Certificate of need and budget
issues at the fore of Emory legislative agenda with state lawmakers

In her first full year of representing Emory's interests to the Georgia legislature, Kathy Fine, director of state government affairs, finds herself with 20 items on Emory's legislative agenda. "The most important items are issues surrounding the Certificate of Need (CON) and the budget," said Fine.

Fine said she anticipates a legislative fight over CON, which is a law passed in 1979 to contain overbuilding of hospitals and health care institutions. "Georgia law really has not been overhauled since the initial 1979 law and could be streamlined," said Fine. "Some groups, particularly for-profit health care systems, support a total repeal of CON. Emory opposes the total repeal and has been working during the past year with the Alliance for Community Hospitals to develop a compromise proposal."

In support of that compromise, Michael M. E. Johns, executive vice president of health affairs, submitted extensive testimony to the Hospital Restructuring Committee on Jan. 22. "Emory's fear is that if CON is repealed, the non-profit hospital community will be undercut by for-profit systems, leaving little care for those who can't pay," said Fine. "Specialized services also will be threatened because it's not profitable to provide them.

"But our biggest argument is that quality of care and outcomes will suffer if there is a diffusion of excellence among small health care centers. Many studies show that good outcomes rely on a concentration of highly skilled teams. But in light of the political realities, which include a good deal of sentiment to do away with CON, Emory has worked with the Alliance for Community Hospitals on an alternate proposal."

Beyond CON, Fine is concerned with budget issues that include Hope Scholarships, Medical Education, Emory-held state contacts, the Georgia Research Alliance and Medicaid. Fine has developed a legislative position for each of these funding issues. "Medical education is threatened from all sides," said Fine. "In the past the expenses of medical education have been subsidized by patient care revenues, but managed care is driving away this subsidy and funding within Medicaid and Medicare is in jeopardy. No institution could pay the true costs of medical education, so we're looking to propose new ways to fund it, perhaps the creation of a trust fund within Medicaid or other mechanisms."

Emory's legislative priorities were developed by Fine following meetings last summer with the deans of Emory's schools and other administration officials. Afterwards, Fine developed an extensive notebook that detailed the issues Emory needed to monitor during the 1997 legislative session and Emory's position on those issues. University officers reviewed the legislative priorities and then Fine got to work on creating strategies to make them happen. "When President Bill Chace created the Office of Government Relations he wanted Emory to have a centralized approach to its advocacy at the state level," said Fine. "Many of the relationships with the state come through the health sciences center, and state funding to Emory totals nearly $8.6 million, with almost all specific contracts in the health sciences center. But I always remember that I'm working on behalf of all the interests at Emory."

Fine also worked closely with legislative groups from the Georgia Chamber of Commerce, the Georgia Hospital Association and the Medical Association of Georgia in preparing Emory's legislative agenda. During the Georgia General Assembly session, which began Jan. 13, Fine attends sessions and hearings, looks to form coalitions with groups who have similar interests and buttonholes legislators in the capitol's hallways. "There's so much going on and so much is at stake that I always worry about missing something," said Fine.

Fine noted that Emory's home district politicians Sen. Mary Margaret Oliver (D-42nd District) and Rep. Mike Polak (D-67th District, have been helpful to her during her first full year of representing Emory's interests at the Gold Dome.

"Some say the 40 days of the general assembly is 40 days and 80 nights," said Fine, who expects this year's session to end sometime in mid- to late-March. "If we can maintain our current contracts and retain the basic structure of Georgia's CON law, then I'll be satisfied with our efforts this year."

-Jan Gleason

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