Two views: Should Georgia establish health exchange?
Moderated by Tom Sabulis
Georgia should not establish a state health exchange under the auspices of Obamacare, argues a writer with a libertarian think tank. After all, the state will have no real control over the exchange. It would cost too much and would also mean higher taxes. But a local health policy expert says it’s a great deal for citizens who can take advantage of new federal tax credits to purchase private health insurance and will see billions pumped into the state economy.
Commenting is open below Tim Sweeney’s column.
By Michael F. Cannon
President Barack Obama has won re-election, and his administration has asked Georgia officials to decide by today whether the state will create one of ObamaCare’s health insurance “exchanges.” Georgia also has to decide whether to implement the law’s massive expansion of Medicaid. The correct answer to both questions remains a resounding no.
State-created exchanges mean higher taxes, fewer jobs, and less protection of religious freedom. States are better off defaulting to a federal exchange. The Medicaid expansion is likewise too costly and risky a proposition. Since the election, many state officials have stood by pledges to implement neither provision. Gov. Bob McDonnell (R-Va.), chairman of the Republican Governors Association and who was on the fence prior to the election, has announced Virginia will implement neither.
There are many arguments against creating an exchange.
- State officials are under no obligation to create one.
- Operating an ObamaCare exchange would be illegal in the 14 states that have enacted either statutes or constitutional amendments (or both) forbidding state employees to participate in an essential exchange function: implementing ObamaCare’s individual and employer mandates. Georgia is one of those states.
- State officials would have to find an estimated $10 million to $100 million per year to run it, raising the prospect of tax increases.
- Today’s deadline is no more real than the “deadlines” for implementing REAL ID, which have been pushed back repeatedly since 2008. Georgia can always create an exchange later if officials choose.
- A state-created exchange is not a state-controlled exchange. All exchanges will be controlled by Washington.
- Congress authorized no funds for federal “fallback” exchanges. So Washington may not be able to impose an exchange on Georgia after all.
- The Obama administration has yet to provide crucial information that Georgia officials need before they can make an informed decision.
- Creating an exchange sets Georgia officials up to take the blame when ObamaCare increases insurance premiums and denies care to the sick.
- Creating an exchange would be assisting in the creation of a “public option” — a federally chartered health plan that thus enjoys special perks and could drive Georgia’s insurance carriers out of business through unfair competition.
- Defaulting to a federal exchange exempts Georgia employers from the employer mandate (a tax of $2,000 per worker per year), and exempts 625,000 Georgia residents from the individual mandate (a tax of $2,085 per family of four). Avoiding those taxes will improve Georgia’s prospects for job creation. It will also protect the conscience rights of Georgia employers and residents from the Obama administration’s contraceptives mandate.
- Finally, rejecting an exchange will reduce the federal deficit. ObamaCare only offers its deficit-financed subsidies to private health insurance companies through state-created exchanges. If all states declined to create one, federal deficits would fall by roughly $700 billion over 10 years.
The Supreme Court gave states the option of not implementing ObamaCare’s Medicaid expansion. Georgia should refuse to implement that new entitlement for similar reasons.
Medicaid is rife with waste and fraud. It increases the cost of private health care and insurance, crowds out private health insurance and long-term care insurance, and discourages enrollees from climbing the economic ladder. There is scant reliable evidence that Medicaid improves health outcomes, and no evidence that it is a cost-effective way of doing so.
Michael F. Cannon is director of health policy studies at the Cato Institute, a libertarian think tank.
Health care, politics don’t mix
By Tim Sweeney
Rather than continue the political debate over the Affordable Care Act, Georgia’s leaders should seize the opportunity it offers to make affordable health insurance available to more Georgians, particularly by expanding Medicaid.
Georgia already ranks near the bottom when it comes to health coverage, and failing to implement provisions of the law that will cover more Georgians would simply aggravate the problem.
Expanding Medicaid, a decision the Supreme Court left up to the states, could mean health coverage for more than 600,000 low-income Georgians who would likely remain uncovered otherwise. Importantly, they would have better access to primary care instead of being forced to rely on sporadic, expensive emergency room care that Georgians with insurance often end up paying the tab for through higher premiums.
