Georgia leaders, experts weigh in on Obamacare

Kelly McCutchen

President and CEO, Georgia Public Policy Foundation

King v. Burwell provides an historic opportunity for a bipartisan “Obamacare do-over” to finally address fundamental problems that make health insurance so expensive.

Concern over the loss of exchange tax credits dominates most media stories, yet every major conservative alternative being discussed in Congress would replace the illegal credits with tax credits that would not be limited to health plans on an exchange. Individuals with pre-existing conditions would also remain protected.

Overlooked are the benefits of a plaintiff victory. The lawsuit would eliminate many of the regulations that have caused sizable premium increases in the individual market both nationally and in Georgia. These high costs forced many employers to drop health insurance coverage, lay off employees or shift employees to part-time work.

The tax credits can be replaced, but a victory for the government does nothing for the countless Americans who have lost their health plans, doctors or jobs. A bipartisan solution would remove financial barriers to health insurance, but without the regulatory burdens that increase costs and prevent individuals and families from choosing insurance that best meets their needs.

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Rep. Pat Gardner, D-Atlanta

We can’t be content to stand idly by if 400,000 residents lose the premium tax credits they rely on.

Should the high court rule against federal subsidies in King v. Burwell, the governor’s office, the Department of Insurance and the Legislature should immediately enlist the help of Blue Cross and Blue Shield of Georgia, UnitedHealthcare and the other companies that have benefited from new business under the law. Together, we could create a Georgia exchange based on any one of the successful models used in other states.

Despite the obstructive tactics, the ACA has reduced the percentage of uninsured residents in Georgia more than all our other state-sponsored health initiatives combined going back over a decade. Unfortunately, we still have a long way to go compared to other states. Standing in the doorway to block this successful law may play well politically, but it does a grave disservice to our residents. We can and should fix this.

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Rep. Jason Spencer, R-Woodbine

If the Supreme Court’s impending decision in King v. Burwell is to void the Obamacare tax credits, then roughly 400,000 Georgians who were forced by Obamacare’s decree to purchase an expensive health plan for which they will no longer receive subsidies.

As a result, conventional wisdom tells us that the true price of Obamacare plans will be realized and invite potential chaos into the health insurance markets. But there is some good news for Georgians.

Individuals for whom insurance coverage is unaffordable without the tax credit will be exempt from the onerous individual mandate. Employers in this state would be exempt from the employer mandate because only state exchanges trigger the mandate, which could lead to Georgia attracting more jobs.

Georgians who lose Obamacare tax credits will be able to buy cheaper plans that meet their individual needs. Small businesses could hire more workers without having to worry about crossing the employer mandate’s 50-worker threshold, and businesses would no longer have an incentive to cut workers’ hours to keep the number of full-time employees down.

A decision by the Supreme Court that strikes Obamacare tax credits invites opportunity for our state to positively deregulate its health policy and become less dependent on federal largesse.

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William Custer

Health policy expert, Georgia State University

A state legislator was recently quoted as saying that he hoped the Supreme Court would rule in favor of the plaintiffs in King v. Burwell so that the Affordable Care Act (ACA) would be dismantled and “we could try a free market approach.” That statement is wrong on two counts: whatever ruling the Supreme Court makes in this case the ACA will remain the law of the land and the ACA is the “free market” approach to health insurance.

At the beginning of the 21st century, 76 percent of Georgians under 65 had private health insurance. A decade later, that percentage had dropped to 60 percent. Health care costs grew to the point where families and businesses had to make hard choices on what they could afford. Healthier individuals dropped out of the market while sicker people tried to purchase coverage. No insurer can stay in business if they only sell coverage to people with high-cost claims. The eventual result is the disappearance of the health insurance market.

The ACA changes the rules of the individual health insurance market to make it sustainable. It requires insurers to sell coverage to everyone regardless of their health, but it also penalizes individuals who opt not to purchase coverage. And it subsidizes the cost of insurance for families whose incomes are less than four times the poverty level. All indications are that these reforms have largely worked: more people have access to coverage, greater choice of health plans, and more economic opportunities.

