On March 27, Governor Brian Kemp signed the Patients First Act into law. The law allows for the submission of two waivers to the Federal Government by the State of Georgia and if approved, make changes to healthcare systems by working around regulations set by the Affordable Care Act.

The purpose of the Act

While the Governor’s office looks for solutions to Georgia’s health needs, Cody Hall, Governor Kemp’s Press Secretary, made it clear that the law was not a cure all for the issues facing Georgia patients.

“The Patients First Act is not a silver bullet to solve all of the healthcare problems in the state,” said Hall. “We think the Patients First Act could help, with reforms to the current Medicaid population.”

Speaking on the bill’s purpose, Hall said there were three main points to passing the Patients First Act in Georgia.

“Our overall goals are threefold, number one to lower cost for hardworking Georgians, number two is to increase access across the state, and number three is to improve quality of care both on the private insurance market and for the Medicaid population.”

Waivers to Federal Law

The waivers created for submission by Georgia to the Federal Government are of two types. The first is called a 1115 waiver, which allows state governments to ignore or waive provisions put in place by federal regulation in order to use federal funds for Medicaid in ways not typically allowed by federal rules.

“Section 1332 of the Affordable Care Act (ACA) permits a state to apply for a State Innovation Waiver (now also referred to as a State Relief and Empowerment Waiver) to pursue innovative strategies for providing their residents with access to high quality, affordable health insurance while retaining the basic protections of the ACA,” according to the Center for Medicare and Medicaid Services.

Amending the State Budget

The new law creates an opportunity for change to Georgia’s healthcare system by amending the state’s Fiscal Year 2019 budget.

The immediate effect of the change is that now, “there is an allocation of funds to ensure that the Department of Community Health can submit a bid process for a consultant to come in, look at Georgia’s population, and identify where problems are,” as well as submit plans for a solution to the Governor, according to Hall.

This consultant will be from a third party private firm.

Now that the bill is signed into law, “the Committee of Health is going through multiple vendors, there’s a bid process within state government that anything like this has to go through so that it’s open, transparent, and able to be viewed by the public,” said Hall.

After the planned solutions are submitted to the Governor, a team from the Governor’s office will review the recommendations and create waiver plans for both the 1115 and 1332 waivers made in the Patients First Act.

What this changes until the waivers are submitted to the Federal Government

While no changes will be affected in the current healthcare system until the waivers are submitted to and approved by the Federal Government, the passage of the bill into law does change some of Georgia’s legal code.

Specifically, the Patients First Act’s final section, which repeals “all laws and parts of laws in conflict” with the Act will lead to some changes. While this section of the Act is common in law to prevent conflicts between codes in other laws, a previous piece of legislation will be removed as a result.

House Bill 990, which explicitly “prohibits Medicaid expansion without legislative approval” was signed in 2014 by former Governor Nathan Deal.

According to Hall, HB 990 took away the authority of the Governor to submit federal waivers without legislative approval, Through the Patients First Act, HB 990 “may in fact be repealed by the legislation.”

Going forward

Hall said that the bill could potentially help the state improve funding for hospitals, with a number of hospitals in rural communities having closed since the Affordable Care Act passed, which had been a subject of concern for Kemp as well.

“Since 2010, eight hospitals have closed their doors – losing jobs, economic investment, and access to care,” Kemp wrote in an op-ed in the Atlanta Journal-Constitution on Feb. 17.

Going forward, Hall said the Governor wants to address problems for Georgians in the healthcare system, where they believe families “are paying too much” while “quality health outcomes just aren’t there for a lot of Georgians.”

By adjusting the current Medicaid laws in place, Kemp’s office hopes to find ways to “add to the rolls” according to Hall, and get more Georgians the healthcare they need.