AJC file

The Jolt: Your own personal tutorial on health care in Georgia

A state-funded report released Thursday underscores the challenges that Gov. Brian Kemp faces in drafting a plan to provide more health care coverage to uninsured Georgians without expanding Medicaid – something he has long opposed. 

One measure of how radioactive the document might be: 65 of its 66 pages, including the title page, are marked: “For discussion purposes only.” Updated: A Kemp spokesman said the repeated phrase is there because a) it’s not a legal document, and b) neither is it a formal recommendation. But it still strikes us as unusual. 

The initial assessment in today’s AJC:

The report by consulting giant Deloitte found that an estimated 1.5 million residents lack health insurance and that Georgia trails other states, even those that also have not expanded Medicaid, in covering low-income residents.

The consultants didn’t include any policy recommendations, but Kemp aides cast it as a road map leading to how Georgia could pursue “waivers” from the Trump administration that could allow the state to seek more federal funding.

Republicans have strongly hinted that they’ll emphasize work mandates in any waiver request, but the Deloitte report contains a wrinkle that could negate some accusations of free-loading:

The report could spur politicians to explore new ways to prod smaller businesses to provide coverage to their employees. It showed that 60% of uninsured Georgians over the age of 16 currently have jobs.

"We need to look at incentives for partnerships in a way that encourages people who have no coverage to move into the health care exchange or encourage employers to cover them,” said state Sen. Dean Burke, a Bainbridge Republican who is a physician.

While it can’t be considered an uplifting beach read, this report is probably the most important assessment of health care in Georgia in years. When debates start on Kemp’s proposal, its contents are likely to become the foundation of all debate. You can download the document here, or stroll through it page-by-page below. In any case, we’ve pulled out some near-verbatim points: 

Estimated uninsured rates:

-- In 2017, Georgia had a 14.8% uninsured rate compared with 10.5% nationally; some counties had uninsured rates greater than 30%;

-- 28.5 percent of the population below 100% of the federal poverty level were uninsured, compared with 19.6% nationally and 26.1% across non-expansion states;

-- The profile of Georgia’s uninsured generally reflects national trends for education and income;

-- 27% of the uninsured population have not graduated high school (the wording isn’t clear whether these are students, or adults without a diploma);

-- 31% of the uninsured population has a household income less than $25,000;

Employer sponsored insurance:

-- The average annual premium for employer-sponsored insurance was lower in Georgia compared to other states in 2017;

-- Georgia had the fourth-lowest average annual premium for single coverage in the country in 2017 at $5,489 ($487 per month);

-56% of members enrolled in employer-sponsored insurance plans were in high-deductible health plans in 2017, placing Georgia in the middle of states nationally;

-- 41.2% of employers offer health insurance coverage;

-- 82.1% of employees work in establishments that offer health insurance coverage;

-- 76.6% of employees in establishments offering health insurance coverage are eligible for that coverage.

About the kids:

-- Children comprised 69% of Medicaid and PeachCare enrollment in Georgia.

-- A majority of uninsured children under 19 years is concentrated in five counties: Gwinnett (26,051); Cobb (16,163); DeKalb (16,163); Fulton (14,402); and Clayton (8,766).

-- However, in some rural counties, the percentage of insured children is over twice as high as the average across the state. The top five: Talbot (21.2%); Quitman (19.1%); Brantley (17.8%); McIntosh (17.8%); and Berrien (16.1%)

-- PeachCare for Kids experienced a 7.2% increase in average Medicaid per member cost from 2014 to 2018, even as enrollment decreased from more than 200,000 to just over 100,000.

And the hospitals:

-- Uncompensated care across the state increased 15% from 2013 to 1017. Total uncompensated care reported by hospitals totaled $1.87 billion for 2017. Grady Memorial Hospital in Atlanta did the most uncompensated work among urban hospitals, approaching $250 million.

In rural Georgia, the burden was carried by Northeast Georgia Medical Center, a system with four locations. Its 2017 uncompensated expenses approached $70 million.

Health rankings:

-- Seven rural hospitals have closed in Georgia since 2010, the third-highest rate in the country, behind only Texas and Tennessee. On Page 50, marked with some serious punctuation (“!”), is the notation that 26 of 63 rural hospitals in Georgia are “at risk of closure.”

-- Some good news: Georgia is doing better than other states’ measures for drug and excessive drinking deaths, placing in the top 15 nationally, the 2018 America’s Health Rankings survey.

-- The bad news: Georgia ranks 46th on clinical measures for access to quality health care and preventive services in the AHR survey.

Georgia’s ACA marketplace:

-- Consumers selecting a plan in Georgia have decreased 15 percent from 2015 to 2019, reflecting national trends;

-- Nearly 50% of Georgia consumers on the marketplace in 2019 had incomes between 100% and 150% of the federal poverty level, compared with 29% nationally;

-- 18 to 30-year-olds represent 30% of the consumers on Georgia’s marketplace;

-- Georgia’s average marketplace premiums are consistently lower compared to other states on the federally-facilitated marketplace for nearly ever metal level from 2017 to 2019;

-- The 2019 average monthly premium is $496 (Bronze), $622 (Silver) and $710 (Gold).

You can read it all for yourself here:

***

Several of the state’s top Democrats - and the state party itself - labeled President Donald Trump a “racist” after he tweeted over the weekend that four liberal congresswoman of color should “go back” to their countries.

The Democratic Party of Georgia also denounced his “white nationalist rally” in North Carolina on Wednesday, when a crowd erupted into a “send her back” chant directed at Rep. Ilhan Omar. From the party: 

“Last night, Donald Trump held a white nationalist rally, invoked the KKK, and threatened a sitting Congresswoman. When will @GaRepublicans, @sendavidperdue, and @BrianKempGA denounce their racist president? (Spoiler: they won’t.)”

Stacey Abrams, the party’s standard-bearer in Georgia, also fired off a tweet in support of Omar and the three other lawmakers Trump wants ejected from the country: 

“Decrying Trump as racist is simple & important. Preserving true democracy-where every eligible vote is counted & every voice is heard-takes work. Let’s fight to show @IlhanMN, @AyannaPressley, @RashidaTlaib, @AOC & every refugee, worker & patriot we demand more for OUR nation.”

But one of the more startling perspectives came from the Georgia candidate for Congress whose last name - Islam - instantly makes her a target of white supremacists. 

Nabilah Islam, a party organizer running for Georgia’s 7th District, shared social media messages that demanded she “go back home” and “leave Georgia.” Islam, a native of Gwinnett County, wrote the following on Twitter: 

“Being told to “go back” is a phrase I’ve grown up with. This un-American rhetoric is driven by @realDonaldTrump to distract from the real problems. We need healthcare. We need an equitable economy. We will never stop fighting & we sure as hell ain’t going anywhere.”

***

We’ve told you about the air between U.S. Sens. Johnny Isakson and David Perdue over Trump’s incendiary tweets. But other Georgia Republicans have had a more muted response.

Aides to Gov. Brian Kemp, Lt. Gov. Geoff Duncan and Attorney General Chris Carr did not respond or declined to comment on Trump’s remarks. 

***

In case you missed it: U.S. Sen. Johnny Isakson stayed in the hospital for another night after falling and fracturing four ribs late Tuesday. The Republican’s office said yesterday that the 74-year-old was staying at George Washington University Hospital in downtown D.C. for “continued observation and pain treatment.” “He is in good spirits and greatly appreciates all who have sent their well-wishes and lifted him up in prayer,” said spokesperson Amanda Maddox.

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