In Georgia, the loss of federal tax credits would remove about $1.4 billion annually from a Georgia healthcare system already stressed by lack of resources. Georgians most affected by the ruling would be those living in rural areas where insurance premiums are already high and access to health care services difficult.

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Earl Rogers

President and CEO, Georgia Hospital Association

The Georgia hospital community anxiously awaits the upcoming decision. Our state has the second-highest percentage of uninsured people in the country, and disallowing the federal subsidies would jeopardize current health coverage for nearly 500,000 Georgians, making a bad public health problem much worse.

When hundreds of thousands of hard-working Georgians cannot afford health insurance and are forced to use the hospital emergency room for their health care, community health declines and health care costs escalate for everyone else — especially Georgia’s business community. That’s why Georgia hospitals, which absorb more than $1.7 billion in uncompensated care annually, are hopeful that the court upholds the federal subsidies.

Regardless of how the court rules, Georgia hospitals look forward to an opportunity to work with all stakeholders to craft a Georgia-specific solution to help all 1.8 million Georgians who are uninsured. Data shows that people with health insurance are healthier and more likely to avoid chronic, expensive health conditions that everyone ultimately pays for.

In short, an insured population is a more productive population and will make our state an even better place to live. GHA and the entire Georgia hospital community look forward to being part of this critical discussion.

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Dr. Manoj Shah

President, Medical Association of Georgia

It is important to remember that every physician does not accept every health insurance plan that is available on the federal exchange because of the narrow or restricted networks of physicians and other health care providers that insurers use to control costs.

The physicians who accept an ACA health insurance plan face a unique and unfair financial risk because of the 90-day grace period that patients have to pay their insurance premium before it is canceled. Their practice often does not know whether a patient is in this grace period when it delivers the care, so if the patient ultimately does not pay their premium the physician might not get paid or the insurer will recoup any claims it has paid.

If the Supreme Court nullifies the federal tax credit, it will be critical for Congress to take swift and decisive action to ensure that patients have access to the medical care they need. We would expect more patients going to a hospital rather than a doctor’s office to seek their care – which will undoubtedly increase costs. And we would expect to see premiums increase as a result of the increase in the number of uninsured and the increase in the number of patients who would seek indigent care.

Regardless of what transpires with the Supreme Court, physicians in Georgia will remain focused on delivering the best possible care for their patients.

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Cindy Zeldin

Executive Director, Georgians for a Healthy Future

Approximately half a million Georgians signed up for health insurance under the Affordable Care Act for during the open enrollment period that ended earlier this year.

Many haven’t had consistent coverage in the past, and some had even been locked out of the health insurance market entirely because of a pre-existing health condition or because of prohibitive cost. A door that had been closed to too many Georgians for too long has finally been opened, and consumers have responded.

The individuals and families who have walked through this door come from all corners of our state. and from all walks of life. But they share a combination of relief and pride at finally enrolling in health insurance that fits within their budget.

Nine in 10 Georgians who enrolled in coverage through the Health Insurance Marketplace accessed tax credits to help make it affordable. If the Supreme Court invalidates them, more than 400,000 Georgians will lose their health insurance unless our state policymakers take action.

These newly enrolled Georgians will be looking to our state leaders for answers. OWhile the specifics of the court ruling will set the parameters for what policymakers can do to stabilize the market in each state and what tools will be available to them to ensure consumers keep their coverage, our state’s leadership should commit to use every tool in the toolbox to allow consumers to maintain access to marketplace health insurance and to the tax credits that have helped make it affordable.

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John Haupert

CEO, Grady Health System

As a safety net provider, Grady supports improved access to care for the underserved of our state.

Every day, we see the often preventable and sometimes devastating effects that result from delayed medical attention. By making health insurance attainable, the tax credits have allowed thousands of Georgians to improve their health status by opening avenues to routine care that were previously not available to them.

Maintaining some form of assistance, whether it’s through tax credits or something else, is vital to the continued improvement of health for our entire community. We cannot afford to move backwards.

Without sustainable access to care, many will revert to episodic and emergency care to maintain their health. That approach to health care benefits no one — not the patient, the healthcare system or our community as a whole.

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