The expansion is also a great deal for Georgia, as new federal funds will cover all of the costs for newly eligible Georgians in the first few years, and at least 90 percent of the costs in the long term. This will be good for Georgia’s economy, too, since the money will be used to pay doctors, hospitals, pharmacies and other health care providers throughout the state. In the first three years alone, the expansion could pump $8 billion into the state’s economy.
Claims that Medicaid is ineffective are wrong. To the contrary, Medicaid expansions in other states have improved health outcomes, boosted residents’ financial security, and even reduced death rates. In Georgia, Medicaid serves more than 1 million children from low-income families and is the primary payer for hundreds of thousands of elderly Georgians and people with disabilities who receive long-term care in nursing homes or community settings. Without Medicaid, many more Georgians would go without health coverage and would face increased financial hardships as a result.
National organizations opposed to health care reform are urging Republican-controlled states not to expand Medicaid in yet another effort to stall and delay the law. They are playing political games at the national level and do not have the interests of Georgia consumers and taxpayers at heart.
These groups are also lobbying against state-based private health insurance markets, or exchanges, under the guise that declining to establish one is akin to “opting-out” of Obamacare and will prevent other parts of the law from taking effect. In reality, since Georgia has failed to lay the groundwork for a state-run exchange, Georgians will instead be served by a federally facilitated exchange. While this is a missed opportunity to build an exchange tailored to our needs, a federal exchange will still allow Georgians to take advantage of new federal tax credits in 2014 to help with the purchase of private health coverage, and other parts of the law will still take effect in Georgia.
Georgia still needs to work with the federal government to ensure that Georgians are well-served by the exchange in the short term, and state policymakers should continue to examine whether a Georgia-run exchange is best for the state in the long term. The time for playing politics with health coverage is over. It’s time for Georgia to move forward and implement the law so more Georgians will have affordable health coverage and the peace of mind that comes with it.
Tim Sweeney is director of health policy at the Georgia Budget & Policy Institute.
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31 comments Add your comment
SAWB
November 15th, 2012
5:24 pm
It does seem like another layer of needless bureaucracy. This entire thing is so cumbersome that no one really understands it or the ramifications of one decision over another. Even the people who passed it admit as much when Ms. Pelosi famously said, “…we have to pass the bill so that you can find out what is in it…”. Long term it might be the right move for Georgia, but I say wait and see how everything shakes out.
Don Kramer
November 15th, 2012
8:50 pm
Mr. Cannon is incorrect. Defaulting to the federal exchange does not exempt Georgia from the employer and individual mandates – states are only exempt if they already have a health care system that meets standards (such as Massachusetts). Whether Georgia steps up and creates the exchange or if the federal government does it, the future will be brighter in 2014 for Georgians disenfranchised in obtaining healthcare via coverage in the individual market because of a pre-existing condition. As well as it would be a travesty if Georgia does not expand the Medicaid piece of health reform – it is far more cost effective (as well as morally the right thing to do) for people to be able to see a primary care physician or specialist by being insured by Medicaid, rather than showing up in the ER at Grady weeks or months later with something that could have been more easily treated early on. In some cases, such as a undiagnosed rapidly developing cancer – it can mean the difference between life and death.
Two views: Should Georgia establish health exchange? – Atlanta Journal Constitution (blog) | YellowField.net
November 16th, 2012
12:42 am
[...] Thе rest іѕ here: Two views: ShουƖԁ Georgia establish health exchange? – Atlanta Journal Consti… [...]
John Wadford
November 16th, 2012
1:20 am
I say screw the Obama administration and their mandate. Georgia needs to fight!!! The mandates need to be totally removed both the businesses and indivisual mandates. Do not give in and give Washington hell! Companies are cutting hrs due to this crap! It’s high time that Barack knows the people are pissed about this crap and we aren’t going to take sh!t from him.
