Georgia Hospitals Want Medicaid Expansion

Georgia’s largest hospital advocacy group wants Georgia to expand Medicaid under Obamacare. Gov. Deal opted out of the expansion program saying Georgia couldn’t afford it.

The Georgia Hospital Association’s vice president Kevin Boyle made the comments to WABE yesterday. 

“We need Medicaid expansion in the state. We need some sort of relief that will help address some of the financial challenges that the health care provider community is facing,” said Bloye. “These issues are real. They’re not going to go away and we trust leadership that they’re going to work with us on this.”

On Thursday, the National Federation of Independent Businesses released survey results that show 64% of small business owners are paying more for health insurance premiums in 2013 than they were in 2012.

Kyle Jackson, state director of NFIB/Georgia, said in a statement he was not surprised by the findings. “The cost of health insurance has always been a big issue for small business, and I think it’s clear from the survey that things are getting worse, not better,” he said.

38 comments

  1. saltycracker says:

    Doesn’t sound like hospitals expect an explosion of millions newly insured. Hospitals are caught in the squeeze of increasing demand, people not paying and unfunded mandates, particularly EMTALA.

    “All patients have EMTALA rights equally, regardless of age, race, religion, nationality, ethnicity, residence, citizenship, or legal status. ”

    Under Obamacare the law should allow providers the right of refusal of services, except for real emergency care, and the right to transfer patients to charity hospitals (another need).

    • Harry says:

      I read that about half of all medical practitioners don’t plan to participate in ACA. So I’m guessing doctors and hospitals still have the right of refusal of services, just like any other professional?

      • saltycracker says:

        Not exactly. Independent Docs and other professionals are a dying breed. Most will be working in large groups or for hospitals. The hospitals and healthcare corps will find ways to stay way ahead and very influential with the legislators and the burden will go to tax compliant individuals.

        My remarks above were more to do with the consequences of bad legislation and the influential screwing those being responsible.

        • Harry says:

          Perhaps subject to further developments but Emory Healthcare and Piedmont will not be accepting patients from the Exchanges.

          • Charlie says:

            I am curious as to what your source is to this. When I looked at the link that showed the various insurance companies underwriting policies for Cobb County residents, most of them were household names around here that shouldn’t have any problem being accepted by major (and minor) providers.

            • Looks like pretty much all the POS plans will include the major hospitals, a few of the HMO plans will limit to one or the other, as a plan like Kaiser already does (everyone I know who has Kaiser likes it, despite this already being in existence).

              Not that you raised it Charlie, but the dumbest possible argument against healthcare reform is that doctors will somehow stop practicing because they don’t make enough money. I have two rebuttals to that – 1 – most doctors I know went into it at least in part because of the love of helping people, not the money and 2 – the average starting salary for lawyers is like 1/6 what a doctor makes and it’s a similar debt burden. If older doctors who’ve already made their nut want to quit, all we need to do it open new med schools and I think plenty of people will sign up to be “underpaid” doctors.

              • Charlie says:

                You’re correct, I didn’t raise it, because what you just wrote may well be the dumbest thing to show up on here in a long, long time.

                You really should take a step back and start studying the various unintended consequences going on with the implementation of this bill, rather than just clinging to platitudes like the crap you just wrote. It continues to amaze me that your side thinks that just because you can write laws, you can re-write the laws of economics.

                As for Harry, here’s a brutal article that does lend credence to his observation:

                http://online.wsj.com/news/articles/SB10001424052702304527504579171710423780446?mod=WSJ_Opinion_LEADTop

                • That article would be brutal, except it isn’t really true. The lady told the AARP she has a high deductible 80/20 catastrophic plan. In Georgia, to treat cancer with a plan like that, you’d likely be paying about $19,564 for a 61 year old, assuming you could even get on that plan but let’s say you were on it before you got cancer.

                  In California, the most expensive Anthem PPO Platinum plan being offered in San Diego for a 61 year old woman is $959/mo. It has a $4000 in network max and a $7000 out of network max. Meaning the premiums would be $11,512 and the total out of pocket costs would be $11k for a total of $22,512.

                  I’m sorry – but if your definition of “BRUTAL” is that a millionaire will now pay maybe $3k more per year out of pocket to treat her stage 4 cancer, then you’re the one who is unserious.

                  Just think about the system pre-ACA that you’re defending – only people who can afford to drop $19k per year can beat cancer.

                  • Charlie says:

                    Except now that she has no market, unless she can pay the total out of pocket care for her doctor. The one that she was told she could keep. “Period.”

