Health care reform: Risk of playing the odds

The federal health care reform act is the law of the land for the foreseeable future. Delaying action on implementing its key provisions could well prove a costly bet for Georgia.

By AJC Editorial Board

Gov. Nathan Deal is no fan of expanding gambling beyond the Georgia lottery. Yet he’s willing to play the odds by betting that Obamacare won’t be on the books long enough to be fully implemented.

That’s too risky a strategy for Georgia, even taking into account the health reform law’s unpopularity in many quarters. Politics shouldn’t trump prudent policy, even during a major election year. To do otherwise puts Georgians at risk of getting a worse deal than those elsewhere.

For the foreseeable future, the federal Affordable Care Act (ACA) is the law of the land. And the rule of law should carry weight in a civilized society, even in these discordant times. The ACA has been tested by the nation’s highest court, and largely allowed to stand. Prospects for change, whether “repeal and replace,” something in between — or no change at all — are uncertain. And it’s hard to bank on uncertainty.

Georgia would do well to accept that fact and begin work to design the best possible health insurance system possible for our citizens within the ACA’s admittedly imperfect framework. Acting now is preferable, rather than doubling down on the iffy prospect of repeal.

The state’s Job 1 in this matter should be to gain the best health care deal possible for Georgians, both in costs paid and results gained in improved health outcomes.

We haven’t done that. In the latest example of ignore-it-and-hope-it-goes-away, Gov. Nathan Deal says he doesn’t intend to get underway on widening Medicaid’s eligibility net, as called for by the ACA. The state can’t afford it, he says, and Washington’s chronic fiscal flakiness makes promised federal reimbursements far less than certain.

Those are not unsound reasons, but they are political ones. And they leave Georgia with nearly 2 million people uninsured. Deal’s stance would save money in the state’s budget, true. But it would cost us in other ways, if health reform continues to be rolled out.

Georgia’s also chosen to not work on setting up the health insurance exchanges called for in the reform act. They would allow people to buy private insurance, presumably at attractive rates. If the law stands, and Georgia doesn’t act, the federal government will set up our exchange. Ceding such control to Washington through inaction shouldn’t be acceptable, especially to opponents of the ACA. Yielding to D.C. bureaucrats is unlikely to gain the best value for Georgians seeking health insurance coverage. Being proactive as a state will likely let us negotiate the best coverage deals.

We can do a better job of getting our money’s worth than simply dragging our feet on implementing the ACA. In the broadest sense, Georgians pay federal taxes that will be allocated nationwide to help to pay for the ACA. If we stubbornly ignore the present reality and take a pass on key points of the law, then money that would have made its way back here will go elsewhere. We shouldn’t subsidize other states when so many lack health coverage here.

As things now stand, the governor needs to detail just how his intention to not act would fill the current coverage gap that leaves 1 in 5 Georgians without health insurance. By saying “no” in effect to the ACA, Deal obligates himself to offer up a detailed, fiscally sound alternative. Just how would he move to solve a national problem at the state level? How would we save money while improving care?

Georgia needs answers and leadership on this issue that affects us all. We can do better, given that Democrats and Republicans alike agree that the current American way of health care is unsustainable and in need of overhaul.

Andre Jackson, for the Editorial Board

D.C. gift comes with too many strings

By Gov. Nathan Deal

Obamacare was sold as a collection of rich promises and benefits — a neatly wrapped gift with a bow on top. Today, 29 months later, every state is learning the hard lesson that the federal government’s version of Christmas morning comes with a big price tag. The proposed Medicaid expansion alone threatens to completely reshape state budgets, crowding out investment in core state functions such as schools, public safety and transportation.

Here in Georgia, we are constitutionally bound to balance the budget. This common-sense constraint means Georgia cannot afford Obamacare. Unless Congress moves to give states more flexibility — such as through a block grant program — it’s likely Georgia will opt out of the expanded Medicaid program.

To entice states to come onboard with the Medicaid expansion, the federal government is using an old trick: The first one’s free. But soon thereafter, the state’s on the hook for ballooning costs.

As such, states face an impossible choice. The federal government promises to pay the full cost of new enrollees for Medicaid for three years. After that, we’re told, states will pick up a share of the expanded population, ratcheting up to 10 percent by 2020.

Realists must express some incredulity about whether our bankrupt federal government is actually going to cough up the money — Washington’s new costs in Georgia alone will amount to $40 billion over 10 years. Even if it does live up to its end of the bargain, there’s no money in state treasuries to cover our part of the bill.

Changes to Medicaid will cost around $4.5 billion in additional state tax dollars over 10 years. Obamacare will add about 620,000 people to Georgia’s Medicaid rolls in 2014, meaning nearly one in four Georgians will be on Medicaid. States, Georgia included, will have to choose between job-killing tax hikes and immense cuts that will dramatically affect public education and public safety.

Even before the expansion, Georgia has struggled to pay the ever-increasing price for Medicaid, particularly as the recession has pummeled state revenues . For the 2013 and 2014 budget years, we face a $700 million shortfall in our Medicaid program — and that’s long before we have to start paying a 10 percent share on more than 620,000 new enrollees.