Health Care Law: GOP Govs Opt Out of State Exchanges – ABC News (blog) | Health Stop
November 16th, 2012
3:51 am
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November 16th, 2012
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DeborahinAthens
November 16th, 2012
6:56 am
The exchanges are the way that an individual can find the lowest price and best coverage for their family. It allows the “free market” to bring costs down. Obama originally wanted a single payer plan, which would be the best. We still have too much involvement by the health insurers. Tim Sweeney is so cute. He is touting all the good things that will come to the citizens of Georgia–better health, lower death rates from diseases that can be prevented–when it is clear that the Republican Party doesn’t give a rat’s ass about whether their fellow man suffers. I read an article before the election that said the Repugs come off as having the attitude that “I have mine, if you don’t have yours, tough!”, and I have to agree with that. Personally, I have good health insurance through my company that has always given its employees access to health insurance. Through the years, their costs and my out of pocket costs have skyrocketed. I hope, with Obamacare, the rates will stabilize.
Debbie Dooley
November 16th, 2012
7:22 am
Mr. Cannon is absolutely correct. Government run health care is not the solution. If you think government run health care is the solution, then I suggest you check with patients under the care of the Veterans Administration or check with patients on an Indian reservation If the states don’t set up the exchanges, the federal government can come in and set them up. The federal government does not have the money to do so and any funding would have to be approved by the GOP controlled House. This is one reason the Obama Administration has extended the deadline the Governors have to inform HHS if their state will set up the exchange. They know the extreme diffuculty the Feds will have in setting up the exchanges.
I am hoping 15 or more states will refuse to set up the exchanges. There are 23 states that have GOP governors and both state legislative branches are controlled by the GOP. Tea party activists in these states are putting pressure on their Governors not to set up the exchanges.
Our nation cannot afford ObamaCare without plunging over the fiscal cliff. We need heath care reform and free market solutions to our health care crisis – not government run solutions.
Ralph
November 16th, 2012
7:55 am
The Libertarian Cato institute is so concerned about their own taxation and individual liberty that they do not seem to care about the child with acute leukemia who did not receive a bone marrow transplantation in Georgia because he did not have Medicaid coverage and his father’s insurance would only pay $10,000. He is now dead. Also, their concern for their own finances does not seem very rationale because they will still pay federal taxes which, instead of coming back to Georgia, will now be dispersed to those states that expand their Medicaid programs, like California and Massachusetts. Since when did the Cato Institute decide to encourage the economic welfare of California over that of Georgia?
Anton Chigurh
November 16th, 2012
8:30 am
“State officials would have to find an estimated $10 million to $100 million per year to run it, raising the prospect of tax increases.”
This is a GOP talking point. A range that wide is obviously not an estimate at all, but a propaganda scare tactic.
Not for or against the issue, but am always against BS.
Anne Beal
November 16th, 2012
10:20 am
People who think having health insurance means that they will get expensive cancer treatments paid for are not facing reality. When I lived in Georgia we had Blue Cross Blue Shield and it was like pulling teeth to get them to pay for ANYTHING. First they would claim they were waiting to see what the co-insurance paid. There wasn’t any co-insurance. Then they would claim that the providers had charged twice the allowable charge, so they would pay 80% of the allowable charge, and we’d have to pay the balance, or 60% of the total bills. There is nothing in Obamacare which would remedy this problem: the providers still get to charge whatever they want, and the insurance companies can continue to pay as little as they want. As long as the insurance companies spend 80% of their revenues on benefit payments, they can get away with it. There’s nothing to stop them from being generous with claims for the first few months of the year, then denying claims after they reach 80% of their revenues. So the child whose father’s policy would only pay $10,000 for a bone marrow transplant would still not get one. The notion that a state health insurance exchange will solve all these issues is just not founded in reality.
Health care, politics don’t mix | Georgia Budget and Policy Institute
November 16th, 2012
10:23 am
[...] As published by the Atlanta Journal-Constitution [...]
jd
November 16th, 2012
11:07 am
Hmmm… so glad we are gonna see more jobs here in Ga… guess these jobs will arrive as soon as the ones get here because we cut taxes, eliminated class action lawsuits, cut spending on education, gutted environmental protection… Yep, we lead the nation in job creation.
