Expand access to care, not Medicaid
Those addressing Georgia’s uninsured and failing hospitals seem stuck between two options: Expanding a government program (Medicaid) with its own long list of challenges, or doing nothing. It’s a false choice.
Expanding Medicaid is undoubtedly the worst option for providing more Georgians access. For providers — even with more money from the federal government — Medicaid still pays less than their cost. It’s a bad deal for taxpayers: Expansion is estimated to cost more than $7,000 for able-bodied adults; the current Medicaid program spends $3,022.
If Georgia’s more than 200,000 low-income adults who already have private insurance opt for the “free” program, the cost will be even higher.
It’s also a bad deal for recipients. A study of Oregon’s Medicaid expansion found enrollees receive just 20-to-40 percent of value for each dollar Medicaid spends — with no physical health improvements. Recipients also have difficulty accessing care — and one-third of Georgia doctors already refuse to see new Medicaid patients.
Unless more physicians are added, it will aggravate care and access to add 389,000 new enrollees, the federal government’s estimate, which is projected to cost $2.85 billion. Even more alarming, an analysis just released by Deloitte puts the number of eligible Georgians as high as 565,000, which could see annual costs soar above $4 billion.
At the very least, Georgia could expand the scope of practice for nurse practitioners to help address an influx of patients without exacerbating access issues for existing Medicaid recipients. Unfortunately, Georgia has some of the nation’s most restrictive regulations for nurse practitioners.
If recipients can’t find doctors and continue to use the emergency room instead, how have we helped improve access, quality or cost?
Solutions require more than Medicaid expansion by another name. They require a fundamentally different approach that puts patients first.
First, pay market rates to ensure patients have access to primary care, even during non-traditional hours. A flat monthly fee for a direct primary care program, for example, cut Medicaid costs 20 percent in a recent Washington state pilot project.
Next, allocate a pool of funds to cover private insurance or eligible Georgians joining employer health plans. Not every eligible individual will sign up for coverage, so unused funds should reimburse safety-net providers for their care.
All funding doesn’t have to come from government. A state that leads the nation in health IT and payment processing should be able to enable recipients, government, employers, nonprofits and even friends and family to pool funds to directly assist individuals in paying monthly premiums.
Hundreds of millions of dollars are spent annually in Georgia on uncompensated care for the uninsured due to an unfunded federal mandate. Uninsured Georgians may not have insurance, but they do get sick. One way or another, we all pay for their care in a way that is terribly inefficient. At a minimum, we should be willing to spend what we already spend in a more rational and innovative manner. That’s a plan all Georgians can support.
Kelly McCutchen is President of the Georgia Public Policy Foundation, an independent think tank in Atlantathat proposes market-oriented approaches to public policy.