The Atlanta Journal-Constitution invited leaders in Georgia health care to talk about federal, state and personal actions that can help Georgians. These statements are condensed from those interviews. See video from the interviews at Politically Georgia on MyAJC.com.
Dr. Steven Walsh, anesthesiologist, president, Medical Association of Georgia
You’ve heard the numbers, health care is approaching 20 percent of GDP. Companies can’t afford it. Families can’t afford it. We have to do something to make it more affordable. And the first steps that were taken within the insurance area, they’re good steps. But we need to continue to bring to the table solutions to reduce cost, eliminate waste and improve quality.
This is a time of great anxiety. And I think Congress can help with that anxiety. By, No. 1, working to stabilize the insurance market. A lot of people are wondering whether they’ll even have an option to buy insurance. Now we are hearing about insurance companies that are pulling out the exchanges. And with that there’s a limited choice or no choice for patients.
I think options are good. Affordable options are good. I think that’s what we need to focus on.
We have some real important issues to address here (in Georgia). In the area of Medicaid we need to be sure that we continue to have funding so there’s care available for the most vulnerable in our state.
A patient can help themselves by being engaged. Learning about insurance networks and how that will affect the individual and their families. Learning about what their deductibles are going to be and their potential out-of-pocket costs so they can better pick a policy that’s suited for the family and their needs.
(However,) I hear from patients all the time that even when they proactively try to understand whether their coverage will be taken care of by the anesthesiologist that’s going to provide their care it’s very, very difficult for them to try to navigate those questions. I think even for me, if I had to find answers to those questions, it would be difficult for me. So we need to help with that transparency.
Laura Colbert, executive director, Georgians for a Healthy Future
Our elected officials can’t address real issues that people are experiencing in the health care system unless they’re hearing from their constituents. And so people should take the time, write their elected officials and email. What’s working for their health care? What’s not working?
Consumers are already going to experience the consequences of what has happened at the federal level. So if Congress doesn’t act, we’re going to see that again in 2019. And I think the sooner that they can signal that there will be certainty and they are going to work for the benefit of consumers, the sooner consumers will feel the benefit of that impact on their wallets.
The first thing that Congress should do when they get back in session is to guarantee that Cost-Sharing-Reduction funds will be guaranteed to insurers and to appropriate those funds through at least 2020. Without those payments insurers are going to have to raise premiums to make up for losses.
It’s pretty urgent on the congressional level. Georgia consumers are already seeing price hikes due to the uncertainty that’s being created around the Cost Sharing Reductions.
(At the state level) Georgia should expand Medicaid to cover everyone under 138 percent of the poverty line — that’s about $16,000 (per year in income) for an individual. We have about a million and a half Georgians that are uninsured. And by expanding Medicaid we would cover about a third of those people. It’s the biggest step that our state can take to covering the remaining uninsured. And also to fully implementing the Affordable Care Act in the way that other states have.
Tom Andrews, president, Mercy Care
I am hopeful for the first time in six months that we may be in a position of bipartisan support of actually looking at the Affordable Care Act and actually fixing the parts that aren’t working. Because I’ve said from the very beginning that it wasn’t a perfect law.
I think the first thing I would say is we need to get the marketplace in a position to be successful. There are a lot of questions out there that the government hasn’t answered with regards to how they’re going to subsidize the marketplace. And you’ve got 18 million people who took advantage of (the marketplace). So putting that into question right now is really dangerous.
(As a state) I think we’re in a really good position. Because we’ve got Health Secretary Tom Price who of course loves Georgia and is really interested in helping to solve some of the issues associated with health care. I think the governor is really interested even though he’s in his final term. And a lot of legislative folks have come out and said that they’re really interested in looking for solutions, unique solutions.
But I think we need to get away from the whole focus around, we’re not going to expand Medicaid. That’s what it’s been for the past five years. But we can talk about some transformational ways that we can bring some of the federal dollars down through things like 1115 waivers and other special grant opportunities that would allow us to expand access to people that are poor and underserved and do not currently qualify for Medicaid, but don’t put them in the Medicaid system.
I think consumers are scared right now. I think they really need to advocate on behalf of themselves and talk to their legislative folks. I think our health care system and the costs are just going to continue to go up, up and up.
Kelly McCutchen, president and CEO, Georgia Public Policy Foundation
Most of Georgia has a situation where they’re one press conference from an insurance company away from not having anyone in the exchanges to buy insurance from. So there are fundamental changes that need to be made. Congress has got to step up and do their job.
There may be compromises that need to be made, but that’s what we put them there for. Whether it’s working with Democrats or getting the Republican caucus together, they need to come up with a plan, work it out with the House and the White House, and get something passed to give the states some relief and give individuals an ability to buy health care at affordable prices.
The great news about the lack of action in Washington is we didn’t really have to have them pass anything for Georgia to move ahead with a (state innovation) waiver. With Tom Price at Health and Human Services, who is begging states to send him innovative ideas, this is a golden opportunity for Georgia to take control of health care, address our problems in our unique way and I think make some outstanding progress in health care.
Right now, Medicaid expansion is funded with 90 percent federal dollars. That’s going to be cut back. Right now, Georgia and other Medicaid programs get 67 percent federal funding. (But for states unlike Georgia, states that expanded Medicaid to cover more poor adults and get that 90 percent federal contribution,) I think it’s terribly unfair that we take the Medicaid expansion population, which is able-bodied, working-age individuals, and we’re funding them at 90 percent — and then we only have 67 percent funding for pregnant women, children, the elderly and disabled. I don’t know how you can justify that. So we need to start out with 67 percent funding. That’s sustainable.
Chris Kane, principal, Progressive Healthcare
The most important thing Congress can do is to focus on the needs of the constituents and not be looking for political wins.
Their constituents compromise every day in their daily lives. And how is it that the Washington politicians do not adopt the same posture?
All of the parties in health care act in a rational fashion. So a consumer that is facing thousands of dollars in premiums may decline to get insurance. The insurance company that says, “I would prefer not to go on the exchange, I would prefer to sell policies to employers”: That’s rational behavior. And so what Congress can do is try to minimize the regulatory environment so those insurance companies do consider going into certain counties, certain geographic markets.
Georgia should look at where can we have pilot programs that enable us to be innovative. That might encompass how we fund and operate Medicaid.
Fundamentally, consumers need to have some type of coverage. And consumers, if they find themselves in debt related to medical costs, then, negotiate with those hospitals or those physicians. Because those organizations are interested in getting some cents on the dollar, not seeing an entire bad debt.
It’s fascinating that when you get your American Express or Visa bill you typically look at it but you don’t doubt the validity of the items. When you get a hospital bill, you don’t understand it, it’s convoluted, there are multiple parties involved. And so many consumers instead of saying “let me get through this,” they put it aside, ignore it entirely, which leads to debt collectors, which leads to frustrated hospitals, who are burdened with free care but would prefer to get some funding along the way.
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These responses have been condensed from video interviews that were conducted by The Atlanta Journal-Constitution. They were edited for length and clarity.