Moderated by Tom Sabulis
When it comes to health care, state leadership is failing Georgia citizens, especially those who need help the most, a local health policy expert writes. With trends looking grim, he criticizes politicians for erecting barriers for Georgians to access care through federal programs such as Medicaid. In response, a nonprofit think tank leader suggests a reasonable alternative to Medicaid expansion is a greater buildout of efficient, locally driven charitable clinics.
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Health trends point down
By Harry J. Heiman
By every measure, Georgia is failing to meet the health and health care needs of its citizens.
Not only are our health outcomes poor, they are declining relative to the rest of the country. Despite political rhetoric that lauds the health and prosperity of our state, objective data tell a very different story. Through a health lens, our state is going from bad to worse, a trend that will continue without a change in course.
Georgia ranked 45 out of 50 states and the District of Columbia in the Commonwealth Fund’s 2014 state health rankings, down from 36th in their 2009 report — across dimensions ranging from access and affordability to healthy lives and equity.
Today, Georgia has the third-highest rate of uninsured persons in the country. We are among the worst states in the country for low birth weight babies, obesity and diabetes, and racial/ethnic and rural disparities.
These are not trends that align with health and prosperity.
Despite compelling data that Medicaid expansion would improve access to care for low-income Georgians, grow jobs and support rural hospitals and the communities they serve, our state Legislature has chosen inaction. Actually, worse than inaction; legislators passed two bills that created additional barriers to access to health care for low-income Georgians, a glaring example of failed state leadership.
But health is much more than health care. Socioeconomic status, level of education, and the social and environmental context in which people live, learn, work and play are now understood to be the strongest drivers of health. Unfortunately, we are failing here as well.
Almost one in five Georgians lives at or below the poverty level, a number that is higher for rural Georgians and for children, where it is more than one in four. Georgia’s unemployment rate is the highest in the country, even surpassing Mississippi’s. Our high school graduation rate ranks 45th in the country. We recently received a grade of “F” for food insecurity and “food deserts,” communities without affordable access to healthy foods.
These are not statistics that reflect prosperity or conditions that support good health. These are statistics reflecting conditions that predictably lead to worse health.
Through the lens of health and prosperity, our state leadership is failing. All Georgians, but especially the most vulnerable Georgians, are paying the price.
State leadership that fails to adequately prioritize and fund education, that fails to adequately manage and staff food assistance programs (jeopardizing federal funding) and child protective services (jeopardizing the welfare of our most vulnerable children), and that fails to take action to provide affordable access to health care for low-income Georgians, is not the leadership we need.
Georgia needs and deserves leadership and a proactive policy agenda that is truly aligned with the health and prosperity of our state.
Georgia needs leaders who are prepared to take action to ensure access to affordable quality health care for all Georgians, and to align policies across all sectors that advance the health and prosperity of our state.
The status quo is unacceptable. Aligned rhetoric in the face of failing policies and failing metrics is no longer acceptable. Our children, our communities and our state deserve better.
Dr. Harry J. Heiman is director of health policy at the Satcher Health Leadership Institute and assistant professor in the Department of Family Medicine at Morehouse School of Medicine.
Charity network is better alternative
By Eric Cochling
The debate raging around Medicaid expansion has been so polarized that very few, if any, alternatives are being seriously considered to address the health care needs of poor individuals who do not currently qualify for Medicaid or Medicare.
This has been no less true of the debate in our state, where more than a half-million Georgians face another year without reliable access to affordable health care while left exposed to the physical suffering and potential financial ruin of the next serious illness.
Despite many justifiable objections to expansion, it is not enough to simply say “no.” Our state must say “yes” to alternative solutions that offer hope for these individuals and are sustainable in the long term.
Fortunately, we do not have to look far for ideas.
While unknown to a lot of Georgians, our state is home to one of the largest networks of free and charitable clinics in the country. Nearly 100 Georgia clinics served over 180,000 individuals and provided over 450,000 patient visits in 2012. Of the patients served by the clinics, 62 percent had incomes below the federal poverty level.
Charitable clinics in Georgia have a long history, dating back over 100 years. The oldest charity clinic in the state, the Ben Massell Dental Clinic in Atlanta, is also the oldest such clinic in the country.
Free and charitable clinics offer a wide range of services including preventive care, dentistry and management of chronic diseases like diabetes and asthma.
Clinics are truly products of their communities. They are created by members of the community to serve local health care needs and are governed by local leaders with a passion for helping the poor.
Notably, most clinics receive no government funding and rely almost exclusively on private donations and some limited patient fees to operate. In 2012, they provided the state $200 million in care to uninsured patients. That savings was achieved largely by providing preventive care to patients with chronic health issues who would otherwise be repeat users of the state’s emergency rooms.
Charity clinics are also efficient, providing nearly $7 of services for every $1 that they receive. They accomplish this, in part, by relying on physicians who donate their services and by managing their resources well. This wise use of resources means charity clinics are able to provide services to patients at an average cost of only $29 per patient visit, a fraction of what it costs other providers.
Because of their proven success in working with the poor, free and charitable clinics offer a viable community-based alternative to serve those who would qualify for assistance under Medicaid expansion. Of course, to serve these additional individuals will require the charitable care network to expand both the numbers of clinics and of patients served. The good news is that the network is poised to expand, provided it has the resources it needs.
To help meet this need, the state should reinvest a percentage of the savings created by charitable and free clinics to help the clinics expand. Just 10 percent of the savings reinvested would provide Georgia’s clinics with $20 million annually. To understand what that kind of investment would mean for Georgia’s poor, consider that according to the Georgia Charitable Care Network, just $2 million would allow clinics to serve tens of thousands of additional uninsured Georgians annually.
Other states, including Florida, South Carolina, Virginia, and Ohio provide support for charitable clinics, recognizing the great good that they are able to do. Georgia should join them.
Additional reforms — investing in telemedicine technology for clinics, expanding the scope of nurse practitioners, and giving charitable clinics the tax advantages enjoyed by other non-profit health care providers – will do a great deal to help these clinics provide the health care so desperately needed by many Georgians.
By supporting charity clinics as they expand health care to the state’s poor, we will also model how states can address local problems with local solutions that are not reliant on uncertain federal funding or hampered by the political dysfunction so prevalent in Washington.
Eric Cochling is senior vice president and assistant general counsel at the Georgia Center for Opportunity.