Fall 2020 Legislative Update

Adrienne D. Zertuche, MD, MPH, FACOG, Co-Chair, GOGS Legislative Committee

The local, national, and international events of the past six months have been, in a word, unimaginable.  Since my last “Legislative Update” (February 2020), we have been confronted by a global pandemic that has politicized science and public health and metamorphosed every aspect of our daily lives.  We have also seen national indignation over police brutality and overdue public discourse regarding systemic racism and the prioritization of diversity, inclusion, and equity.  While these times are certainly unprecedented — and often disheartening – our advocacy efforts have become more critical than ever.  Atlanta lost a great man when John Lewis passed away in July, but his voice lives on and words like these push us forward: “Do not get lost in a sea of despair.  Be hopeful, be optimistic.  Our struggle is not the struggle of a day, a week, a month, or a year, it is the struggle of a lifetime.  Never, ever be afraid to make some noise and get in good trouble, necessary trouble.”

Our GOGS Legislative Committee may not be getting in precisely the good and necessary trouble to which Lewis was referring, but we have certainly been hard at work on the legislative advocacy front.  When we have been lobbying for our 2020 health policy priorities, we have been, in our own way, advocating to improve the health and livelihood of Georgia physicians, women and infants — despite a debilitating virus, in the face of institutional injustice, and regardless of race, ethnicity, or socioeconomic status.

GOGS’ primary focus during the Georgia General Assembly 2020 Session was to continue the fight to improve our state’s maternal mortality/morbidity rates and disparities.  Georgia’s 2019 House Study Committee on Maternal Mortality (which included GOGS Advisory Board Members) recommended postpartum Medicaid extension as a vital strategy, and GOGS’ main “ask” during this year’s Georgia Patient Centered Physicians Coalition “Day at the Capitol” was means to support this measure.  To that end, I am thrilled to report that House Bill 1114 passed both chambers (despite the intervening COVID-related months-long recess) and was approved for $19 million in funding (despite an overall 10% cut to the state budget due to COVID).  This (now) law extends comprehensive Medicaid coverage for low-income Georgia mothers to six months postpartum and provides for lactational support services.  While a one-year Medicaid extension is certainly the ultimate goal – to facilitate ongoing monitoring, diagnosis, and management of potentially fatal postpartum issues like mental illness, addiction crisis, hypertension, and cardiovascular disease – the magnitude of this victory in the current state of affairs simply cannot be overstated.

Notably, another almost $2 million of the slashed FY 2021 budget was also allocated to increase Medicaid reimbursement rates for selected E&M codes.  Both the Medicaid postpartum extension and outpatient rate raise will help ob/gyns across Georgia keep their doors open during the COVID pandemic (especially in rural areas, where the payor mix is dominated by Medicaid, and maternal mortality rates and health disparities are often magnified).

In other good news from the Georgia capitol, none of the bills involving licensure of certified professional midwives (“lay midwives”) came to a vote on the chamber floor.  This success was due at least in part to testimony provided by GOGS Legislative Committee members.  As we emphasized at the committee hearings, our organization certainly has an interest in expanding access to obstetric services, particularly in our state’s rural shortage areas.  However, it is critical that any midwife seeking to provide maternity care to Georgia women meet minimum education and training standards, and CPMs traditionally do not.

Unfortunately, Georgia’s first true attempt at tort reform legislation in 15 years (Senate Bill 415) failed to pass the Senate and cross over to the House.  In partnership with the Medical Association of Georgia and our legislator allies at the capitol, our GOGS Legislative Committee will certainly attempt to reintroduce this critical issue next year.  Georgia now ranks 6th on the list of “Top 10 Judicial Hellholes” and 41st in the U.S. Chamber of Commerce’s Lawsuit Climate Survey.  In an increasingly litigious society, it is critical we make an effort to control professional liability costs.  Georgia is already struggling with a shortage of obstetricians, so we must do everything we can to make our state a more attractive place to practice.  To that end, one last-minute bright spot this Session was the Assembly’s passage and the Governor’s approval of Senate Bill 359, which provides certain liability protections for Georgia healthcare providers (including a heightened standard of gross negligence) during the COVID pandemic.

Before retreating into quarantine in mid-March, GOGS members did have the opportunity to meet with state elected officials at the Georgia Patient Centered Physicians Coalition “Day at the Capitol” (March 5th) and with federal elected officials as part of the ACOG Congressional Leadership Conference in Washington, DC (March 10th).  At the Georgia capitol, we lobbied for postpartum Medicaid extension, medical liability reform, and stringent midwifery licensure processes.  At the U.S. Capitol, we advocated for increased NIH funding for women’s health research and for postpartum Medicaid extension, as well.  Furthermore, we asked our U.S. legislators to urge the Centers for Medicare and Medicaid Services (CMS) to correct an oversight in which they did not apply E&M payment increases to global maternity care codes (which was anticipated to lower payment rates overall for obstetric care).  As a result, in early August CMS announced a proposal to increase the relative value of global obstetric care packages commensurate with increases for other types of office visits.  ACOG is still working with a broad coalition of other medical societies to waive the Medicare budget neutrality requirements for 2021 and thereby stop any further payment cuts.

While we have not seen each another in-person since these pre-COVID advocacy events, our GOGS Legislative Committee continues to be in communication via Zoom calls and WhatsApp messaging.  I am excited to announce that we recently reinvigorated the GOGS GynPAC Subcommittee, which has been strategizing a transparent process by which to evaluate and select state candidates deserving of PAC support.  We are also developing processes by which we will hold elected officials accountable for their actions, or subsequently consider directing their funds to others.  Furthermore, our Georgia Section recently submitted our inaugural application to the ACOG Ob-Gyn PAC Committee to request campaign contributions from this federal PAC to support our most-valued local women’s health champions.  We are optimistic these supplemental funds may be an asset to our political strategy for years to come.

Moving forward, while we anxiously await the November elections and the 2021 Georgia General Session, our GOGS Legislative Committee will continue to closely monitor COVID-related policies, with a focus on extending coverage and maximizing reimbursement for telehealth services.  Please do not hesitate to contact me with suggestions for legislative priorities, advocacy strategies, or anything at all.  Thank you, as always, for staying engaged in our efforts to improve the health and healthcare of the women of Georgia.  Our committee is proud to