Tim Barnes, CLU
November 16th, 2012
11:15 am
Obviously, this article was written in the past. Apparently, Kathleen Sebellius extended the deadline from November 16 to December 14 for states to declare if they were going to run their own Exchanges. As it stands now, only 17 states plus the District of Columbia have agreed to set up their own Exchanges. The rest of the states have defaulted to allow a federally run Exchange, at least for 2014.
DownInAlbany
November 16th, 2012
11:41 am
As a healthcare professional, I have followed this with great interest. It is very difficult to understand given the previous comments that even Congress doesn’t understand the full ramifications of the bill they passed. As I understand it (with the caveats above), states are not required to implement the exchanges and the feds neither have the authority or the funds to implement at the nation level. As a side note, the “deadline” has been extended to December 14, I believe.
The bottom line is this…sure, we have people who are not receiving needed healthcare, but, it’s not solely because the help is not there. Our practice does not turn anyone away, regardless, of their ability to pay. Most public hospitals are in the same boat…they are prohibited from refusing care. Unfortunately, that (the ER) is the most expensive venue to treat patients.
My point is, this law does nothing to improve healthCARE…it simply addresses heatlh INSURANCE. It does nothing to address the COST of healthcare. These are related, but, very different conversations. With insurance exchanges this is what I see happening: we, for example, provide health insurance policies for our employees (at a cost of +$800 per month). This is a benefit. We cover the entire cost. If I, as a businessman, have the option of continuing the $800 per month or pay the $2000 fine. Which makes financial sense to you? If employes take pay the fine rather than provide coverage, the employees end up in the exchange where I’m sure payments to provider will be a Medicaid type levels. This will drive many physicians out of practice, or they will refuse to accept these patients, further exaserbating the problem
VERY complicated with no easy answers…
yuzeyurbrane
November 16th, 2012
12:02 pm
Don Kramer is correct on the facts. It is about time the radical right wingnuts realize that the battle is over and it is time for pragmatic nonpartisan on implementing the law of the land. They may not like it but they had multiple chances and killing Obamacare and, with the exception of the Medicaid issue, were rejected by the Supreme Court, the American people or both. Continued lieing about the facts will not change the outcome. And, quite frankly, considering the state of Georgia governance, I am not sure if the citizens of Georgia would not be better off with a Federally run exchange.
Michael
November 16th, 2012
12:19 pm
GA OPTING DO NOTHING ON HEALTH CARE!!!….Just more “Good Ol’ Boy” Politics that run so deep in this state! All under the fog of huge miss-information by far too many “entertainment journalists/organizations and concerned citizens” that way too often make a very comfortable livings and personal gain promoting dissension; Give Me a Break!!!…what about the current state tax structure/revenues (income, property, sales, lottery…etc); you just got to know huge chunks of money are going for yet another 2-3 year study somewhere or “Grease Money” to keep the gravy train moving. GA politics has become an art form of how to look busy yet get nothing done blaming the “other guy”.
SHAME ON US FOR LETTING THIS CONTINUE IN GEORGIA AND NOT HOLDING ALL ACCOUNTABLE…Lost jobs, a very sluggish economy and falling standard of living is OUR FAULT for enabling one political class of PLAYING NOT TO LOOSE at CITIZEN EXPENSE.
curious
November 16th, 2012
2:55 pm
ER doesn’t provide the comprehensive level of healthcare that will drive down the overall costs through prevention. You can save short term by not checking/changing the oil in your car, but one day the engine is going to blow up.
However, better medical care might decrease death rates and that is counter to the Republican plan to “just let’em die”.
MrLiberty
November 16th, 2012
3:06 pm
We have one guy saying that healthcare and politics shouldn’t mix and two guys who deperately want at some level for the politicians to stick their nose into healthcare. What is wrong with trying FREEDOM and actually separating politics from healthcare.
