Georgia Republican pols had historic, if depressing, vantages of today’s Supreme Court decision in which key elements of President Barack Obama’s signature health care reform were upheld, planted in the two epicenters–the courtroom where the ruling was delivered, and the hotel room of Republicans’ choice for the White House–of the affair.

Roswell Congressman Tom Price was posted inside the high court by Speaker John Boehner, while Georgia Attorney General Sam Olens was reportedly in the Washington hotel suite of GOP’er Mitt Romney as the much-anticipated opinion was released.

A Romney aide confirmed to Tipsheet Olens was in the company of Romney, but as much was clear when the attorney general retweeted a message by an editor at the Boston Globe.

RT @mviser: Romney watched Supreme Court decision from his Washington Hilton hotel room with staff and Georgia AG Sam Olens, aide says.

— Glen Johnson (@globeglen) June 28, 2012

In spite of their red-letter postings, both were deeply frustrated with the court’s decision to leave the legislation largely intact.

“I call on Congress to act swiftly, repeal the law and replace it with real reform that respects the Constitution as written,” Olens, who was among 26 state chief law enforcement officers who challenged the legislation, said in a joint press release Thursday with Governor Nathan Deal.

Price, himself an orthopedic surgeon, said today’s ruling established a “dangerous precedent” that threatens personal freedom. “We have no choice but to exercise every possible legislation option to repeal this disastrous law,” he said, “and the American people should know that House Republicans will continue to advocate on their behalf to restore personal control over health care decisions.”

- James Richardson

Even as the U.S. Supreme Court restricted on Thursday the Medicaid expansion provision in the Affordable Care Act, the Georgia agency tasked with oversight of the health program announced today it had canceled its next monthly board meeting for a lack of consequential considerations.

The Department of Community Health emailed a notice Thursday morning, just minutes after the court had made public its health care decision, that a “sparse agenda” had precipitated the canceling of its July meeting. The email, sent by the executive assistant to the commissioner, said its next meeting would be held in August.

An incredulous Tipsheet source forwarded the two-sentence memorandum, expressing concern how “the board with responsibility for implementing Medicaid changes” could announce it was “canceling its July meeting because of a sparse agenda.”

A DCH press officer confirmed the meeting had been cancelled, but offered no more explanation as to why.

The recent health care law, which largely cleared a critical judicial hurdle today, stipulated an expansion of Medicaid eligibility guidelines underwritten by more tax dollars, first absorbed by the federal government and later by states. By 2020, individual state coffers would be ponying up ten percent of costs associated with the expansion.

Those states that refused cooperation would be stripped of existing federal funding.

Georgia’s Medicaid program, which DCH administers, consumes $21 million in state and federal funds per day. (The already-cash-strapped program has recently begun reorganizing the safety net for the state’s underserved population as it wrangles an expected annual deficit of more than $600 million by 2015.)

But the Supreme Court ruled today that while it was within the authority of Congress to expand Medicaid’s enrollment roster, it lacked the authority to enforce a punitive provision on those state’s that failed to acquiesce. “What Congress is not free to do is penalize states that choose not to participate in that new program by taking away their existing Medicaid funding,” Chief Justice John Roberts wrote.

State health chiefs from Washington State to Florida are already scrambling to reassess obligations in the wake in the ruling. But here in Georgia, the agenda is sparse.

- James Richardson

Tipsheet contributor Brandon Howell relays at the Daily Caller today the political vulnerabilities implicit in the Supreme Court’s looming health care opinion for incumbent moderate Democrats:

As lawmakers, activists, hacks and flacks alike wait with bated breath for the Supreme Court’s imminent opinion on the constitutionality of the Democrats’ health care law, expected to be revealed on Thursday, Washington’s lingering crop of Blue Dog Democrats are laying the markers for rough re-election bids.

Some are weighing whether to attack the court or the conservatives who fomented the decision, but all are increasingly desperate to move past it. The Blue Dogs were complicit in Obamacare’s adoption, and any reminder of that complicity is a nuisance to their efforts to feign moderation.

No one understands this better than embattled Georgia Congressman John Barrow. Facing a redrawn district that favors Republicans (just 44% of its vote went to Obama in 2008), Barrow is struggling to balance the liberal interests backing his campaign with the political realities of rural Georgia. Like former Blue Dog Jim Marshall, who represented a neighboring Georgia district until his defeat in 2010 by Republican Austin Scott, Barrow voted against Obamacare but has refused to say that he will vote to repeal it. Scott defeated Marshall in a district that gave a similar percentage of the vote to Obama in 2008, and he did so by vowing to fight for Obamacare’s repeal and railing against Marshall’s vote for the 2009 stimulus package. In all likelihood, Barrow will face a similar refrain this fall.

Read the item in full at theDC.

A bipartisan group of Dixie Congressional lawmakers will host a pair of roundtables on Tuesday to probe the region’s alarming HIV/AIDS infection rates.

Nine of the ten states in which new occurrences of HIV/AIDS are most common are concentrated in the South. With more than 2,000 new cases of infection in 2010, Georgia is among them: the Peach State ranked sixth by the Centers for Disease Control and Prevention’s most recent estimates.

Even still, the region claims a disproportionately low number of HIV specialists relative to traditional epicenters.

Tomorrow four lawmakers–two from each chamber, both of different parties–will co-host complimentary forums to examine that dovetailing dynamic.

Georgia Rep. Hank Johnson will be among them.

“Make no mistake — HIV/AIDS is devastating communities of color, women and young gay and bisexual men in the U.S., especially in the South,” the Lithonia Democrat said Monday. “We don’t want this to grow like it did silently in the late ’70s and early ’80s with gay men, and people were dying unnecessarily because there had been n attention paid to the rising numbers.”

Johnson’s co-sponsors include Republicans Senator Jeff Sessions of Alabama and Rep. Ileana Ros-Lehtinen of Florida and Democratic Senator Kay Hagan of North Carolina.

- James Richardson

As the Peach State’s 1.7 million Medicaid enrollment roster swells by another 600,000, a new report by a state health official has revealed the program is facing a massive shortfall north of $300 million.

Georgia’s Department of Community Health will lobby the General Assembly next legislative session for $308.2 million to plug fiscal 2013′s budget gap, its top financial officer said this week.

The program’s fiscal outlet has precipitated more serious consideration of shifting more patients from fee-for-service coverage to managed care.

“Right now we’re at about 16 percent of the state budget,” DCH Commissioner David Cook told Atlanta public radio WABE. “That’s projected to grow to 17 and 18 percent in just the next year or two. The numbers are not sustainable.”

State health officials are expected to finalize a overhaul scheme by summer’s end, at which time the DCH will entertain the bidding of private health care providers.

Already 1.2 million of the state’s Medicaid enrollees receive managed care from one of three private outfits.

But the program’s greatest expense is owed to the care of the blind, aged and disabled. It’s this group, whose per-patient costs register $9,500 annually, that relies on fee-for-service

Cook told WABE he’s hopeful a shift to managed care will benefit both the state and its disabled enrollees: “There’s a lot of talk about how we implement that. We can coordinate care so that we don’t do unnecessary tests; more communication between providers; more nurse follow-up on making sure people are taking their medication.”

- James Richardson