Commentary: Time is of the Essence in State Health Care Reform

Kelly McCutchen

Monday, October 2nd, 2017

With the failure of health care reform in Congress, Georgia faces decision time: Accept the status quo or lead a state-based effort to address the issue. The decision state leaders make – one that must be made quickly – will have long-lasting effects.

On the negative side of the ledger, the gridlock in Washington leaves many challenges unaddressed. It’s not pretty. Nearly all of Georgia’s rural hospitals are struggling to stay in business. Medicaid recipients search in vain for doctors willing to take new patients.  Several hundred thousand low-income Georgians are unable to afford insurance. Hundreds of thousands of working-class Georgians are trapped on the federal exchange, facing skyrocketing premiums and shrinking options.

On the positive side, the debate in Washington highlighted some common ground. Conservative proposals allocated substantial funding to help low-income citizens afford access to health care. While major differences on insurance regulation remain, conservatives proposed ways to fund pre-existing conditions with tax dollars instead of forcing a small fraction of the insurance market to subsidize those costs through higher premiums.

This is crisis, not political hyperbole. In Valdosta, for example, a 2017 silver plan costs a family of four $22,402 without subsidies. As announced just this week, premiums next year will increase by 57 percent to $35,171. That’s on top of premiums doubling over the past four years.

In exchange for these high premiums, Georgians are stuck with a massive deductible and a limited network where it is difficult for the truly sick to find the specialists they need. At the same time, health plans are exiting the system: Next year, 91 percent of Georgia counties will have no choice of insurers. The remaining counties will have just two insurers; don’t count on competition bringing down prices.

The good news is there is a better option. Built into the Affordable Care Act is the State Innovation Waiver, which gives states unprecedented flexibility in redesigning major government health care programs. Through this waiver, Georgia can pool all federal health care funding, including funds that would have been available through Medicaid expansion, and restructure how these funds are spent.

The political will to begin the process is evident in Georgia. Resolutions encouraging the pursuit of a federal waiver were introduced this year in both legislative chambers.

Georgia has an opportunity to take the lead in transforming health care. Health and Human Services Secretary Tom Price has encouraged states to be bold in submitting these waiver requests. With one of the highest uninsured rates and some of the worst health care outcomes in the nation, Georgia has a historic opportunity and much to gain.

The Georgia Public Policy Foundation has outlined a waiver plan based on four goals: 1) investing in primary care, 2) ensuring hospitals no longer lose money on patients they are required by federal law to care for, 3) allowing flexibility for local community solutions and 4) ensuring funding is sustainable.

Such a waiver could draw down $2 billion to $4 billion in new funding to Georgia, more than enough to eliminate uncompensated indigent care and protect rural hospitals. Such a move could dramatically enhance access to care while recognizing that Georgia is a diverse state whose communities face unique challenges.

Georgia’s health care problems are not going away.  Bold state leadership can pick up the baton Congress dropped and lead the way on creating practical solutions. Georgia's example would undoubtedly encourage many other states to follow suit, which may be the reality check needed to spur Congress to action.