Expand Medicaid?

Moderated by Rick Badie

Gov. Nathan Deal has decided against expansion of  Medicaid, saying to do so would exacerbate the unsustainability of the program. His decision, writes the president of the Medical Association of Georgia, is no surprise given the deficits already facing the program and lack of resources to add patients. A health care advocate says policymakers shouldn’t spoil an opportunity to insure more Georgians and address comprehensive delivery of care.

By Sandra B. Reed

In my role as the president of the Medical Association of Georgia (MAG), the leading voice for physicians in the state, I wasn’t surprised when I heard that Georgia Gov. Nathan Deal said that he has “no intention” to expand the Medicaid system in Georgia.

The simple truth is that Medicaid is flawed and unsustainable. And change notwithstanding, that’s going to be the case whether the state expands the program by hundreds of thousands of new patients or not.

That is why MAG has — as matters have grown progressively worse —  called for a  sustainable solution for the Medicaid program in the state for a number of years. MAG believes that failing to do so will have disastrous results for our neediest patients.

The fundamental problem is that there simply aren’t enough resources to go around.

For example, Medicaid physicians in Georgia are paid at a rate that is less than the cost of service delivery.

The American Medical Association (AMA) reports that “a physician who treats a Medicaid patient can expect to be paid about 28 percent less than the physician would receive for providing the exact same services to a Medicare patient. For primary care services, it is even lower, about 34 percent less.”

This helps explain why the number of Medicaid physicians in the state has declined by more than 15 percent since 2009, according to the Georgia Department of Community Health. AMA says that less than 70 percent of the physicians in the U.S. accepted new Medicaid patients in 2011. Medicaid pay for physicians in Georgia has remained flat for 10 years, despite the effects of inflation.

And let’s not forget that these physicians are responsible for the same employee payrolls, bills and other financial obligations as any other business.

Note, too, that the Henry Kaiser Foundation has reported that the amount of money that Georgia currently spends on Medicaid patients per capita is already the third-lowest in the nation, at a little more than $4,000.

As if matters weren’t bad enough, Medicaid physicians are being subjected to an increasingly punitive administrative burden (e.g., prior authorizations, coding, audits) as a result of a multitude of government rules and regulations, fueled in large part by the Patient Protection and Affordable Care Act that went into effect in 2010.

Physicians aren’t going to bankrupt their practices to fulfill a government promise. Therefore, growing numbers of physicians have reached the breaking point, which means that it will become more and more difficult for Medicaid patients in Georgia to find the essential medical care they need because there simply won’t be enough physicians who are willing to participate in the program in the state.

The future looks especially bleak for primary care physicians in rural areas who have disproportionately high numbers of Medicaid patients, who should be concerned that this gap could ultimately be filled by less-qualified health care providers.

I see how public policy affects people in a personally relevant way as a physician who sees a number of Medicaid patients in my ob-gyn practice in Thomasville each and every day. I also know firsthand that physicians simply want to do what they were trained to do —  care for  patients.

MAG  will not assume a formal position on any Medicaid expansion in Georgia until its members consider the issue during its annual meeting in October.

We know with certainty that no matter what transpires, the Medicaid program must be adequately funded to ensure Georgia’s most vulnerable residents have safety,  security and peace of mind.

Sandra Reed is president of the Medical Association of Georgia.

By Cindy Zeldin

Nearly 2 million Georgians are uninsured; that number is among the highest in the nation.

Georgia policymakers have long recognized this problem as a tragic reality for the one in five Georgians who struggle to access medical care when they need it, as a strain on our state’s health care delivery system, and as a weight on Georgia’s economy.

Until now, however, they haven’t had the tools and resources to comprehensively address it.

What has changed?

The Affordable Care Act  put in place a basic framework to ensure that all Americans have a pathway to affordable health carecoverage.

This framework has three key components. First, those of us who get health insurance at work as an employee benefit will continue to do so.

Second, new health insurance marketplaces, or “exchanges,” will come on line in just over a year to help consumers who don’t have employee coverage at work find an affordable health plan that meets their needs.