Unfortunately, Medicaid is just one challenge presented by Obamacare. Under Obamacare, expensive employer mandates will stunt private-sector job creation, effectively blocking the only real path to sustainable economic growth.

Obamacare, with its vast catalog of complicated new regulations and mandates, imposes unprecedented costs and uncertainties that downgrade America’s competitiveness. If allowed to stand, this singular piece of legislation will prove the largest tax on job creation in the history of our nation.

Thus far, I have followed the pattern of most observers and commentators in defining the Obamacare challenge in terms of costs and competitiveness, and while these concerns are well-placed, we focus on these “dollars and cents” issues at the risk of ignoring implications that I believe are more troubling still. By requiring citizens to buy a product, Obamacare is an attack on self-determination and personal liberty. It runs counter to the bedrock principles and freedoms that have defined the American character and experience.

The best hope for Georgia taxpayers is change in Washington this November.

Nathan Deal is governor of Georgia. This column originally appeared in the Washington Times.

Medicaid expansion is not a hard call

By Linda S. Lowe

Governor Deal has said he is leaning against extending Medicaid health coverage in early 2014 to 650,000 Georgians under 65. Federal funds would pay all the costs for three years and would phase down to 90 percent after that.

Here are a couple of facts and an all-too-real life story that bear on our state’s choices.

Fact: Georgia is conspicuous among the states for the high number of non-elderly who lack health insurance. We rank fifth among states with the highest numbers of uninsured, whether you look at numbers or percentages.

Fact: Despite what many believe, if you are an adult, you can’t get Medicaid in Georgia just because you are sick and poor. If you are younger than 65, with no minor children, and you don’t meet the tough Social Security disability standards, you can’t get Medicaid, period. Some parents of minor children can get Medicaid, but the income limits are very low if you are not pregnant. If you are a working parent with two children and income of more than about $10,000 a year, for example, your application would be denied.

Now for the story about a real person’s illness and the consequences for her, the hospital, the doctors who cared for her, and the rest of us: She is a homemaker who was 63 years old and, as it turned out, had colon cancer. In early 2008, she had begun to experience abdominal pain, bloating and diarrhea. She had no medical coverage so she tried to treat herself with over-the-counter medicine. The symptoms just got worse.

She saw a doctor that spring who wanted her to have an MRI, but she couldn’t afford it. She and her husband just get by on his Social Security retirement.

Several months later, the pain became so severe that she could only lie on the floor. She finally saw a doctor who confirmed she had a large mass and performed surgery the next day. However, by that time her colon was so distended that she suffered surgical complications, a lengthy hospital stay, another operation and prolonged chemotherapy.

Despite her life-threatening illness, this lady could not get Medicaid under Georgia’s current rules. If the Affordable Care Act’s Medicaid plan had been in effect at the time, though, she would have been eligible. She could have had earlier care and suffered less, and her treatment probably would have been a lot less expensive. The doctors and the hospital that treated her could have been paid instead of having to pass along the cost to people who are insured. It costs insured families an estimated $1,000 a year in higher premiums to pay for care for the uninsured.

This is where we are, then. Thousands of Georgians like this lady can remain uninsured. They can keep suffering from preventable or treatable conditions until things get too bad, and then get care that is unnecessarily expensive. We can all keep paying for it in higher insurance premiums, an inadequate trauma system, and community hospitals on the brink of closure because of their uncompensated care burdens.

Or, we can get health coverage for many more of our citizens using at least 90 percent federal funds and bring in $36 billion over 10 years that will shore up the state’s fragile health system and ripple through the economy in dozens of positive ways. And remember, we will keep paying our federal taxes for Medicaid whether we take back our share of the money or not.

How hard a choice is it really?

Linda S. Lowe is the health policy specialist for the Georgia Legal Services Program.

18 comments Add your comment


September 10th, 2012
4:53 am

Governor Deal was also falsely fearful the cost of running a federally funded high risk pool until the year 2014 under Affordable Care Act (ACA) would burden the state of Georgia because so many Georgians would sign up and the and the 117 million allocated to Georgia would run out, and Georgians might be left holding the bag. Well less than 2,000 people have signed up thus far.

Instead of providing jobs to Georgians to administer the high risk pool program, and designing lower cost options, like so many other states did (Like the State of Pennsylvania so smartly did), Governor Deal, again, sat on his hands for political purposes to try to please the Tea Party; and sadly, Georgia, Georgians and Georgia businesses were the losers in the end, because of his foolish recalcitrance.

Let me restate: Had Georgia elected to run its own high risk pool, it could have lowered its monthly premiums, and provided Georgians badly needed health insurance at a much better rate. The State of Pennsylvania charges a 50 year old around $297 per month, for health insurance, but Georgians, whose rate was initially based off what it’s state Insurance Commissioner allows for a basic individual policy, may pay around $500 to $650 a month, per person. That is $2,000 to $4,000 more per year, per insured individual in the most common age group. Because of Governor’s Deal lack of judgement, on this one area alone, there are less dollars being spent in our local economy. And, how many more Georgian might have been insured if the premium for high risk insurance was made more affordable locally? How many lives might have been saved?

