Covering More Georgians through Medicaid

By Cindy Zeldin

The Georgia Budget & Policy Institute’s Tim Sweeney makes a compelling case for expanding Medicaid to cover more Georgians in today’s AJC as part of a pro/con piece on the opinion page. Read it here.

Medicare Expansion Dies, Costs Control is New Focus

By Mike King

O.K., so the Medicare buy-in proposal survived what, a week or so, in the Senate? What looked like a promising compromise over the sticky issue of how to best cover more of the uninsured — by allowing 8 to 10 million Americans 55 to 64 years of age to purchase a Medicare plan — died quickly at the hand of Sen. Joe Lieberman, the Connecticut independent who Democrats probably now wish they had never agreed to let into their caucus room. No go, Lieberman said on a Sunday morning talk show. It would cost too much.

To be fair, it wasn’t all Lieberman’s fault. He mirrors the nation’s split personality over the role of government in health care. As the feisty, but woefully misinformed grandmother famously said at one of the August town hall meetings, “Keep the government out of my Medicare.”

Now Lieberman, who clearly has become a key player in the debate, seems to be turning his attention to controlling costs in the same program, Medicare. He says he’ll get on board with a final bill if it strengthens one of President Obama’s key provisions, calling for an independent Medicare Commission to make recommendations about how best to bend the curve of Medicare spending. Virtually every health policy expert understands something like this will be needed to control Medicare costs in the years to come, but talking out loud about it can quickly prompt a new round of “rationing” and “death panels” charges. Yet on this issue Lieberman has a liberal ally, Sen. Jay Rockefeller (D-West Va.), who was the Senate’s best advocate for expanding Medicare to all Americans.

Among other things, the Medicare Commission may not only be employed to recommend a list of procedures and treatments that are most cost-effective, but also to decide which are unnecessary and should no longer be paid for. The Commission could, for instance, be empowered to act like the independent commission that makes recommendations on military base closings. (That commission takes testimony from the Department of Defense, holds hearings, visits sites and recommends to Congress what bases should be closed or phased out. Congress can only say yes or no to its recommendations. It cannot alter them.)

Agreeing to giving the Medicare Commission that kind of power poses a real test on the Senate, which, with its now routine demand for 60 votes for passage on virtually any issue has become a de-facto veto chamber for proposals coming out of both the White House and House of Representatives in recent years. For a body that used to be seen as the staid “deliberative” chamber, its individual members have come to realize they can exert enormous influence over key issues as the head count nears the magical 60 votes. (See Joe Lieberman, Olympia Snow, Ben Nelson.)

And now, in what really seems ironic, the latest scuttlebutt out of Washington has a right-wing blog reporting that the White House is threatening Nelson, the Nebraska Democrat, that it will close Offutt Air Force Base in his state if he doesn’t vote for the health reform bill.

Given the source of the information, who knows if it’s true. But then again in this long slough through health care reform, the U.S. Senate has shown time and again that some of its members only want to know what’s- in-it-for-me?

Mike King is a retired journalist who specializes in writing about health policy issues. He also serves as editor and administrator of the Healthy Debate blog.

Focus on the Key Myths

By Mike King

The Business section of the Philadelphia Inquirer provides some useful information in discussing the most-often repeated, and most misleading claims about health care reform, including the one from reform advocates that “you can keep your health insurance if you like it.”  The other claims include: It’s a government takeover; it will lead to rationing; it does nothing to control cost growth and that the bill is too big and we ought to be tackling one issue at a time.

These are persistent themes that can be addressed when talking about health care reform with individuals and/or groups. As opponents of the effort are keenly aware, fear is a strong motivation and it’s easier to motivate people to be against something that to be for it.

Here’s the link:

Medicare for Early “Retirees”?

By Mike King

Part of the proposed Senate compromise on the public option stalemate over health insurance availability includes a very interesting – and timely – alternative: allowing 55- to 64-year-old Americans to buy into Medicare starting in 2011.