Here’s where to start:
Mandatory coverage – currently GA mandates 24 separate items that EVERY health insurance company MUST cover for every policy. These include mental health coverage, drug abuse/rehab, alcohol rehab, and others. The addition of every single mandate raises the cost of coverage. Eliminate these mandates completely and allow insurance companies to sell a’la carte policies so that individuals can purchase only what they need, thus reducing their prices.
Out of state insurance – currently GA prevents the sale of health insurance from out of state companies. Why? Aside from pure protectionism for in-state companies (or to extract taxes, etc. from companies that open state offices and deal with the state bureaucracy, there can be no other reason. Being able to purchase insurance from lower cost companies in other states would do two things – lower the cost to consumers, and encourage the legislature to make GA even more insurance friendly thus attracting even more business.
Profession licensure – Every state in the union colludes with the AMA and other so-called professional organizations (really just lobbyists) to reduce the availability of services to keep prices higher. Restrictions on who can be licensed, how much they must pay, what services they can and cannot Again, protectionism from government to disinfranchise customers, drive up prices, and restrict access to competition. These restrictions and regulations need to go. Health care providers must be held accountable for their actions, their product claims, and consumers must be allowed to chose for themselves who they wish to have perform what service for them in the healthcare realm. This would also have the immediate effect of lowering prices and providing far more competition in the healthcare sector at a time when doctor shortages, etc. are impacting the basic ability of people to even find a caregiver.
End the state war on drugs – cannabis has been well-documented over the past 10,000 years of use to be highly effective at addressing literally hundreds if not thousands of medical ailments. Plenty of other safe plant products have also been used by cultures all around the world that remain illegal because of politics, protectionist regulations (designed to provide a protected monopoly to bigPharma,etc.), and an unwillingness of spineless state legislatures to stand up to Washington thugs. Colorado and Washington states have shown us the way. Georgia too should stand up for freedom and tell Washington to stand down and allow us the freedom to decide to what degree we wish to allow persons to own their own body and control what goes into it.
I am sure that there are plenty of other government-created issues that are driving up healthcare costs. These are just the big ones. The solution in all cases is the same – FREEDOM.
Yes, let’s get politics out of health care. The only way to do that is to get GOVERNMENT out of healtcare – completely !
MrLiberty
November 16th, 2012
3:09 pm
Virtually every problem we have in healthcare today is government-created. There is NO possible way that more government intervention will fix what government has caused. Get government out of healthcare completely.
Missy
November 16th, 2012
3:35 pm
I plan to write the Governor and request that he DOES NOT set up an exchange in Georgia. It’s the only responsible thing to do for the residents and business owners in the state. Socialized medicine does not work like most people think it’s going to work. In the UK my boss’s mother needs expensive arthritis treaments but because she is 86 they have refused tretment saying it is too expensive. My grandmother in Germany needs an operation for an ulcer but the government panel has ruled 4 years straight that she can live without it since she is 86 years old. Our UK head office and Canada offices still have to purchase health insurance on top of the mandated health insurance because people so not want to wait two months to see a government doctor so they still end up paying for insurance premiums. I am sorry but the only thing the government does relatively well is the military and line their own political pockets in government. The government needs to get out of the way and let the free market place work.
luangtom
November 16th, 2012
3:56 pm
The implementation of Obama-care will not upgrade anyone’s quality of care. It will most likely drive the quality of care down, as most specialists will opt out of accepting low-cost government-sponsored insurance. The public hospitals and the government-run clinics will be the only ones offering care to the majority of the populace. We will soon be like Canada. Our citizens will be on waiting-lists to see specialists and our citizens will seek out-of-country care, just like our friends to the North do now. Our going with government-mandated care will also put our Canadian friends at risk. Where will they now migrate to that is so close and can offer better care? I suspect more and more people will be seeking out-of-country care now with trips medical-vacations to Thailand, Singapore and Japan. It happens now on a small scale. Just what will it be when all of Obama-care is implemented? I am fortunate to not have many years left on this planet in my mortal-life. I truly feel bad for those with long-lives ahead of them.
