Skilled home health care serves some 3.5 million Americans, including 85,000 Georgians. Because the fastest-growing segment of the U.S. population is those who are 80 years and older, we are seeing more chronic diseases today than ever before. These require more services and more health professionals. The promise of the human genome project includes the possibility of interventions which might mitigate the onset or progression of some aspects of the aging process.
Like so many health services, skilled home health care is important, and changing circumstances over time may require adjustments in delivery and reimbursement rates.
However, a larger issue that directly affected more than 47 million Americans, before March 2010, was lack of health insurance. Passage of the Affordable Care Act (ACA) was intended to address this reality through a series of mechanisms, including the expansion of the Medicaid program and the establishment of health insurance exchanges in each state.
A ruling by the U.S. Supreme Court gave states the option to determine whether or not to expand Medicaid. The ACA also provides that the federal government will support 100 percent of the costs of Medicaid expansion for three years, then 90 percent of the costs annually thereafter. Thus far, 25 states and the District of Columbia have elected to expand their programs, and the other half of the country has not yet done so. A preponderance of the states in the South, including Georgia, is in the latter group.
Among the reasons given for states to refrain from participating in Medicaid expansions: Georgia could not afford it; the federal government would not meet its financial commitments to the program; and the insurance exchanges would not work.
We now have the benefit of some nine months of experience since Medicaid expansion was implemented, along with the state or federally operated health insurance exchanges and their income-related health insurance subsidies.
A Health Reform Monitoring Survey done in June 2014 by the Urban Institute found the number of uninsured American adults had fallen by 8 million since September, 2013. The greatest gain of insurance coverage was among low- and middle-income individuals. In states that did not expand Medicaid, there has been little or no decrease in the number of uninsured citizens.
Among health service providers, HCA Holdings Inc., the nation’s largest publicly traded hospital company, just reported a 14.2 percent increase in second quarter net income, along with a 48 percent decline in its number of uninsured patients. Tenet Healthcare Corp. reported a 22 percent drop in uninsured patients. The ACA is working for these companies.
A poll released by Gallup and Healthways on Aug. 5 found states that expanded Medicaid and developed health insurance exchanges had the largest decreases in numbers of uninsured, led by Arkansas with a 10.1 percent reduction, and Kentucky with an 8.5 percent reduction.
These reports show that, at this early stage ACA is having a positive effect in states that expanded Medicaid and implemented health insurance exchanges. More remains to be done, but there is clear progress.
These accounts should encourage Georgia’s governor and state legislators to re-evaluate their current positions to not expand Medicaid and to not establish a state-run health insurance exchange. With the health status of Georgians ranking 38th among the 50 states, Georgia should be doing more to support our citizens in their efforts to obtain health insurance and access to health care.
According to the Bureau of Economic Analysis, Georgia’s gross domestic product of $454 million in 2013 was almost four times that of Arkansas and 2 1/2 times that of Kentucky. In 2012, the $25,309 per capita income of Georgians easily surpassed the per capita income of the citizens of Arkansas or Kentucky.
How is it that Arkansas and Kentucky can afford to expand Medicaid and establish health insurance exchanges and Georgia can’t? Georgia is not poorer than these two fellow Southern states, which are smaller than Georgia and traditionally rank lower on various economic measures. Are we poorer in our humanitarian spirit — in commitment to our fellow citizens?
As a Georgian, born and raised in this state, I urge all of us to aim higher, and find ways to invest more in our most precious resource: our citizens, especially our children. We should demand more and expect more from ourselves and from our elected officials.
Dr. Louis Sullivan was secretary of U.S. Health and Human Services under President George H.W. Bush.
