Gov. Sonny Perdue and Lt. Gov. Casey Cagle are both promoting various pieces of recently introduced legislation that they hope will reform health care in Georgia.

Perdue wants tax breaks and other incentives to help people buy health savings accounts (HSAs) and high-deductible insurance plans.

A high-deductible plan requires consumers to pay out of their own pocket for the first $2,000, $5,000, or even $10,000 of their annual medical costs, but their monthly premiums are greatly reduced.

Cagle wants to establish an online "Georgia Health Marketplace" that would allow consumers to comparison shop for the individual health plan that best fits their needs and budget.

He also wants to create a "Healthcare Safety Net" of volunteer-based free clinics all over the state, providing care to those who can't afford to purchase any insurance plan.

Cagle said he was inspired by Good News Clinics in Gainesville, one of Georgia's largest and most successful free clinics. "We think that the model can be duplicated," he said.

Cagle said he will request $1.5 million from the state's general fund budget to operate the program for the first year, which will begin July 1 if the legislation is passed. Communities wishing to start a free clinic could apply for planning grants of up to $30,000 and implementation grants of up to $150,000.

Once a clinic is established, Cagle said, the organizers would have to come up with a fund-raising mechanism to pay for ongoing operations. "But this puts real money on the table for planning and facilities," he said.

Cheryl Christian, executive director of Good News Clinics, provided input in drafting the Safety Net legislation.

"We worked closely with the lieutenant governor on this," she said. "This is the first time free clinics have ever had a champion (in state government)."

Christian doesn't expect that all of the new clinics will be as elaborate as Good News. Founded 16 years ago, the clinic now has an annual budget of $1 million, funded entirely by donations. It serves about 5,000 medical and dental patients each year, thanks to the donated services of 43 dentists, 35 doctors, eight nurse practitioners and physician assistants, and 50 community volunteers.

Christian acknowledged that Good News could never have expanded to this extent without the resources and proximity of Northeast Georgia Medical Center.

"Having a partnership with your local hospital is very important," she said. "Some counties in rural Georgia don't have a hospital. They may have to have a regional (free) clinic, drawing volunteers from several counties."

However, that scenario could present transportation problems for patients, many of whom are too poor to own a car or can't afford enough gas to travel far. Christian said a community might have to work out an arrangement, such as using church buses to transport patients.

She said there are currently about 70 free clinics in Georgia, but they're often bare-bones operations.

"Some are open just one night a week, or one day a month," she said. "Many free clinics operate out of a church fellowship hall."

But when health care is available only sporadically, there will still be occasions when patients seek care in emergency rooms, believing they have nowhere else to turn.

Cathy Bowers, spokeswoman for Northeast Georgia Medical Center, said about 11 percent of all patients treated at the hospital last year were uninsured. But in the emergency department, the uninsured portion is much higher - 24 percent.

"About 40 percent of our business comes from outside Hall, so it would be helpful if some of the other counties had free clinics," said Bowers.

The hospital has been trying to redirect non-emergent patients to less expensive, more appropriate providers. Hall County residents have several options, including Good News, the Health Access Initiative, the health department's primary-care clinic, and MedLink Gainesville, which gets federal subsidies to charge low-income patients on a sliding fee scale.

The Health Access Initiative is a network of about 165 local physicians who provide free care to patients who need to see a specialist. It has the same eligibility criteria as Good News. Patients must not have access to insurance through their employers, Medicaid or Medicare, and their income can't be higher than 150 percent of the federal poverty level.

Executive director Kim Smith said the initiative, funded through grants and private donations, serves about 1,200 people each year, though only about 300 are enrolled at any given time. She said the program is intended to help patients who need some assistance until their circumstances improve.

"Many eventually get jobs and are able to get insurance," she said.

Smith commends the legislature for trying to solve Georgia's health care crisis.

"Anything the state is doing to look at the needs of the uninsured is positive," she said.

But indigent care is only one piece of the puzzle. An even greater challenge may be providing reasonably priced insurance to working-class folks who don't have coverage through their employers.

"We've got this whole group of people right in the middle who don't qualify for (government) insurance programs but can't afford to buy their own," said Deb Bailey, director of government affairs for Northeast Georgia Health System.

That's the population targeted by Perdue's market-based proposals, which would lower the cost of buying individual insurance plans.

Perdue spokesman Marshall Guest said the initiatives could help cover as many as 500,000 uninsured Georgians.

"Nobody is going to say this is a cure-all. But it's a step in the right direction," he said. "By cutting the red tape, by making it more affordable, hopefully more people will sign up."

Much of the legislation favored by Perdue was sponsored by state Rep. Mickey Channell, R-Greensboro, who believes the best solution for many of the uninsured is a health savings account combined with a high-deductible plan.

"Only about 5 percent of Georgians have individual plans, and affordability is certainly a major issue," he said.

One obstacle to buying insurance is that people have to pay state and local taxes on their premiums. Channell's House Bill 1087 would eliminate those taxes. It would also give people a deduction on their state income tax for buying insurance, and would give a tax credit to small businesses whose employees sign up for high-deductible plans.

Channell said with the incentives offered in the bill, Georgians would be able to purchase a health savings account for 30 to 40 percent cheaper than they could get elsewhere.

"The notion is that with an HSA, people will look after their own health better when they're responsible for the money," he said. "Yes, there is a cost, but it's not nearly as expensive as having a catastrophic illness and no coverage."

Cagle's proposed online Health Marketplace is aimed at reaching those who think they don't need insurance.

"The largest pool of uninsured are age 20 to 25, what we call ‘the invincibles,'" Cagle said. "They could get a catastrophic plan (through the Marketplace) for $45 a month."

Cagle said he does not want Georgia to attempt what has been tried in Massachusetts, with every resident being forced to buy health insurance.

"I believe in the free market," he said, adding that he wants the state to spend about $3 million to create the new Web site and insurance products, and to market the idea.
"We would have a very aggressive advertising campaign," he said.

Still, getting people to purchase insurance is a tough sell, especially in today's economy.

"When people are in relatively good health and are having trouble paying their daily expenses, it's difficult for them to justify buying insurance," said Bowers.

There are also inherent drawbacks to the HSA/high deductible combination. Many people live from paycheck to paycheck and don't even have a regular savings account, so they would be unlikely to set aside money in an HSA.

Also, when people haven't met their deductible yet, they tend to delay seeking care for as long as they can. Then they end up going to the emergency room, where they can't pay the bill.

Despite all the health care resources in Hall County, Northeast Georgia Medical Center still has a huge problem with uncompensated care. Bowers said the hospital spent about $50 million last year providing charity care and writing off bad debt from patients who couldn't pay.

But hospital officials don't oppose the state's effort to get people enrolled in high-deductible plans.

"While a high-deductible plan is not a perfect plan, you have to remember that these are people who currently don't have any insurance at all," Bowers said. "Any level of insurance is better than none."