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.
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24 comments Add your comment
SAWB
September 6th, 2012
11:34 am
While the idea of expanding medical coverage for lower income working adults and the promise of $14.5 Billion Federal dollars sounds good I wonder how we pay for this. Ms. Zeldin needs to remember that “Federal Funds” do not come from a pot at the end of a rainbow, but from individual tax payers. Our National Debt is out of control and the economy is dragging we need to address these issues first.
Bernie
September 6th, 2012
11:43 am
Governor Deal is Wrong….. Again! on This decision that is SOLELY of HIS own making NOT To EXPAND The State Of Georgia Medicaid Program. just as his WRONG decision to support and promote the Ill advised plan of the T-SPLOST referendum this past summer.
The Hundreds of Thousands of Georgia Citizens who represent the most POOREST & NEEDIEST residents of Georgia will PAY the ultimate Price of DEATH and Untold numbers of Illnesses and preventable illnesses that will go untreated and not medically cared for as a result.
This decision by the Governor is a Politically motivated MOVE to show his support to the Republican Party and not for the WELFARE and CARE of the Millions of Georgia residents Governor Deal is PAID to represent.
The Millions of Georgia Citizens will REMEMBER this “ill advised” decision when a SECOND TERM for this Governor is up for consideration and Deny an expansion of a SECOND TERM as Governor of the STATE of Georgia.
fed up
September 6th, 2012
12:20 pm
Once again, If we expand the program, will Georgia give more to the immigrants/refugees than to its own citizens? Georgia will keep Grandma out of a nursing home to bring in more individuals then we can afford. If we do not receive any Fed dollars, who is going to pay more for all of the others?
Marlboro Man
September 6th, 2012
12:47 pm
Bad deal, hospital will close and people will die.
Sam
September 6th, 2012
1:53 pm
It is painful to see physicians who have sworn the Hippocratic Oath and gained public office, lobby for their own welfare rather than their patients. The additional stupidity of gathering federal taxes in Georgia and shipping them off to care for the patients in California, New York, etc. appears to be the antithesis of the usual self-serving Republican philosophy. The physician oversight (precetification, guidelines, etc.) are actually less in Medicare and Medicaid than most private insurance programs. These antiMedicaid views are clearly political and not based on good judgement.
Bernie
September 6th, 2012
2:05 pm
fed up @ 12:20 pm – Your comment is untruthful to its core and a repeating of a LIE.
There is no widespread use of Medicaid dollars on so called illegals or refugees.
The Governor and his party made sure of THAT! Nothing for them at ALL!
ZERO, NADA, ZIP, Goose EGGS, Snake Eyes, NOTHING!
The MAJORITY of citizens who receive Medicaid in Georgia are Seniors, Seniors in Nursing and hospital facilities, The disabled, White females and their children. There is a sizable number of African American women and their children as well, but by far the largest numbers can be found in the rural areas all over this State which are poor White Citizens of Georgia. Most whom are working in low paying jobs without health insurance and benefits for themselves or their children.
These are the FACES who will SUFFER the MOST! how can WE possibly claim to such GOOD CHRISTIANS and be a God Fearing people, when we are willingly ready to walk away, not care and ABANDON the POOREST Among US?
This is a VILE and Hateful act to be DENIED to fellow citizens of this STATE. This says more about WHO WE TRULY are as PEOPLE. NOT so much about WHO we CLAIM to BE as CHRISTIANS and as caring population.
This is NOT RIGHT! it is EVIL and Never considered the CHRISTIAN thing To DO!
fed up
September 6th, 2012
2:59 pm
Bernie, you need to find out why refugees/immigrants are put on Medicaid after 30 days of being here. Check with Dekalb County BOH. Do not jump down somones throat until you get all of the facts. It is a sure thing and a done deal. Check your facts before questioning mine. Maybe I know something that you do not. I do not want to see anyone suffer, especially the ones that need Medicaid. Why don’t you check into the facts, they may make you angrier.
Bernie
September 6th, 2012
3:13 pm
Ms.Reed with MAG has said a lot of things here but there are many things she has purposely not told you.
1. What has MAG done as far as lobbying Georgia legislators to increase Physician
Payments within the Medicaid Program?
2. She did not Tell or inform YOU of the amount of MONEY that organization
has donated to the Governors Campaign and other politicians at the
Dome, as well as Congressmen and Senators to lobby to PREVENT The Passing
and implementation of the President’s affordable Health Act. The amount of
money donated would ASTOUND YOU! or maybe not! I can assure you, it had
many Zeroes behind it, for sure!