                    So because some paid $19K and had doctors she liked, they can now pay $11,500 and not get the treatment she needs, and you guys are crowing that she no longer has a “junk” plan? Really?

                    But you’ve also changed the subject, a usual tactic when progressives are caught in their own logic.

                    You stated that doctors make “enough” and won’t quit practicing and leave the industry because they are altruistic. That, sir, is when you decide that you’re changing the laws of economics when you pass your legislation that tells us what we bought in a competitive market is “junk”, but forcing us to buy what we don’t want and doesn’t meet our needs is better.

                    The American public is well aware of this, and all the anchors on MSNBC can’t cover for it.

                    • Let me address two things in separate comments. First, as I thought my comment very clearly and explicitly addressed, the Anthem plan available for $959/mo has an out-of-network maximum of $7,000. I don’t know what your definition of out-of-network is, but unless I’m wrong that means she can go to whatever doctor she wants and pay for it herself with a maximum out-of-network cost of $7,000. That plan has a 50% coinsurance for out-of-network, so she’d only be paying $7k if her total bill was greater than $14k. Now, she’ll probably hit that $7k out of network max, but whatever.

                      I highly doubt there were many plans in California before that had both of those facilities in network. Last time I checked, Stanford is nearly 500 miles from San Diego. The reason she could go to both places on her previous plan is because it was a catastrophic plan and she can afford to pay the maximum out of pocket costs, unless she was lying to the AARP.

                      So very clearly, so you understand – her old plan didn’t really have a “network” as far as she was concerned. She was responsible for all costs no matter where she went up to $10,000/year with no copay at all, then she had to pay 20% up to a certain amount. All of this was on top of whatever they paid in premiums. In Georgia, you too could have had a plan like that, and treated all of your symptoms at Stanford or MD Anderson or Emory or Grady or wherever you liked and it would have cost $19,000 each year to do so.

                      She is complaining because the exchange doesn’t sell a single plan to her that has both Stanford and UCSD in network. Well guess what – I did some basic journalistic research and discovered that she can buy a plan, for $22k instead of the $19k she MAY have paid last year (I bet she paid closer to $22k already) that is on the exchange or off. This plan should have UCSD in network and Stanford out of network. But guess what – she can still go to Stanford, it will just cost her a maximum of $7k per year in addition to the premiums that she needs to pay.

                      So when you say quote: “So because some paid $19K and had doctors she liked, they can now pay $11,500 and not get the treatment she needs” it is you that is wrong. She can get the EXACT same treatment she got the year before, and it will be about the same price. She just can’t find a plan that offers both in network. The plan she had didn’t really have a network since it was all catastrophic. These details are important, and for you to say the article is “brutal” without digging for all the facts (I mean come on – WSJ op-ed page – wouldn’t you do some fact checking if I posed a “brutal” op-ed from the Nation about something?) shows how lazy you are on this. And by the way, as I’ve shown, you’re still wrong.

                    • Harry says:

                      The situation facing senior citizens is very complex and expensive in any case, and Obamacare isn’t helping because it isn’t true reform. But, the real brutality is and will be the insurance premiums experienced by young healthy people under 0-care. They are the least economically stable but are expected to carry the load for everybody else, including those who made bad lifestyle choices. Let’s talk about young people when you have a minute.

                    • Second comment: I didn’t say anything about junk plans, you’re kind of putting words in my mouth and trying to tie it to what I said earlier. On to the actual topic:

                      Here is what I do know: no economist in their right mind would say that the current medical system, including how doctors are compensated, is a functioning market. I checked, and the average salary for a doctor in America is somewhere north of $300,000/year. Even the average salary for family medicine is around $199,000 with an average starting salary of $138,000.

                      Other people on this thread were saying that doctors are going to leave insurance and only treat private patients, which is what I was responding to in my original comment. I think some might. But I also think if that’s the best argument you have against Obamacare or any type of insurance reform, that’s a pretty weak argument.

                      Even if existing doctors do want to move on to do something else with their time, I think we can bridge the gaps with more nurse practicioners and by opening additional medical schools to train more people to be family medicine, internists and general practicioners.

                      I look rationally at Obamacare and also what was going on in medicine before it, and I conclude that with 17% of our GDP going to health care, sooner or later the supply and demand dynamic of doctors is going to change, similar to how it has changed for the legal profession. Maybe not everyone can be a highly paid specialist, the same way that not every law can be a highly paid corporate litigator who is a partner at a tony law firm pulling in $1,000,000 a year. But I wager that many, many, many people who do not currently practice either general medicine or lower could be filling the demand created by Obamacare.