George
November 16th, 2012
4:12 pm
Many Georgians had hoped that Obamacare would be voted down but both the electorate and the Supreme Court have spoken. Bucking the system will lead to a further deterioration in Georgia’s care system with Medicaid reimbursements stuck at a low level rather than being increased to match Medicare. Many middle class families (like the boy who died with inadequately treated acute leukemia) will still be unable to qualify for Medicaid and stuck with poor private insurance such as the managed care program discribed by the former Georgia resident. Both the exchanges and, particularly, the Medicaid expansion, should be supported because they will increase funding for adequate healthcare and begin to bring down the gigantic overhead being siphoned into the pockets of the private insurance bureaucrats and unethical practitioners. The pursuit of life, liberty, and happiness should include adequate healthcare for all.
An observer
November 16th, 2012
4:12 pm
Why should 50 states create 50 different exchanges? This is a tremendous duplication of effort. The federal government can create an adequate exchange. Some one save some money, please. The country is already derp in debt and digging the hole deeper.
Rick
November 16th, 2012
11:59 pm
Georgia holds some of the worst statistics in the national; we have shamefully high mortality rates,, poor vaccinations rates, and very bad pollution coupled with poor asthma ratings. We are nearly at rock bottom for high school graduation rates, and the percentage of those currently insured for health care.
Governor Deal doesn’t seem to care or really understand that his political grandstanding is going to cause the death of Georgians, literally.
Good going Governor?!!! A federal program that cares about you, is world’s better than a state one that doesn’t.
jmc1007
November 17th, 2012
2:08 am
The whole debate is mute. Obamacare is unconstitutional.
The Supreme Court this summer ruled Obamacare is a tax. All tax bills must originate in the House. This bill originated in the Senate by Harry Reid. There is currently a lawsuite pending and moving through the courts on this matter.
jmc1007
November 17th, 2012
2:16 am
BTW, why is this section called “Forward”? Why would a newspaper copy the political slogan of a President and his campaign slogan? Do you not realize that “Forward” was used by many Socialist organizations during the early part of this century to further their causes
Just saying…
Rockerbabe
November 17th, 2012
2:39 pm
Missy:
You are confusing the European model with the models now available here in the USA. Just because Britain or Germany has one set of policies doesn’t mean we are going in that direction. Anyway, most citizens in all parts of western Europe have better outcomes and are healthier than the Americans. We do not have socialized medicine. Even Medicare and Medicaide is not socialized medicine. Folks enrolled in both those programs can go to any MD or hospital that takes the program reimbursement structure. And, just a private insurance, the programs cover just about everything. Private insurance is not available to everyone or everywhere.
With 50+ million citizens in this country who do not have or cannot get private insurance, I would say that the private sector has not lived up to their billing. There is not a private marketplace available at this time that will cover citizens over the age of 65, citizens with pre-existing condiditons and then there are those who just flat out do not make enough to afford a private policy. If private insurance would cover everyone, we couldn’t have the issues we have now; you seem to be in denial or have been watching way too much Faux News.
Insurance exchanges are just a marketlplace were all citizens and many businesses can shop for health insurance products in a convenient place and compare one policy offering to another as well as negiotate for better pricing. It is a mall for private medical insurance carriers.
Your and many citizens like you have a gross lack of knowledge about the reality 20% of our population faces daily and your lack of willingness to fix the problems, shows your greed and stupidity.
Jm
November 17th, 2012
6:44 pm
Obamacare
Bad for America
Wrong prescription
An observer
November 17th, 2012
7:41 pm
Rockerbabe, your comment is well written and it seems you understand the subject. Maybe you could help all of us by reasonably explaining what is gained by each state developing its own exchange, and why those benefits will not be available in an exchange developed by the federal government? It just seems to me that the federal government can develop a very good exchange that meets the needs of the citizens of Georgia, at a lower cost than if all 50 states go off creating their own exchanges. There must be economies of scale here.
Liberal Pariah
November 17th, 2012
9:10 pm
Liberal Nanny Staters believe the Federal Government is the answer so let ‘em have at it…heheheheheheh