Georgia, like many states, faces a host of health care challenges: access to care, too many people without health insurance, failing rural hospitals, and unsustainable health care spending that is crowding out other priorities – for government and for families.
Expanding Medicaid, a complex, highly regulated program with its own long list of challenges, is not the solution. Medicaid was designed for our most vulnerable populations: pregnant women, children, the disabled and the elderly. Why would we want to flood the system with hundreds of thousands of able-bodied, working-age adults when current recipients struggle to find doctors who accept Medicaid and taxpayers struggle to fully fund the program?
Doing nothing to address these problems, however, is also not acceptable. Our nation desperately needs new ways to provide better health for more people at lower cost. Georgia should use this opportunity to be bold in trying to solve the problem rather than accepting the status quo.
There are three principles to keep in mind:
First, at a minimum, we should be willing to spend what we are already spending. The federal law requiring hospitals to treat the uninsured, while humane, is one of the largest unfunded mandates in American history. The uninsured may not have insurance, but they do get sick. One way or another, we are all paying for their care in a way that is terribly inefficient.
Second, money should follow people. Yes, we need to make sure we support the institutions and providers that make up our safety net, but the solutions should be people-centered instead of institution-centered.
Third, innovation requires flexibility and choices. Micromanaging every last detail by regulation is a recipe for the dismal status quo.
What if we converted the funds we now spend subsidizing the care of the uninsured (after the fact) into vouchers or refundable tax credits? Low-income individuals could use these funds to buy into an employer’s plan or purchase private insurance. The funding could be adjusted by age and health status, providing purchasing power for older and sicker individuals and creating an opportunity for cost savings if they stay healthy.
But what if these low-income individuals can’t find insurance at a price they can afford? Or what if they simply choose not to sign up? The solution is for a portion of the unused funds to flow to the safety net providers in the communities in which the uninsured individuals live.
Instead of seeing uninsured patients or patients with Medicaid’s low reimbursement rates, hospitals and clinics would either see patients with private insurance or receive a predictable flow of funds to offset their costs.
Even if no one signed up for insurance in the first year, needed funding would immediately flow to safety net providers. This could provide funding to implement some of the good ideas suggested by the Rural Hospital Stabilization Committee last month.
Georgia is the ideal state to allow the powers of disruptive innovation to tackle our health care challenges. Georgia already is a leader in telehealth and health information technology. We have one of the largest and most successful charity care networks in the nation. Visit almost any technology incubator in Georgia, and you are likely to find a startup company focused on using technology to provide better care to people with chronic diseases. Combining these assets in unique ways could make Georgia a leader in solving the nation’s health care problems.
This initiative would require approval from the General Assembly and the governor, then a waiver from the federal government. Copying the successful model of Georgia’s criminal justice reforms, a bipartisan commission could be tasked with hammering out the details of the proposal. This approach resulted in comprehensive criminal justice reform bills passing the Legislature unanimously. Similarly, broad bipartisan support would make a federal veto of the proposal very difficult.
The cost of the program would be less than what the federal government is willing to spend on Medicaid expansion, so Georgia would be in good position to limit the cost to state taxpayers and control the program locally while meeting the goal of providing access to care for the uninsured.
Georgia’s Republicans and Democrats can work together to solve this long-term problem and, in the process, empower individuals and local communities. If it’s successful, both sides could claim some political credit. More importantly, it would improve the lives, health and pocketbooks of hundreds of thousands of Georgians.
Kelly McCutchen is president and CEO of the Georgia Public Policy Foundation, a nonprofit research institute.
