The start of the annual state Legislative session in Atlanta is something like the first day of school: a bit of anticipation all around, new folks finding their assigned seats and most everyone wondering what exactly will happen.
The expectation is a lot of focus outside of metro Atlanta, to those spots where doctors, transit and broadband internet are lacking; and how to work on that within Georgia’s budget.
The lawmaking year starts Monday with the swearing-in of Gov.-elect Brian Kemp and Lt. Gov.-elect Geoff Duncan, both Republicans. The majority-Republican state Legislature gets sworn in too, under the Gold Dome in Atlanta. It’ll have more Democrats than it has since 2012, so governing might be less of a one-party affair than it’s been in years.
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Health care problems are top-of-mind for many under the Gold Dome. According to the U.S. Census, about 13.4 percent of Georgians didn’t have health insurance at any point in 2017, almost five points above the national average. That uninsured rate is tough on rural hospitals that serve poorer patients than city hospitals, because hospitals have to write off the cost of caring for people who have no way to pay. Another important issue: all those Georgians who have a long drive between home and a hospital, nurse, obstetrician, psychologist, pediatrician or other specialist.
There are a couple of ideas out there to get more Georgians in front of doctors and nurses. Kemp and some others have suggested openness to putting some public money in health care for folks who don’t have insurance or who have especially high costs. But Kemp is opposed to expanding Medicaid, the nationwide health insurance that’s part subsidized by the state and part by the federal government.
And Kemp and Duncan both want to use more state tax credits — as much as $100 million — to get more private donations to struggling rural hospitals. As a state House representative, Duncan sponsored the 2016 bill that gives folks a state income tax credit worth 70 percent of what they donate to those hospitals. However, the program was capped at $60 million in 2018.
The donations help those hospitals create new revenue streams, said Duncan. “These hospitals have used these dollars … to buy new medical equipment for new procedures that allow them to create millions of new dollars in new revenue that helps them be self-sustainable,” he said in a pre-session interview.
Duncan is also looking to telehealth — when a medical specialist in one place examines a patient who’s in another via high-tech, online cameras, monitors and sensors. Telehealth brings efficiency to suburban parts of the state, Duncan said, and access to rural parts of the state.
State Sen. John F. Kennedy, R-Macon, also said he foresees a bigger emphasis on telehealth.
“The economics are such that … because of the limited number of doctors and health care professionals, you’re just not going to have someone a few minutes away if you’re in rural Georgia like you do elsewhere,” Kennedy said, in a conversation before session.
Meanwhile, panels in the both the state House and Senate have suggested partially opening up the highly regulated hospital industry to more providers.
There’s a state requirement that many kinds of would-be medical service providers show the need for their services before they’re allowed to open, say, an imaging service center. The idea of dismantling this system in urban areas has the most support, because the “certificate of need” regulation is seen as unfairly protecting some robust hospitals from competitors. But there’s apprehension about dismantling CON in rural areas, where it’s seen as protecting struggling rural hosptials from competitors that might try to swoop in and serve only the most lucrative patients.
But health care won’t be a one-year job. The state House’s top official, Speaker David Ralston, R-Blue Ridge, has just appointed a bipartisan special committee of lawmakers on “access to quality health care,” to focus especially on rural areas. It’s a typical strategy for Ralston when it comes to knotty issues: put together a panel of lawmakers who will study and work on something for more than the three months of session. Recommendations large or small may come from the committee, this year or next.
“This is an issue that we have kicked around here for many years in this Capitol,” said Ralston, “and it’s my view that it’s time that we kind of drill down, and let Georgians know what the issue is about and let’s resolve it.”
Georgia Democrats have for years endorsed an expansion of Medicaid to more residents.
That “remains the top priority for us,” said state House Minority Leader Bob Trammell of Luthersville.
“For our caucus, a predicate for any conversation about changing the framework in Georgia on certificate of need requires us to address the issue of Medicaid expansion. Rural hospitals continue to need the funding that would be available if we expanded Medicaid,” Trammell said.
And there’s at least one more medical question — that of medical marijuana. Georgians who have a state medical marijuana card can legally posses certain products made from cannabis, but Georgia law does not include any way to manufacture, buy or sell those products in the state. Even states that do allow cannabis cultivation are closing an eye to federal law that still classifies cannabis as a schedule I banned substance.
That last part, that federal law, is why Kennedy is not sure there’s traction for medical cannabis cultivation in Georgia.
“It’s hard to envision a long-term solution for that challenge of being able to get the medicinal value from cannabis products to those that need it, when it’s illegal under federal law,” Kennedy said.
Plenty of legislators share that worry, and it’s a big part of why medical cannabis cultivation legislation has not so far gotten through the full Legislature.
But on the other hand, the idea has its dedicated — and Republican — backers, who are winning more allies. Late last year, study committees from both the House and Senate endorsed some forms of cannabis cultivation.
Another big issue will be public transit outside of metro Atlanta, an issue that state House leaders promised to address this year. In cities like Macon and Columbus, there’s a need for “workforce” transit, said Columbus Democrat Calvin Smyre, who’s spent the time since early 2017 on a House transit governance and funding study committee.
Most Georgia counties have a transit system, even if it’s very modest. But there’s often a need to cross county lines to get from home to work and back.
“If we could find some kind of transit system, some sort of collaboration between the various counties, then I think we’ll have a tool for workforce development,” said Smyre.
One more big, ongoing problem is the internet — how connections are slow or nonexistent in parts of Georgia.
So far, companies haven’t found it profitable to run the fastest broadband out to every farmhouse and country town in Georgia. So those places are off-limits to would-be residents or investors who need fast internet.
The Legislature has discussed some form of subsidy or regulatory changes to get broadband to more places: maybe electric utilities could provide broadband; maybe fiber could be buried in state road rights-of-way. There’s even an idea of a telecommunications tax, which would include taxing video-streaming services like Netflix to underwrite rural broadband.
“I think broadband is foundational to so much to what we’re attempting to do to revitalize rural Georgia,” said Ralston, in a pre-session press conference Thursday. He called it critical to business, education and medicine, and said he’d endorse that telecommunications tax for rural broadband.
“Until we bring [broadband] to rural Georgia, we’re always going to operate with a handicap in those areas,” Ralston said.
The money question
Some other potentially pricey policy changes are on the horizon, like a new voting system. Pretty much everyone agrees the old no-paper machines need to go; and this year the Legislature is set to decide on some kind of new system that involves creating a paper trail. That could cost more than $100 million.
And, one of Kemp’s marquee campaign promises was a $5,000 raise for teachers. He’s been tight-lipped about how to pay for that at about $600 million annually — even as he’s also said he wants to cut taxes and cap state spending.
Details of Kemp’s spending plan should appear in January in the form of a draft state budget for a little more than $26 billion. The state House and Senate will draft their own budgets as well. The budget is the only bill that lawmakers must pass. And that will happen probably in late March, when the Legislature usually schedules the end of their annual session.