3. She did not tell you of their NON support, Vote and lobbied the State Politicians
against the idea of putting Licensed Physician Assistants and Nurse Practitioners
in the rural areas. They are aware and know much needed medical care is
desired where many must drive for miles to get the most basic services.
They know providing them with authority to prescribe medicines and care
independently threatens their profession. and this cannot happen but other states
allow it. They know this would address Georgia’s long standing critical need in
those areas where physicians refuse to serve or not interested in.
She would not tell you of their use in Atlanta with at least 50% of insureds or more
now get their care from and the profession is not threatened in Atlanta.
4. she did tell you they are not willing to support the care of the many poor and
needy of Georgia right now through the Medicaid Expansion. but you can bet it will
stay the same as it is when the member physicians vote on it. If additional
money is not to be made to their liking, then they are not interested in it. Do not
expect them to request an increase of funds for Primary Care or any thing else.
This group hopes and prays, it all fails and burns into FLAMES. Do not expect a
change. Just more “NO”!
5. She did not Tell you of how the physicians are caught in a TRAP of supporting the
politicians who are against any of the Healthcare changes. And at the same time
not coming across to the the public as non-caring group of business people who
happen to be physicians who want to make more money in their profession.
something that would look very bad for them in the patients eyes. You know being
a DOCTOR and ALL then not caring looks BAD!
6. She also did not tell you of any of their IDEAS presented and proposed to our
State Leaders to make sure something is done to address the problems we all are
faced with as well. They Do NOT CARE!
7. Finally she did tell you that ultimately the STATE must spend more money on
Medicaid to provide the needed care for these POOR patients. However they
will not be the ones to lead the charge to make sure its done and will sit back and
let others do it and they reserve the right to JUDGE it, if it works or not.
8. Bottom line …if you want us to DO it…We Will, if The Governor Pays the
Physicians more! However, we know The Governor will NOT, because we are
donating TONS of money supporting his position to say “NO”.
This is part of the problem of a STEAMY MIX of VOMIT, we as Georgians and patients must deal with everyday. No one is looking OUT for US! Not the politicians
nor the Physicians as a Group. There may be a few physicians that disagree with this groups plans and ideas, but they are in a very small minority of VOICES.
Chris Sanchez
September 6th, 2012
3:13 pm
Governing is about making choices and Gov. Deal is doing what he believes is best for our state as a whole. If you have been caught up in the hype, relax. Nothing has changed and no, the sky is not falling. The same programs that have been there for decades remain in place. Nobody is being thrown out in the streets. The mortality rate is exactly the same as it has been throughout history…100%. Yep, 100% of people die. It is not a matter of if rather it is a matter of when.
Don’t try and drop this in the lap of Christians @Bernie. What have YOU done specifically to serve your fellow man lately? Have you donated any of your hard earned money? Better yet, have you volunteered your time to help those among us in need? Charity starts at home Bernie. Are you doing your part?
Bernie
September 6th, 2012
3:21 pm
fed up @ 2:59 pm – I am aware of the many Muslims from The Yugoslavia/Serbia conflict who are TRULY IMMIGRANT/REFUGEES who are authorized by the Federal government and the STATE of Georgia to receive those services.
I too was surprised to hear of it and saw it first hand myself. That is a NATIONAL authorization and NOT solely a state approved decision alone.
So as stated your intent was to inflame anger on our Hispanic and Latino communities. which they are not being given FREE services as your comment
would imply!
I differed with Your slick and dishonest assertion of the FACTS!
Rick
September 6th, 2012
3:27 pm
When Governor Deal allows politics to govern his actions, rather than morality, it is a sad day in Georgia. This is the Governor who pushed to give Gulfstream jet owners a sales tax exempt on parts last year. May God forgive him.
Bernie
September 6th, 2012
3:31 pm
Chris Sanchez @ 3:13 pm – Do not attack the messenger who is sharing truthful information with you. You need to put those same questions to Gov.Deal. he is the one who is denying the many citizens of Georgia of a federally funded and approved mandate NOT me! Other states will accept and utilize these funds as directed.
Citizens of Georgia will NOT because of REPUBLICAN PARTY LOYALTY!
Gov.Deal is the MAN who said NO to GRANDMA,GRANDPA, MOM and her children. Millions of them too!
ALL for a few GOLD COINS……now tell me again how such a Christian and caring ACT it is to deny the poor and needed, when it is in your POWER to CARE for THEM.. Jesus was Betrayed for about the same amount too!
