By JEFF GILL
Critical care physician Dr. Dhaval Patel pounded the table twice and raised his voice as he spoke about health care in Georgia — and specifically waivers Georgia is seeking at the federal level.
How to provide input
Deadline: Dec. 3
Mail: Lavinia Luca, c/o the Board of Community Health, P.O. Box 1966, Atlanta, GA 30301
“For God’s sake, your communities are getting destroyed. Georgia is virtually behind every other state in every outcome imaginable I can think of, and you sit there playing Democrat and Republican while people die,” Patel said, speaking at a public hearing on the requests Monday, Nov. 11, at the Gainesville Civic Center.
“Expand your insurance and cover everybody. At some point, you’re going to wake up and smell the coffee.”
Patel spoke during one of two sessions held by the Georgia Department of Community Health on the waiver requests addressing health insurance access and Medicaid changes. The requests were announced earlier this month by Gov. Brian Kemp to fulfill the Patients First Act passed by the legislature this year.
We are grateful the state recognizes too many of its working, low-income citizens do not have access to or are unable to afford health care coverage.Deb Bailey, governmental affairs for the Northeast Georgia Health System
Kemp is proposing that uninsured adults in Georgia who make no more than the federal poverty level would qualify for Medicaid assistance if they spent at least 80 hours a month working, volunteering, training or studying. They would also have to pay monthly premiums.
The federal poverty level is just under $12,500 for an individual.
Georgia is one of 14 states that have not fully expanded Medicaid under the Affordable Care Act. Kemp’s office has said full expansion would cost Georgia taxpayers more than $1.5 billion in the first five years.
The state plans to seek a 90% match from the federal government for its more limited expansion. That would make the cost to Georgia $10 million in the program’s first year; otherwise, it would be $36 million.
Supporters of a full Medicaid expansion have estimated it would cover roughly 500,000 Georgians. The governor’s office projects this expansion will cover more than 52,000 people in its fifth year.
The health insurance request — referred to as Georgia Access — is for a waiver under the Affordable Care Act, which would allow residents seeking insurance through the ACA marketplace to opt out of the federal portal and instead use brokers or buy directly from insurance providers.
Deb Bailey, executive director of governmental affairs for the Northeast Georgia Health System, said Monday that the system supports the Medicaid proposal.
“We are grateful the state recognizes too many of its working, low-income citizens do not have access to or are unable to afford health care coverage,” Bailey said.
NGHS is obligated to provide indigent and charity care and often incurs debt in order to do so, she said.
Jordan Hussey, the executive director of the Gainesville recovery center J’s Place, spoke as a representative of the Georgia Council on Substance Abuse.
“This is an important step in the ongoing process to provide effective and affordable coverage to the people of Georgia and demonstrates a commitment of our state leadership to address the complicated issues,” Hussey said. “For far too long, too many Georgians have not had access to safe and effective insurance. For far too long, funding has been a barrier for those who need quality access.”
Hussey said that “while there is still more to do, we are excited to contribute.”
“We look forward to ensuring that job requirements, transportation, reporting and other aspects of Georgia Access have zero unintentional consequences which negatively impact the Georgia recovery community,” she said.
But Heather Breeden, representing the National Multiple Sclerosis Society, had some concerns about the work requirements excluding some people with MS from benefiting from the plans. The application “includes so many barriers to coverage that we know that only a small fraction of uninsured, low-income individuals living with MS will gain coverage,” she said.
Many with MS are not able to work, Breeden said.
“Georgia only seems interested in providing coverage to individuals deemed deserving,” Breeden said. “… I would like to remind you that Multiple Sclerosis is not the result of some sort of moral failing or character flaw.”
This does not adequately cover homeless or mentally ill Georgians, caregivers or seasonal workers. It actually leaves out a great majority of uninsured Georgians, doing little to alleviate suffering among our indigent neighbors.Carole Maddux, Georgia Interfaith Public Policy Center
Hall resident Leigh Miller said after her daughter was diagnosed with Type 1 diabetes, her family was “thrown into a health care system that did not care about us and was not structured to support us.” Full Medicaid expansion is the more morally and fiscally responsible choice, Miller argued, and she said Kemp is in the “unique position” to make the change in Georgia.
“We pay the same federal tax that other states pay, and we refuse to take the benefits from those taxes,” Miller said. “This has resulted in a crisis in our state. Rural hospitals are closing, and the ACA marketplace is completely out-of-balance. Premiums are unaffordable for the middle class and self-employed citizens.”
Carole Maddux represented the Georgia Interfaith Public Policy Center, and she also said the proposal was inadequate for showing “neither justice nor love.”
“This does not adequately cover homeless or mentally ill Georgians, caregivers or seasonal workers,” Maddux said. “It actually leaves out a great majority of uninsured Georgians, doing little to alleviate suffering among our indigent neighbors.”
Diana Lewis represented Mercy Care, a group of clinics that serves Medicare and Medicaid patients, the uninsured and the homeless population. Lewis said she also saw some gaps in the proposal.
Lewis said that because it includes work requirements, the proposal does not address many of the barriers that prevent people from being healthy, including lack of access to transportation, healthy food and education.
“Patients with significant health, social, housing and life issues are not in a position to work until their health and social issues are addressed,” Lewis said.
Brittney Butler, a senior at Georgia State University, said “health care in the United States continues to be a civil rights issue.” She had concerns about how the plan would disproportionately affect minorities — according to the Kaiser Family Foundation, in fiscal year 2013, the most recent data available, 40% of the state’s Medicaid enrollees were white, while 46% were black.
“Georgians should oppose the (Section) 1115 Medicaid waiver until the governor and state lawmakers find a way to make Medicaid a more expansive program to help the millions of uninsured Georgians that remain without access to health care,” Butler said. “… Until we can do away with the discriminatory practices that affect life and death situations in our communities, we do not need to give biased lawmakers more power than they already have.”
Monday’s meeting was part of a statewide tour by the state to gather public input on the proposal. Gainesville was the fourth city on the tour, and other stops are planned for Rome and Kennesaw this week.
The public comments will be provided to the state’s Board of Community Health before the board’s Dec. 12 meeting, when the board will vote on any proposed changes.
The Associated Press contributed to this story.