                      If you want to talk economics, the state pays $131m/year to operate the Medical College of Georgia. Let’s stipulate that Obamacare is create the demand for lower-compensated doctors. Why on earth wouldn’t the state just open another medical school to fill that demand? And in what world (Obamacare or not) would the state open a new professional school to create more professionals and we would expect their salaries to rise?

          • saltycracker says:

            Way before Obamacare the big hospitals and insurance companies, including Medicare would clash. Years ago the concern for me was Aetna dropping some hospitals but they worked it out.

            Participation issues will always be in play and legislating them is a slippery slope. Legiskative coercion has a lot of unintended consequences.

          • Ellynn says:

            This looks more like a big city issue. When you live in a city or a county with only one hospital, that hospital won’t unilaterially refuse a carrier. It’s madness for them and in the long run costs them more. Example, my hometown hospital was sold a few years ago to a major company, and they came in trying to force out Anthem Blue Cross and Blue Shield coverage. The probelm was the 3 largest private employers in the county all carried Anthem policies. (Not to mention Anthem had a claims call center three blocks from the hospital.) Those 3 companies were also some of the largest donners to the hostpial center and one ran an on-site clinc and doctors office at their company. I’m not talking a small town, but one over 40,000 and a county at 65,ooo. And when I say employers, I’m talking a S&P 100 type.

            Savannah has three hostpials owned by two comapanies. One hostipal is the only level one trama and the major surgury center on the east side of the state, and the other is the children’s hostpial and INICU for a 9 county area. Both have to deal with two sets of state exchanges for local coverage, not to mention the snowbirds who live down her 5 months out of the year and are not 65 yet who havew God knows what type of insurance.The third hostpal is connected to the Catholic church. You really think it’s are going to just say screw all that Mathew 25 stuff and refuse care…

            • Harry says:

              You’ll have medical services, just not at a very high competence level. Reminds me of the joke about the French Foreign Legion lost in the desert. “All we have to eat is camel s*** but the good news is there’s lots of it!” The extreme example is Cuba. Ever see the photos inside one of their “normal” hospitals? Google on that.

              • Ellynn says:

                So your saying the Emory medical students attached to one of the Savannah hosptitals are not at a “very high competence level”… And your dissing the nuns…?

                I am sadden by your lack of trust in the Methodist and Catholic schools of higher medical learning.

        • Ed says:

          From one healthcare exec I’ve talked to (and I can’t remember the exact mechanisms so I’m giving the very broad sketch of what will happen) he fully expects independent doctors will begin to stop accepting health insurance so that they can provide a higher level of care to a more affluent clientele and be able to more effectively act as doctors.

          I fully expect that that practice will be made illegal in no time.

          • Harry says:

            How can you force a practitioner to accept an insurance reimbursement which they don’t approve? These people are already leaving the profession prematurely in large numbers.

            • Ed says:

              By mandating that you must accept insurance or be part of the national network to administer medicine.

              Under Obamacare, there will be greater authority given to nurse practitioners etc (IIRC) so I doubt the doomsday predictions will come true.

  2. Harry you wanted to talk about young people but I don’t think I can comment anymore on the above thread. It’s true that some people who are young and healthy and make too much to qualify for a subsidy won’t have access to an individual market anymore that sells them cheap plans that they likely don’t use.

    But I also think that the typical experience of a 35 year old male over the past ten years in the individual market was something like this:
    Age 25-31: $60/mo coverage they probably didn’t use.
    Age 32-35: $400/mo coverage once they got married with either no maternity coverage or $1,000/mo surcharge for a maternity rider.

    Under Obamacare, their experience might now be in ten years:
    Age 25-31: $150/mo coverage they probably won’t use.
    Age 32-35: Married, $700/mo coverage that covers maternity care.

    In total, you’re looking at about $23,520 in premiums under the baseline pre-ACA. And probably about $20k to have a child whether they did maternity waiver or not (pay upfront or after the fact). Plus whatever deductibles.

    Under ACA, $44,400 in premiums. Plus deductibles.

    Over a broader life cycle, it’s about the same. More earlier, less later. Yes, some people who don’t have kids, who would have always been healthy, who make too much to qualify for a subsidy, who aren’t covered through a work plan, etc will pay more.

    • Harry says:

      My only comment is, 0-care will sink or swim based on the experiences of people in their 20s, 30s, and 40s. And, not just 0-care but health policy in this country is in need of a severe overhaul. 0-care isn’t about reform because it’s been vetted and approved by the insurance companies and pharma companies etc. We couldn’t afford to pay 18% of GDP for health services, and we certainly can’t afford 22+% under 0-care.

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