ANOTHER VIEWS

Georgia can’t afford feds’ bad Medicaid expansion

By Nathan Deal

Growing health care costs, whether through employer-provided health plans or the Medicaid and PeachCare programs, increasingly crowd out other state priorities in our budget.
Obamacare has exacerbated the problem. Like all private-sector businesses in Georgia, the state government is seeing its costs grow for employee health plans because Obamacare’s coverage mandates have driven up prices. We’re talking hundreds of millions of dollars.
As expensive as the mandates are, they are chump change compared to the costs of Medicaid expansion. After the Supreme Court ruling, states can choose to accept or reject the Medicaid expansion. I’ve stood strong against expansion because the state can’t afford it as it is currently configured, and there’s little reason to believe that our debt-soaked federal government will continue to pay 90 percent of the cost far into the future. Expansion will exacerbate the problems of an already unsustainable program.
I recently signed into law a second layer of protection for taxpayers. Now, instead of a governor single-handedly deciding to commit the state to billions in new spending, any Medicaid expansion must also pass the General Assembly.
This puts into law what already existed in fact. Governors can’t spend money if legislators don’t appropriate it. A large commitment of public dollars, such as Medicaid expansion, should have the support of both the executive and legislative branches before it moves forward.
Obamacare negatively affects the state budget no matter which way we turn.
If we accept Medicaid expansion, we have a new entitlement that grows no matter how state revenues or the economy are performing. That means less money for our top priorities such as education, which is more than half of the state budget.
Expansion, which would add hundreds of thousands to the Medicaid rolls, wouldn’t be a slam dunk win even for low-income Georgians. Coverage isn’t the same as access. Those kicked off their private health insurance would now have little choice in coverage or doctor and would have to wait to see the limited number of providers willing to accept Medicaid, which reimburses below the cost of care.
That competition for limited spots would spell trouble for the 1.8 million children, pregnant women, seniors and those with disabilities in our current Medicaid program.
If we don’t expand, the federal government makes darn sure we’re punished. The Obama administration refuses to allow a block grant approach, which would spur state-level innovation. Giving flexibility would go a long way toward covering the affected demographics without piling a huge new financial burden on states. Adding insult to injury, the administration will soon cut the payments to safety net hospitals that serve a disproportionate share of Medicaid patients, on whom they lose money.
Leaving those cuts in place when nearly half of the states have decided against expansion exemplifies how the Obama administration has refused to acknowledge that the Supreme Court changed the playing field. Rather than working with us, the federal government has relied on strong-arm tactics to crush dissent.
We’re plotting a sustainable path forward for Georgians, but the “one size fits all” approach that Washington demands is ironically hurting the very cause it claims to champion.

Nathan Deal is the governor of Georgia.

Medicaid expansion best option for coverage gap

By Tim Sweeney

A quick scan of recent headlines could leave you with the impression two state laws approved this year all but end any conversation about Medicaid expansion in Georgia. Fortunately that isn’t the case, for the sake of more than 500,000 uninsured Georgians, the state’s health care providers and its economy.
No question, the new law to require approval of Medicaid expansion by state lawmakers to prevent the governor from acting on his own adds another step in the path to adoption. And a related law is designed to make it more difficult for government employees to say positive things about the federal health care law.
But clinging to the status quo in Georgia is not a realistic or humane option. Georgia, after all, is the state with the country’s fifth-largest number of uninsured people. Many of them wind up in emergency rooms after postponing treatment because they can’t afford it. Hospitals are obligated to treat a sick person who can’t pay, which causes financial struggles for many of Georgia’s care providers.
These problems did not go away April 29, when the governor signed off on the two new laws.
State lawmakers said they should be included in any discussion about expanded Medicaid eligibility, so let’s hope they start a serious conversation about ways to improve access to health coverage for Georgians who go without it. To date, state leaders haven’t presented an alternative to Medicaid expansion that systematically increases access to health care for low-income, uninsured Georgians.
Any new competing plan should be evaluated against the great health improvements people in other states are getting through expanded coverage.
Massachusetts provides a great example, with its eight-year track record of health reforms that served as the universal coverage model echoed by the national health care law. Coverage expansion in Massachusetts reduced “mortality amenable to health care,” or deaths that could be prevented by medical care, by 4.5 percent, according to a study just published in Annals of Internal Medicine.
The study’s authors found mortality improvements are greatest in areas with higher uninsured rates and lower incomes prior to the coverage expansion. Georgia’s policymakers should find this compelling, as it suggests people in Georgia’s communities with the greatest needs stand to gain the most from expanded coverage.
Georgia lawmakers often limit the Medicaid expansion conversation to affordability within the state budget. No question, it is their responsibility to make sure the state can afford it. I’ve done the math. The feds will pay at least 90 percent of the cost of expanded eligibility. That’s a great financial deal for Georgia.
The Massachusetts example shows expanding health coverage can make a real difference in people’s lives.
More than 500,000 low-income Georgians in communities from Blue Ridge to Valdosta now go without health care coverage. Medicaid expansion promises them better access to health care for prevention and after they get sick. It could even help them live longer.
That should also be part of the conversation when lawmakers tackle the future of Georgia’s health care policy.

