How to care for the uninsured

Moderated by Tom Sabulis

Gov. Nathan Deal’s announcement this week that he would not expand Georgia’s Medicaid program because of its expense – even though the federal government says it will pick up at least 90 percent of the tab – brought an array of feedback. Democrats say the Affordable Care Act is a bargain and other states will gladly take the money due us. Republicans counter that the feds can’t be trusted to pay and that the state is seeking more creative ways to meet the needs of our uninsured.

By Pat Gardner

If you think we are scrambling now to come up with a workable Plan B to deal with transportation gridlock after the defeat of the T-SPLOST last month, think about this:

There are no options on the table – in Atlanta or Washington – to get as many as 1.3 million Georgians health insurance as fast or as effectively as implementing the Affordable Care Act would.

Georgia is getting a grand bargain under the new health care law. In less than two years the federal government will pay 100 percent of the cost of the Medicaid expansion and no less than 90 percent after that.

Such a generous level of funding will not jeopardize the state’s $19.3 billion budget, as the governor’s office had to acknowledge recently.

Turning away our share of the $35 billion slated to come to Georgia through the ACA – funds that will go to other states that will happily use it to expand their Medicaid programs – seems a fool’s game. Yet that’s what Gov. Nathan Deal said he would do when asked about it by reporters at the Republican National Convention in Tampa.

While we play that political game, our people will remain uninsured and New York, North Carolina, Ohio and other states will get to use our taxes to help their working families get the health care they need. Our tax dollars will in fact subsidize our business competitors in Charlotte and Knoxville…and that can’t be good for growing jobs in Georgia.

By expanding Medicaid an estimated 650,000 Georgians will no longer rely on hospital emergency rooms to get their care for free but will have access to a doctor in their community. A similar number will be able to purchase affordable coverage for the first time through private carriers selling plans on a statewide insurance exchange.

If we don’t implement the new law, the nearly  2 million Georgia adults under 65 will continue to go without health insurance, keeping us near the bottom among states in that dubious category. And this dismal statistic remains in place years after we have tried alternative plans that were supposed to reduce the number of uninsured and control costs.

You may remember some of these — caps on medical malpractice awards, mandated managed-care for Medicaid recipients, the sale of bargain basement, high-deductible plans, allowing insurers to get out of covering some benefits required by the state. It’s worth asking how those have worked for us.

Moreover, without the expansion those of us with insurance will continue to pay higher and higher premiums and co-pays because hospitals, doctors and others have to offset the cost of caring for the uninsured.

By some estimates this cost-shift or hidden tax inflates family premiums $1,000 a year. Why wouldn’t we want to get rid of this unofficial premium surcharge as soon as we can?

Still, the bottom line is this: Expanding Medicaid is simply the right thing to do. Most of the people expected to qualify under the new eligibility rules are the working poor — Georgians who work in low wage jobs . They still have to pay the rent, buy food and clothing — as well as health insurance — on that income.

They can’t afford to wait for a Plan B that doesn’t exist. Neither can the rest of us.

House member Pat Gardner, D-Atlanta, represents District 37.

By Sharon Cooper

On June 28, the U.S. Supreme Court gave states a significant gift when it ruled the Affordable Care Act (ACA) constitutional but struck down the part that allowed the federal government to financially punish states that refused to expand their Medicaid programs.

Thankfully, that change allowed states to continue to have the major say in determining their financial future.

Just as with Georgia families, this prolonged recession has made it necessary for the state to greatly reduce its budget.

With the governor’s leadership and the Legislature’s hard work, we have made the necessary cuts to balance our budget. Georgia remains only one of eight states with a AAA bond rating, which allows the state to save millions of dollars in bond interest that can then be used to fund critical  programs such as education.

The new law’s expansion requirements would add approximately 625,000 more Georgians to our Medicaid rolls.

A Kaiser Foundation report estimates the price tag for that expansion would be $4.5 billion over the next 10 years.

Our current Medicaid program already consumes 17 percent or $2.5 billion of Georgia’s budget, and its costs continue to escalate.

Given these facts, it would be financially reckless for our state to undertake a massive expansion of our Medicaid program.

Putting aside the steep cost, it is important to understand that access to coverage does not necessarily coincide with access to care.

Georgia has a major shortage of physicians, especially outside metro Atlanta.

Primary care physicians, who play a major role in the delivery of health care, are particularly scarce in Georgia. There are only 74 active primary care physicians for each 100,000 Georgians, making us a dismal 41st in the nation.

