In The Art of War, great military tactician Sun Tzu tells us, “in the midst of chaos, there is also opportunity.” If the Supreme Court’s impending decision in King v. Burwell is to void the Obamacare tax credits, then approximately 400,000 Georgians who were forced by Obamacare’s decree to purchase an expensive health plan will no longer receive subsidies. As a result, conventional wisdom tells us that the true price of Obamacare plans will be realized and invite potential chaos into the health insurance markets. But there is some good news for Georgians. By passing the Georgia Healthcare Freedom Act in 2014, the state of Georgia executed a preemptive strike for a time such as this to protect its citizens from some of the most onerous provisions of the so called “Affordable” Care Act (ACA). As a result of the Georgia Healthcare Freedom Act and a court ruling that invalidates the Obamacare subsidies, the following outcomes could occur in Georgia:
- Individuals for whom insurance coverage became a greater out-of-pocket expense (exceeding 8 percent of annual income) without the subsidy will be exempt from the onerous individual mandate.
- Employers in this state would be exempt from the employer mandate because only state exchanges trigger the mandate, which could lead to Georgia attracting more jobs.
Moreover, Georgians will no longer face tax penalties, which average $1200, for not having insurance, and many of those who lose Obamacare subsidies will be able to buy cheaper plans that meet their individual needs, such as critical illness policies. In addition, individuals can take advantage of participating in “health sharing ministries” which are permitted to operate in the state of Georgia through a law that was passed in 2011 (House Bill 248). Health sharing ministries are a much more affordable opportunity for families and individuals and are one of the fastest growing alternatives to health insurance. Health sharing ministries also promote personal responsibility to staying healthy and allow people to share health expenses efficiently for the common good and free from a government mandate. Also, there is pending legislation (Senate Bill 74) that would allow for the establishment of “charity healthcare organizations,” which are funded through individual and corporate state tax credits to provide alternatives to lower income individuals who have difficulty paying for healthcare out of pocket.
Furthermore, the removal of subsidies will make the employer mandate unenforceable in Georgia. As a result, small businesses could hire more workers without having to worry about crossing the employer mandates 50-worker threshold, and businesses would no longer have an incentive to cut workers’ hours in order to keep the number of full-time employees down. Also, businesses would be able to raise wages for their employees. Georgia would continue to bolster its reputation as a business friendly state and attract jobs from states that have created state-based exchanges. Prospective companies will know they can avoid the employer mandate by relocating jobs to Georgia because we protect individuals and employers from these penalties.
Among other considerations, Georgia should deregulate or repeal its current Certificate of Need (CON) program to increase access to affordable care in the face of a subsidy eliminating decision. Georgia’s current CON policy limits the ability for communities in Georgia to expand health care facilities and provide greater access to affordable care. In particular, our rural communities have limited access because many hospitals in these communities have cornered the market in providing health services through the economic protectionism offered by Georgia’s CON policy. It has been demonstrated that Georgia’s CON policy restricts hospital bed availability. For example, with Georgia’s population of approximately 10.01 million, the CON program correlates with about 13,228 fewer hospital beds throughout the state. Unfortunately, rural hospitals are financially struggling as a result of an adverse combination of policies that includes Georgia’s current CON program, a perverted healthcare reimbursement structure, unsustainable healthcare price inflation, and the lack of price transparency in healthcare. Deregulating or eliminating Georgia’s CON policy would invite more affordable care options to rural Georgia.
Finally, we need to start appropriately expanding the scope of practice for physician assistants (PAs) and nurse practitioners (NPs) within the realm of primary care, especially in rural areas. The doctor shortage in Georgia is profound and recruiting young doctors to come to rural communities must be creatively incentivized, such as introducing student loan forgiveness in exchange for caring for indigent and low-income patients. Until we can attract doctors to these communities, practice barriers to PAs and NPs must be removed. For examples, NPs need the authority to order appropriate tests and PAs need to be able prescribe appropriate medications for patients who need them. If not, then we relegate rural Georgians to a Third World class status.
A decision by the Supreme Court that strikes Obamacare subsidies invites opportunity for our state to positively deregulate its health policy and become less dependent on federal largesse. Georgia’s current policy to prohibit the creation of a state-based exchange coupled with the court’s potential ruling to eliminate subsidies will result in a very large tax cut to individuals and employers alike. We have an opportunity to change our policies for the better, not to continue more tired government interventionist policies which have riddled Georgia’s healthcare system.
Representative Jason Spencer represents the citizens of District 180, which includes Camden, Charlton, and Ware counties. He was elected into the House of Representatives in 2010, and currently serves as the Secretary of the Special Rules Committee. He also serves on the Game Fish & Parks, Human Relations & Aging, Science and Technology, and Juvenile Justice committees.
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