Today’s Courier Herald Column:
The Health Care Reform Law is more commonly known as the now pejorative Obamacare moniker, and is in the process of being phased in as the overriding health care policy of choice. While much of the publicity regarding the law and its legality has focused on the individual mandate, the sweeping reforms directly affect the State’s budget.
Medicaid currently represents the fastest growing segment of Georgia’s budget. In a down economy, the number of people requiring indigent health care is naturally increasing, while health care costs continue to rise significantly faster than the rate of inflation.
The burden may rapidly increase for Georgia and its taxpayers. Should the President’s health care reform package withstand the current Supreme Court Challenge, an estimated 650,000 Georgians are expected to be moved onto Georgia’s Medicaid rolls. To put that into perspective, that’s approximately the population of an entire Congressional district added to the cost of one of the state’s most burdensome programs. What was billed as “bending the cost curve” at the federal level faces breaking the budget at the State level. Obamacare is set to deliver Obamacaid to Georgia.
Georgia’s Department of Community Health is responding to this challenge as well as the overall delivery of medical care via Medicaid with a study and proposal to overhaul the entire system. While goals include improving health care for members and enhancing the use of services by members, the study conducted by Navigant Consulting of Chicago has the attention of state leaders because of the third goal: long term sustainable savings in services.
Their assessment was conducted during the last half of 2011 and the report was posted this January. Public comment ended fairly quietly at the end of February, with an internal DCH deadline suggested for adoption of recommendations by the end of this month. There appears to be a move to postpone this deadline and consider further study. Given the uncertainty of a Supreme Court changing the entire game within months, a slower pace of decision is certainly warranted.
Those representing groups who receive Medicaid services will likely use any extra time to ensure that the redesign of Medicaid is not a “one size fits all” model. The Navigant report seems to favor a flat fee per patient covered model by health care providers, extending those who currently service Medicaid patients into a business model acceptable to Care Management Organizations.
Critics argue that CMO’s serve the general population very well, but have neither the track record nor capacity to handle more complex categories of patients which require care. These groups are generally classified as ABD (Age, Blind, and Disabled), but also include other high risk/service groups. They include a large segment of the seriously mentally ill and developmentally disabled, Hemophiliacs, and those with HIV/AIDS.
This issue is not unique to Georgia, and some other states have already implemented similar reforms. In Chicago, prison beds are now filling up with patients who used to be serviced by the Medicaid program. Cook County Sherriff Tom Dart told the New York Times in February that the service delivery system in “is so screwed up that I’ve become the largest mental health provider in the state of Illinois.”
Georgia faces a large and growing problem with respect to Medicaid’s rising costs. Whether or not Health Care Reform is upheld or struck down, the growing population served by Medicaid and the programs skyrocketing costs must be addressed.
The managed service approach recommended by Navigant is a good place to start. However, companies who have thrived by excluding those with pre-existing conditions should not be given the primary responsibility for providing coverage for high risk groups whose needs fall outside of traditional health care delivery.
This, combined with the uncertainty regarding a pending Supreme Court decision not only justify, but mandate an alteration of the Department of Community Health’s timeline for deciding on a path forward.
When that decision is made, it must be made with a full understanding of how many Georgian’s are likely to rely on these services, and how the most vulnerable among us will receive the best possible care as efficiently and cost effectively possible.