Before ObamaCare, numerous national reports indicated between 40,000 to 50,000 people die each year because they were denied access to health care. Governor Deal is creating an unnecessary and immoral tragedy in our state.

bill copeland

September 10th, 2012
2:29 am

the economics of medicaid expansion are overwhelmingly in favor of an expansion. over the time of the expansion, the expansion of medicaid will result in a general fund PROFIT for the state of georgia (because the economic expansion from the medicaid expansion would pay back more in new taxes than the general fund cost to the state. further, the ‘no trust that the feds will pay’ argument of the governor will be rendered meaningless, if most of the states use the expansion–the politics at the national level would then be too powerful, if every state bought in to the expansion.

[...] Health care reform: Risk of playing the oddsAtlanta Journal Constitution (blog)The federal health care reform act is the law of the land for the foreseeable future. Delaying action on implementing its key provisions could well prove a costly bet for Georgia. By AJC Editorial Board. Gov. Nathan Deal is no fan of expanding gambling … [...]

Lynnie gal

September 9th, 2012
6:33 pm

Andre Jackson is correct. I resent my governor choosing to leave me and thousands like me in Georgia out of a health program that will help me. We pay Federal income tax. We should get a share of federal dollars to help Georgians. His decision not to expand Medicaid and set up state insurance exchanges is ignorant and disgusting. I will certainly vote against him and anybody in my district that opposes the ACA.

Vast Right Wing Conspiracy

September 9th, 2012
5:41 pm

Thanks to Governor Deal and his staff for doing their homework and stating the obvious – Obamacare is fiscal suicide for the states. The federal government and the democrats do not care about this, they just want another opportunity to tax people (get the camel’s nose in the tent, so to speak). Ask John Roberts.

Get your elective work done between now and the end of 2013, folks. You will have to go abroad after 12/31/13.


September 9th, 2012
2:06 pm

Christopher Sanchez @1:34 pm – As you have stated the Republican Party beliefs of Let THEM ALL DIE. The cost of not planning and opting in to this plan will Cost Georgia far more in loss of Jobs. When the planned Federal Hospital payment reductions kick in, the many Hospitals across the State would have no choice but to reduce staff by as much as 20% initially. More as time passes by. This will call for slower Healthcare delivery across the board for everyone, insured alike. Surgery availability times will be slowed, emergency room services will be have to suffer and slowed due to reduced staffing for all of US.

Pray tell where is the logic and intelligence in the causing of such a disruption. This is is a decision that is much more about the concern of MONEY.

Money, apparently the Governor feels there is no concern about. He is planning to implement a NEW BIG Government Program state wide called Charter Schools, that is unproven and untested in the next 60days!. There will be with an initial investment of $430 million dollars. Untold millions of dollars will have to be spent to justify the LOSS when it finally fails. Your argument although simplistic, fails in the face of the coming realities. The realities we will all experience if the BALL is not move forward not with foresight and planning.

The moment when the Governor does agree to OPT in. Surely he will instruct the carriers of that order to TAKE THEIR TIME. This is Georgia, nothing moves fast here, but Laziness and stubbornness, especially when it is something you do not fully support. I challenge YOU to inquire within your own Family and extended family. The number of members who have benefited from this very important program. You will be surprised at the results you will find. A Grandmother or Grandfather, Aunt or Uncle and/or several who have passed on already.

Christopher Sanchez

September 9th, 2012
1:34 pm

@Bernie: Tax and spend, tax and spend, there is far more to governing that simply raising taxes and spending money. Governing is about making choices and Governor Deal has done just that. Clearly you do not care of that choice in this instance but he has made a decision. Here’s the thing Bernie: there is ALWAYS going to be one more person to spend money on. There is always going to be one more person who has a tragic story to share. There is always going to be one more senior or one more child that didn’t receive assistance.

There is a limit to the finances available to help people. It really is that simple. How much more money shall be taken from people to help other people? Is it one percent like the TSPLOST that failed miserably? Is it five percent more? Ten percent more? How much more Bernie? Guess what? When government has said just a little more often enough and so little changes and vast amounts of resources thrown various issues with diminishing returns people get fed up. We work hard for our money (that is when we can find a job!) and many of us would simply like to hang on to more of what we have earned and have the benefit of our labor for our own families. There is nothing wrong with that either!

The fact is that there is no amount of money that will satisfy all of the government programs that could be created. Governing is about choices Bernie and sometimes we have to say no. The state of Georgia can opt in and expand Medicaid at a later date if we choose to do so. Right now, Governor Deal has weighed the benefits against the costs to the citizens of Georgia and made a decision. Many of us agree with his view.


September 9th, 2012
1:31 pm

An observer @ 12:52 pm – tell that to ALL of the Hundreds of Thousands of Georgia Citizens that receive the necessary Medical Care that allows them to stay alive and live a reasonable quality of life.

I can assure if you look within Your own Family and/or a Neighbor, you will find at least one or more of their family members have received a benefit from this very important program.

A Program without its many Benefits, they could not have survived financially or medically without it.