The domino effect of Congress’ failure to revise, rework or reject the Affordable Care Act last month has tossed the ball back to the states to figure out how best to deal with their indigent, uninsured residents. And this time, Georgia may have to pick that ball up and run with it.
When the law known as “Obamacare” was first passed in 2009, it offered states federal dollars to expand their Medicaid programs to provide health care for the poor. Many states, including Georgia, passed on that expansion, partly because of politics (Democratic law, Republican states = just say “no”) but also because those federal dollars would be lessened over time, leaving states on the hook to pick up the rest of the cost.
Even then, as the years passed and the ACA became more entrenched, some states, including Georgia, pondered whether to go ahead and expand Medicaid after all. In our state’s case, finding a way to provide funding for failing rural hospitals and patients lacking enough health care options have become a priority. Last year, there was talk such a move might be possible from Republicans in this year’s General Assembly session.
Then the Trump train came rolling along, sweeping such ideas aside in favor of the GOP notion to revoke the health law and implement a new plan. As we saw, the plan to replace the ACA collapsed like a cake in the rain, done in by both a lack of buy-in from the left, namely every Democrat with a pulse, and many on the right who saw it as “Obamacare lite” and weren’t on board with its incremental changes.
It’s possible a version of this plan, or perhaps a different approach, will re-emerge by the end of the year. If not, it leaves Georgia and other states back at square one to decide how best to deal with a population of low- or no-income folks who can’t afford to buy policies, with or without federal subsidies, nor can they get them on the job.
Thus, the momentum has again started toward a state expansion that could add some 600,000 people to Medicaid rolls that now total some 2 million. Other states are moving that way; Kansas and North Carolina are the latest aiming to join the 31 states plus District of Columbia on the plan, and Georgia may not be far behind.
Barring some sweeping new reforms, the state has to find a way to care for its most vulnerable residents. The main motivation for that is, of course, humanitarian; people who are sick or hurt deserve care no matter what their financial status may be, and no civilized society can turn their back on them.
But there’s also a pragmatic economic angle to providing such help. Indigent patients without health insurance or other options frequently fill hospital emergency rooms when they can no longer get care elsewhere, sometimes with illnesses or chronic conditions well advanced from a lack of primary care. Those ER visits are written off by the hospital for those who can’t pay, which in turn raises health costs for everyone else.
From a practical approach, we need a healthy workforce and populace. Many lower-income folks fill key jobs that can leave a gap in production when they’re too sick to work. Those who do try to suck it up and show up on the job can spread their germs and maladies to others, as do their children sitting alongside others in classrooms and on buses.
The failure of the GOP’s health plan might buy the state a little more time. With Obamacare still in place, those who choose that option will keep their insurance policies and stay off Medicaid rolls, for now. Even then, the clock is ticking; news that the parent company of Blue Cross and Blue Shield of Georgia may pull out of many exchanges could leave many of the state’s rural counties vulnerable. Without changes at the federal level, insurers losing money through Obamacare may continue to abandon it.
And in the long term, giving states more leeway in implementing indigent care could lead to more innovative solutions than the federal, top-down approach of the ACA.
Other states are doing this, for instance, by letting Medicaid recipients pay for their own health insurance with state-provided supplements, which could be cheaper to taxpayers and better for the policy-holders in the long run. Another angle would be to pump more resources into district health clinics that can provide effective primary care and keep more folks out of the ER and on the job.
Such potential innovations that emerge state-by-state may work better than crafting a one-size-fits-all policy out of a big federal block of marble. None of this will come cheaply, but failure to do anything could cost more in the long run.
It was too late obviously for Georgia leaders to take on the health insurance puzzle this year. The stall of the GOP plan didn’t leave enough time in the legislature session, so it will have to come next year.
In the meantime, legislators have months to tinker with ideas, ideally with bipartisan support, to put in place at the start of next year’s session. They should at least begin the process now, even not knowing what might happen at the federal level to change the playing field of health care insurance in the future.
Many are not thrilled with Obamacare or expanding entitlements, but there is little practical choice but to find the best way to provide health coverage for those in need in a cost-effective way. In the end, if too many of us are sick and can’t get necessary care, it puts everyone at risk.
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