Our shortage of all types of doctors places our rank even lower. Georgia also has a deficit of other allied health providers such as nurses and physicians assistants.

Since Georgia already struggles to find physicians to treat patients in our current Medicaid program it would certainly be counterproductive to increase the number of Medicaid recipients by over 40 percent.

Tragically, in the 2,000-plus page ACA, the authors failed to include provisions for increasing the number of students graduating from medical schools and residency programs. By 2025, the U.S. will be short 130,000 physicians.

Georgia is being proactive in addressing this issue by increasing the number of our medical school slots and Gov. Nathan Deal has secured funding for additional residency positions.

Georgia continues to find innovative ways to provide health care coverage for our uninsured.

The establishment of 27 federally qualified health centers in Georgia with 163 service-delivery sites has increased access to cost-effective, patient-centered care.

The Georgia Association for Primary Healthcare estimates that the yearly per-patient cost at one of these centers is $385 compared to an annual expense of $4,510 per Medicaid patient.

We have also passed laws to encourage health care professionals to donate their time in free clinics across the state.

Quality patient-centered care is our goal for all Georgians.

Sharon Cooper, R-Marietta, is chair of the Georgia House Health and Human Services Committee.

52 comments Add your comment

Bernie

September 2nd, 2012
12:47 pm

William Harding @ 2:15 am – The idea of Physicians donating their time is IDEAL but not in the long term will not work. Georgia’s Physicians shortage could be wiped way in ONE Legislative ACT. An ACT they would never do because of the Millions of dollars donated to their campaigns and numerous free Lunches by AMA American medical Association,GA-AMA and untold scores of other physician related organizations.

If the Georgia Legislators would JUST give the Authority to the thousands of Licensed Physician Assistants and Nurse Practitioners the authorization to practice medicine independently in areas of Georgia where there is the greatest need of a Physician related services.

its the same type of primary and some specialty Medical Care that 80% of Atlanta’s Insured population now currently receive on a DAILY basis. Think on that the next time any of you got your Physician for medical services. For at least 50% of YOU the physician assistant and the Nurse Practitioner IS YOUR Primary Care Provider.
About another 25% of YOU have not seen a REAL PHYSICIAN in a year or more!

This comment will upset a LOT of people ……..Who are not truly concerned about the Healthcare system. Like Rep. Price,MD (r) & and good ole rep. Phil Gingrey md (R)
they both will tell you this is NOT a good idea! or its impractical! but strange how it is practical and working for millions of Atlanta’s citizens, 7days a week for YEARS!

at a cost reduction to GEORGIA insured plans in the BILLIONS!

Shhhhhhhhhh…….. You are NOT suppose to know that!

William Harding

September 2nd, 2012
2:15 am

Sharon Cooper’s submittal to the debate regarding Georgia opting out of expanding the Medicaid program as set forth by the Affordable Care Act is sheer nonsense. Her assertion that Georgia is finding innovative ways to provide health care to the uninsured by establishing 27 “federally” qualified health centers with 163 service delivery sites around the state is incredulous. She further asserts that the Georgia Association for Primary Healthcare estimates that the cost per patient on a yearly basis at one of these centers is $385 compared to an annual cost of $4,510 per Medicaid patient. Wow. If any of this were believable, Georgia should immediately shift all our Medicaid patients to these federally qualified health centers.

First, what is a “federally” qualifed health center? Is it a hospital? A clinic associated with a hospital? A “doc in the box” contracted with the state to provide medical services to the uninsured? Where are they located? Do the uninsured know where they are? Maybe this is why their costs are so low. Nobody knows they exist, so nobody uses them.

Second, what is the Georgia Association for Primary Healthcare? I’ve never heard of these folks before. Are they a group of concerned health care professionals? A group of doctors? A health care lobbyist organization? A lobbyist organization that specializes in providing bogus information to state legislators so they can submit stupid articles like this?

Finally, Ms. Cooper states the Georgia Legislature has passed laws “encouraging” doctors to donate free time to these clinics. When she says “encouraging”, what does she mean? Tax breaks? How many doctors are taking advantage of this encouragement and donating their time?

Here’s an idea. Why doesn’t our beloved state legislature and governor pass a real encouragement law by donating money to a medical student’s education in return for “x” number of years of free service at a health care clinic? This will go a long way to relieving the so called doctor shortage we have in this state. But this would take real leadership on the part of the state GOP, and we all know Republicans won’t do anything substantive if it costs money.