You and I belong to TWO different forms of Christianity! I know what mine says and
Believes.
You and GOV.Deal belong to something else….I am not sure what it is…but Jesus is
NOT there for sure!
Paul Bolster
September 6th, 2012
3:38 pm
Meccaid expansion brings in $36 billion federal dollars over ten years. This cash infusion in Georgia’s health economy is estimated to have a $77 billion impact on the State’s economic activity.
I hope that we continue to develop more information on the effect of this program on the whole state. The Governor says that we can’t afford the $4.5 billion that it will cost the state to extend Medicaid to 650,000 uninsured Georgians. Here are some questions that still need to be answered before the decision is final:
1. How much revenue do state and local goverments bring in on $77 billion in economic activities?
2. How many new well paying jobs will be created by this economic stimulus to the Gerogia economy?
3. How many state and local dollars are currently spent providing services to the the population targeted for eligibility? How many of these dollars would be “suplanted” by the Medicaid dollars?
4. Will providers leave Georgia because other states have created better opportunities for them through their Medicaid expansions?
5. How many small businesses will leave the state because the health care of their low paid employees are covered in another state? How many will not come here or expand here?
6. How much will it cost Gerogia tax payers to pay for the Medicaid expansions in other states?
7. What are the economic and health benefits for rural Georgia?
8. What is the flow in the money through the federal tax system? I will bet overwhelmingly money coming into Georgia versus money going out in federal taxes. We ought to take the Yankee money and run.
Drik
September 6th, 2012
4:23 pm
Lots of folks quick to find fault for his not commiting us to the debt. Not too many folks who can identify real expenses that have to be cut and the prices to be paid after the federal money runs out. And there is nothing in Christianity that advocates using the power of the gun to force other people to yield money that you then give away. That is Ceaser that you are advocating rendering to, not God.
Bernie
September 6th, 2012
4:29 pm
DriK @ 4:23 pm – Ok.. Satan share more DEATH & DESTRUCTION with us. Let them DIE…let the OLD and the children get sick and provide no medical care!
no cares and no one should care!
It costs too much money! Ahhhhh! The Money! …….this is Your God!
USA! USA! USA!
SAWB
September 6th, 2012
9:03 pm
Man, I wonder if half of y’all really believe what you post on here.
Bernie
September 6th, 2012
9:35 pm
SAWB – 9:03 pm I do not know about the others But I stand by my comments 100% 24/7. Just exactly where is it that you stand. is it with the Governor or THE PEOPLE,your neighbors,fellow citizens and family members. We know where the Governor and Physicians stand. WHO will stand with the Seniors, women and the children. Tell me…. who is standing with them?
Bernie
September 6th, 2012
9:41 pm
it seems to me that the Republicans at the DOME are more interested in hanging a stone copy of the TEN COMMANDMENTS. but consciously, purposely and with great intent to avoid,deflect to carry out the very precepts they claim to believe in. These are PAPER CHRISTIANS. Those who will point at a some intangible object and say LQQK at what I did? When you ask to show me what have you done for the POOR and least among you? they will look away and there is no response!
Only Silence…………………
SAWB
September 6th, 2012
11:40 pm
Well, I hope I stand with logic, common sense and responsible behavior. I am no Kool-aid drinker who blindly follows a political party or hates another simply based on that affiliation.
I understand the need to get the nation’s fiscal house in order and get the economy going again to increase the tax payments allowing us to pay for some of these programs. I am by no means a fan of Mr. Deal and not really much of a fan of the Republicans right now, but I do believe at least sometimes they seem more like the “grownups” when it comes to fiscal issues.
Also, I am someone who fears if some of the rhetoric here is genuine and representative of larger portions of the citizenry there is no way we will ever reach any meaningful consensus on important issues.
Bernie
September 7th, 2012
12:00 am
SAWB @ 11:40 pm – Your Stand and Vote as I interpret is to let this portion of our population to fend for themselves the best way possible and refuse this mandated federally funded plan.
While this same Governor is prepared to spend $430 Million Dollars in 60days on a unproven and untested State Wide Charter School plan that will only serve about 15% of the minor student population of the entire State of Georgia. I can think of a better investment into our present healthcare crisis of these same funds. how about you?
Pat
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.
Bernie
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.
Sebelius delivers defense of health insurance reform | Health Care Symbol
September 7th, 2012
9:05 am
[...] 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) [...]
Heika
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.