This is the first time in the long debate over reforming health care that expanding Medicare – the 45-year-old program guaranteeing insurance for America’s senior citizens – has generated serious discussion. That it might become a part of the eventual compromise on reform raises some interesting long-term issues, and could logistically serve a very useful purpose.

As American employers have downsized and shed millions of workers in recent years, the 55- to 64-year-old worker group stands out for having “voluntarily” taken retirement rather than risk being laid off. This trend line is likely to continue as long as the recession lasts, and probably even longer since these are often a company’s most expensive employees.

Many of these workers accept severance packages that allow them to continue health care coverage as long as the severance lasts. But after that, unless they start taking a pension and are eligible for a retiree health plan, they lose coverage. (They can also lose retiree coverage if a company gets in really deep trouble.) When that happens, things can get complicated fast, unless they can get on another payroll with a group-health plan or can afford the steep premiums to maintain their coverage through COBRA.

A good number of these former workers also have pre-existing, chronic conditions like hypertension, mild diabetes, asthma and high cholesterol, etc. They need close monitoring and regular medications to stay well. Private insurers eschew them because of that and can exclude them from coverage. Even if the new rules of health reform forbid denials on the basis of pre-existing conditions, this group would still have to pay substantially higher premiums than their younger counterparts enrolling in the same plans. That’s what makes this Medicare compromise so interesting, even if new enrollees have to pay the full cost of premiums, estimated to be about $7,000 a year. (Presumably some of them would eventually qualify for subsidies based on their income.)

Medicare beneficiaries often report higher satisfaction rates for their coverage than private insurers. The plan is relatively simple to administer and, because the government does the negotiating with hospitals and doctors, is more cost-effective than what can be offered in the private sector. That’s why liberals have for years pushed the idea of “Medicare for All” as the best public option alternative. This compromise falls far short of that, but it does take a giant step in that direction and is a logical extension that deals with the practical realities of the new American workforce.

Of course hospitals and physician groups hate it and are expected to fight it vigorously. Medicare’s negotiated reimbursement rates are often 10 to 20 percent lower than the private sector and these big players aren’t ecstatic about that – even if it could be a big benefit for millions of hard-to-insure Americans.

But at least now it is on the table.

Mike King is a retired journalist who specializes in writing about health policy issues. He also serves as editor and administrator of the Healthy Debate blog.


Health Care Reform Will Help Georgia Residents Find Coverage

This post originally appeared in the Atlanta Journal-Constitution on December 8, 2009.

By Cindy Zeldin

Our nation is on the cusp of historic public policy change. In the next several weeks, the most sweeping health reform legislation in 40 years will likely become law. Despite the heated town halls of August and the steady stream of information coming from the legislative debates in Washington, many Georgians are still wondering: What does this mean for me?



The “Cost” of Health Reform

By Mike King

Jon Cohn, senior editor of The New Republic, has an excellent commentary that helps decipher the various Congressional Budget Office “scorings” of the proposed health care reform bills. (You can find the link to the Kaiser Health News, which published Cohn’s comments today, on the widget next to this blog.)

When the CBO estimates are released, partisans on both sides of the issue pick over the analysis to highlight specific findings that support their point of view, often overlooking the overall theme of the report. That certainly happened last week when the CBO finally weighed in on the Senate’s plan and how it might impact consumers who already have insurance. Lost in the translation, however, was that many consumers now relegated to the private market — because their employers don’t provide it or because of a pre-existing condition, etc. — are forced to purchase policies that have high deductibles, high co-pays and lousy benefits, just to protect themselves from catastrophic expenses. Many of these people, the CBO says, may opt for a higher monthly premium (subsidized because of their income) in order to purchase more comprehensive coverage. That’s a good thing. A very good thing. The best way to control overall costs is for people to keep themselves healthy by having regular contact with a physician when they need it and not deferring care because they are worried they can’t afford the co-pay or deductible.