Tim Sweeney is director of health policy for the Georgia Budget and Policy Institute.

10 comments Add your comment

Our Lord and Savior Jesus Christ

May 12th, 2014
2:55 pm

Even the African Americans who live in a fantasy world know what time it is. They tell their sons “it is a waste of time to be interviewed for employment with your pants sagging. No one is going to hire you looking like that. As soon as you finish completing the application and walk out, they throw it in the trash can.

Amen?

Our Lord and Savior Jesus Christ

May 12th, 2014
2:37 pm

Now that leads me to uninsured or insured little Pookie Black. Black is bleeding profusely after being shot. He is dropped off at the emergency room. He is holding his pants up with one hand and tugging at the wound with the other. Doctors come to his room and looks at him. Little Pookie doesn’t say a word. In the inner recesses of him mind, he assuredly knows that his life if basically over.

You know what time it is.

Amen?

Our Lord and Savior Jesus Christ

May 12th, 2014
2:25 pm

President Ronald Reagan knows what time it is. On March 30, 1981, he was rushed into the emergency room after being shot by John Hinckley Jr. But just before Doctors started to operate on him, Reagan said, “Please tell me that you’re Republicans.

You know what time it is.

Amen?

Our Lord and Savior Jesus Christ

May 12th, 2014
1:49 pm

Mr. Jackson,

We don’t need a regular government regimen of basic healthcare to practice eating healthy, exercising daily, avoiding illicit drugs, and sleeping at least 8 hours per night. That should be a given. Reading How to Eat to Live, by the Honorable Elijah Muhammad is also apropos. Basic healthcare should be passed down from parents to children to reduce/eliminate the need for medical attention.

Moreover, even if we authorized a single payer system, citizens who live in the fantasy world created and enforced by educators and the media, will do everything that is detrimental to their health. Consequently, it is just a matter of time before they get seriously ill and die prematurely. The priority should be expanding good healthy practices, not expanding Medicaid.

In terms of relying on ER’s as first line clinics etc, many uninsured Georgians know by now that Doctors and other medical technicians do not honor the Hippocratic Oath.

Amen?

Andre Jackson, Editorial Editor

May 12th, 2014
11:36 am

Dear person who ID’s self as the Christian Savior: IMHO, getting some of Georgia’s 650,000 uninsured on a more-or-less regular regimen of basic healthcare would likely accomplish much of what you mention in terms of nutrition, drug avoidance, etc. Certainly not all of the poor are drug users, but healthy eating and preventive care will likely save money and lives as opposed to what we have now — relying on ER’s as first-line clinics, etc.

Our Lord and Savior Jesus Christ

May 12th, 2014
10:13 am

I never thought I would be caught quoting Hillary Rodham Clinton. But if our citizens are completely disconnected from reality, “what difference – at this point, what difference does it make” if Governor Nathan Deal or the General Assembly decide not to expand Medicaid.

Amen?

Our Lord and Savior Jesus Christ

May 12th, 2014
9:58 am

A healthy dose of reality: Here is an unhealthy perspective of our citizens that is outside the boundaries of reality. Everyone knows or should know that NBA owners are responsible for the players and coaches receiving the benefits of playing basketball.

The NBA owners choose to hire their coaches. The owners and coaches choose to hire the players. It stands to reason that as a result of playing basketball, the owners are responsible for their employees receiving lavish salaries, cars, houses, properties, etc.

But nevertheless, some of our citizens are not realistic. Many of them believe that NBA owners are not responsible for the players being able to receive the benefits of playing professional basketball. This is an unhealthy perspective of reality.

Amen?

Our Lord and Savior Jesus Christ

May 12th, 2014
9:16 am

Even The King of Pop, Michael Jackson and NFL rookie Michael Sam had and have better perspectives of life than our citizens. Under the circumstances, do you honestly believe that expanding Medicaid will make a qualitative difference in their lives?

Since our churches have been infiltrated by the enemies of Our Lord and Savior Jesus Church, someone like Governor Nathan Deal should come forward and give our citizens a healthy dose of reality before it is too late.

Amen?

Our Lord and Savior Jesus Christ

May 11th, 2014
5:56 pm

Instead of fully implementing the ACA or expanding Medicaid, I would like to see the federal government pay the total cost of encouraging citizens to eat healthy and not use illicit drugs. Encourage citizens to exercise daily and get at least 8 hours of sleep each night.

No expanding health care act is sufficient for citizens determined to live in a fantasy world that is consistent with self destruction. The Church etc. should attend to the needs of the sick and shut-in.

Amen?

meno

May 11th, 2014
4:18 pm

Interesting that the governor claims (among other things) that Obama care is causing both higher insurance costs and people to be dropped from their coverage, and that the feds are not allowing flexibility in how states can expand coverage to the poor. Every single one of those claims is demonstrably false (see, for example, Arkansas or that most people say Obamacare has not effected them personally).

It would be nice if we could have a discussion about something so serious as expanding coverage to the poor that is actually fact based, but I suppose antipathy for all things Obama makes that impossible.