Third, a new category of eligibility for Medicaid was created for the lowest-income consumers, many of whom work in low-wage jobs that don’t come with health insurance, yet earn too little money to afford a private health insurance policy.

In June, the U.S. Supreme Court upheld the constitutionality of the Affordable Care Act but ruled that states could choose whether or not to implement that third component, the Medicaid expansion.

Covering the lowest-income uninsured through Medicaid will provide access to basic prevention and treatment services that uninsured Georgians lack today.

A landmark study published last year by the National Bureau of Economic Research found that people who gained coverage through Medicaid were more likely to access preventive services and have a usual source of care than their uninsured counterparts.

A study published in the New England Journal of Medicine found that states that expanded Medicaid saw lower mortality rates, even after taking into account a range of other factors, than their neighboring states who did not.

In other words, if you want to improve health care outcomes, expanding Medicaid is a proven way to accomplish this goal.

The benefits to Georgia of expanding Medicaid go far beyond the 650,000 uninsured Georgians who stand to gain coverage. Because the Medicaid expansion is financed almost entirely with federal dollars, an infusion of resources will be pumped into our state’s health care delivery system.

If Georgia expands Medicaid, we stand to draw down approximately $14.5 billion in federal funds over the six-year period between 2014 and 2019, according to an analysis by the Urban Institute. In fact, Georgia taxpayers are already contributing towards the cost of the Medicaid expansion. It’s just a question of whether some of that money comes back to Georgia or whether we leave it on the table and allow it to be diverted to other states.

Last week, Gov. Nathan Deal announced that he did not intend to move forward with the Medicaid expansion, expressing concerns about the federal government’s long-term fiscal outlook. Just last month, states received word that they have an important element of flexibility: They can implement the Medicaid coverage expansion and, after a few years, if it isn’t working for them, they can withdraw.

There is no reason why Georgia can’t take advantage of the tools and resources before us to invest in our state’s health care economy today  and revisit our participation periodically to ensure that the federal government is meeting its end of the bargain and that the program works.

We have an unprecedented opportunity to improve the health of Georgia patients and consumers, strengthen our state’s health care delivery system, and bolster the state’s economy by moving forward with the Medicaid expansion.

Georgia policymakers should seize the moment and invest in our  future.

Cindy Zeldin is executive director of Georgians for a Healthy Future.

24 comments Add your comment


September 8th, 2012
11:30 am

Then I’m willing to have my taxes raised to pay our 10% of the new Medicaid deal. There, I said it.

[...] Expand Medicaid? Third, a new category of eligibility for Medicaid was created for the lowest-income consumers, many of whom work in low-wage jobs that don’t come with health insurance, yet earn too little money to afford a private health insurance policy. In June, the … Read more on Atlanta Journal Constitution (blog) [...]


September 7th, 2012
1:09 am

Pat @ 12:07 am – I hear and understand more than you know. surely you are thanking the good Governor too on his plans to spend $430 million dollars on a untested and unproven State Wide Charter school System in the next 60days or so. Whereas these same funds could be used to expand Medicaid coverage to your non insurance covered patients and you could be paid a little better. Sometimes our thinking becomes a little clouded when we are thinking of ourselves only.


September 7th, 2012
12:07 am

Thank you Dr. Reed for expressing the views of most practicing physicians in Georgia. Like Dr. Reed, I practice in south Georgia, and like her, the vast majority of my patients are already on Medicaid. And I do also see patients who have no insurance (yes, I ask them to pay, but for most of them, if they pay at time of service, my fees and the medicines I prescribe cost less than they would pay for insurance.)
So cut out the demagoguery about patients who don’t have insurance not being able to get medical care. And please do not call us immoral for not wanting the few patients that we do have who have insurance to drop it and go on an expanded Medicaid program. I make less working full time than my retired younger sister who is a teacher.
Just where do you think the Federal government is going to get this money to give to Georgia? They will borrow it and we and our children and grandchildren will have to pay the interest on it – unless the dollar is devalued and then where will our elderly on fixed incomes be? Spending more borrowed money is immoral. I thank Gov. Deal for having the courage to turn down “free” money that in reality is not free at all. I wish more politicians had his courage.