Similarly, Georgia officials have taken of late to complaining about having to put up additional money under the reform efforts to expand Medicaid, ignoring the fact that by doing so — and by getting more than 90 percent of it to be paid for by the feds — the state would put a significant dent in the estimated 1.8 million Georgians who now lack insurance.

By focusing solely on “cost” — the government’s or individual’s — and ignoring the larger benefit of expanded coverage, better access and improved chances to stay healthy, the debate gets warped and can easily be manipulated. It’s good to keep that in mind as these deliberations continue.

Mike King is a retired journalist who specializes in writing about health policy issues. He also serves as editor and administrator of the Healthy Debate blog.

Georgia Wins if Medicaid Expands

By Cindy Zeldin

This post was originally published in the Savannah Morning News.

The health reform legislation being debated in Congress right now features a range of provisions aimed at increasing the number of Americans who have health insurance.

One of these elements is a significant expansion of Medicaid, the joint state-federal program that provides health insurance to low-income, uninsured families. Under the bill recently passed by the House, Medicaid would be available to individuals and families with incomes at or below 150 percent of the federal poverty level, or approximately $27,465 in annual income for a family of three.

This expansion would go into effect in 2013, with full federal financing in 2013 and 2014. After that, the federal government would pay for 91 percent of the cost of the newly eligible population, leaving the state to pay for the remaining nine percent beginning in 2015. The Georgia Department of Community Health recently estimated that Georgia’s share of this expansion would cost around $2.4 billion over the five-year period between 2015 and 2019.


Grady Needs Public Support

Guest Blog By Benjamin Nanes


Grady Memorial Hospital’s decision to close its outpatient dialysis clinic has brought protesters to hospital board meetings, sparked a lawsuit, and generated headlines across the country. The clinic’s patients, mostly undocumented immigrants who cannot get regular care elsewhere, will be forced to leave Atlanta or to seek care through emergency rooms.


They will face delayed and inadequate treatment, spend more time in hospitals and die sooner.


It’s a dramatic story, but the closing of Grady’s dialysis clinic is only one symptom of a larger problem. Grady is in trouble, largely because the state and county governments, while claiming to support the services that Grady provides, have failed to support the hospital financially. That needs to change. Without adequate funding, Grady will be forced to cut more services, leaving even more people without the medical care they need.




National Medicaid Expansion Is a Bargain for Georgia

By Tim Sweeney

Over at the Georgia Budget & Policy Institute, we’ve recently released a brief that shows why expanding Medicaid to cover hundreds of thousands of low-income, uninsured Georgians is a bargain for the state. (Read the brief here.)

Instead of focusing on the small portion of the expansions costs that will be borne by the state (about 10 percent for newly eligible people), Georgia leaders should focus on the substantial social and economic benefits that the expansion and additional federal money would bring to Georgia.

Low-income Georgians already have far less access to employer-sponsored health insurance than higher income Georgians, and are seeing their limited access decline even more. Georgia had the 10th highest uninsured rate in the nation, on average, from 2006-2008, and because Medicaid eligibility thresholds here are pretty low, the state would benefit greatly from the national expansion.

Tim Sweeney

Sr. Healthcare Analyst

Georgia Budget & Policy Institute


Georgia May Just Say No

By Mike King

With a month to go before the 2010 session of the Georgia General Assembly convenes, a leading Republican lawmaker has already staked out what the state party’s position on any health care reform measure coming out of Washington will be: Georgia wants no part of it, says state Sen. Judson Hill (R-Cobb County).

Hill, one of the chief proponents of market-based, non-government health reform measures in Georgia in recent years, has pre-filed legislation (SR 794) for the 2010 session that would do three things. It would provide Georgia residents a right to obtain coverage through a private insurer, allow them to buy health care services with their own funds directly from doctors and hospitals and be free not to buy insurance or participate in a particular health plan. All these rights would need to be secured with an amendment to the Georgia Constitution.