Editorial: Laura Colbert of Georgians for a Healthy Future cites Georgia’s high uninsured rate, the opioid epidemic, and the financial struggles of rural hospitals in calling for the state to…
Last week, Georgia health advocates, service providers, and enrollment assisters combined forces for a day of learning, sharing, and planning at our second annual Getting Georgia Covered summit. In conjunction with the event, Georgians for a Future released a new publication focusing on key themes in consumer and assister experiences during the 2016 open enrollment period, best practices for outreach, enrollment, and reaching eligible Georgians who remain uninsured, and policy opportunities to increase enrollment, improve access to care, and address affordability issues. The report, Getting Georgia Covered: What We Can Learn From Consumer and Assister Experiences During the Third Open Enrollment Period, is intended to be a resource for health care stakeholders, advocates, and policymakers.
In addition to workshops that fostered collaboration between organizations and individuals working on behalf of health care consumers in different ways, we also featured presentations and remarks from Dr. Pamela Roshell, Region IV Director, US Department of Health and Human Services, Dr. Bill Custer, Director of Center for Health Services Research and Associate Professor, J. Mack Robinson College of Business, Georgia State University, Heather Bates, Deputy Director, Enrollment Assister Network, Families USA and Sandy Anh, Associate Research Professor, Georgetown University Center on Health Insurance Reforms. Jemea Dorsey, Chief Executive Officer for the Center for Black Women’s Wellness, and Sarah Sessons, Executive Director of the Insure Georgia Initiative of Community Health Works also offered their expertise and insights in a closing panel. In the coming weeks, we will release a publication highlighting promising opportunities to improve consumer health through collaboration, drawing on the discussions and ideas that came out of the workshops and discussions.
2016 Linda Smith Lowe Health Advocacy Award: Tim Sweeney, Former Deputy Director & Health Policy Analyst Georgia Budget and Policy Institute
2016 Community Impact Award: Carole Maddux, Executive Director & CEO, Good Samaritan Health & Wellness Center
For more than ten years, Tim Sweeney set the standard for reliable and responsible health policy analysis in Georgia. His insights and analysis equipped Georgia’s health advocacy community with the information needed to be a strong voice for consumers. He dissected the state budget each year, decoding line items and formulas. Tim read studies and briefed us on their findings, helping us all connect the dots between data and the health care stories of individuals, families, and communities across our state. While we know he will continue to achieve great things throughout his career, the people of Oregon will now benefit from his expertise and commitment. For his decade of service in Georgia, we are proud to honor Tim with the Linda Smith Lowe Health Advocacy Award.
Carole Maddux lives and breathes health care access through her work leading Good Samaritan Health & Wellness Center in Pickens County. Under her leadership, Good Samaritan has recently transitioned to a federally qualified health center, is undergoing an expansion to better meet the community need, and is engaged in a local partnership to foster better collaboration locally. Carole also provides a clear, moral voice for systemic change in health care, speaking out on behalf of Medicaid expansion and other public policies that would expand coverage and increase access to care for all Georgians. For her leadership, commitment, and impact, we are proud to honor Carole with the Community Impact Award.
We hope you’ll join us on September 28th as we recognize Tim and Carole! RSVP
Harry Heiman & Abby Friedman
AIDS Healthcare Foundation
Cindy Zeldin & Doug Busk
Easter Seals Southern Georgia
Georgia Association for Primary Health Care
AbsoluteCARE Medical Center & Pharmacy
Georgia Charitable Care Network
Ilene Engel & Bob Arotsky
American Diabetes Association
Bo & Chris Hagler
Essig Gehl Consulting
Feminist Women’s Health Center
The GHF Staff
Jeff Cornett & Edward Fernandez-Villa
UGA College of Public Health
Voices for Georgia’s Children
Georgians for a Healthy Future’s Executive Director Cindy Zeldin sat down with A Spirit of Charity author Mike King to discuss his new book on the role of public hospitals in America. Below is a Q&A that delves into some of the book’s major themes. On July 19th, Georgians for a Healthy Future will hold a book event in Atlanta with Mike King, providing a unique opportunity for the advocacy community to discuss the history and role of public hospitals in America and the direction of health policy in Georgia with the author.
Why did you decide to write this book?
I have been writing and editing stories about medicine and natural medicine like thai kratom powder and health care policy for about 30 years where they use different kind of medicines, you could for example this reach out to one!. When the newspaper business collapsed and I chose to leave it in 2009, I thought I’d just retire and take it easy. But when the Affordable Care Act passed in 2010 I realized I had the time, without daily deadline pressures, to tell a story about the most important effort at reform over the last 50 years and how it might play out right here in Atlanta and at Grady in particular,.
How do public hospitals serve as a window into America’s health system?
As the book hopefully makes clear, the people who show up in the emergency rooms and clinics of America’s public hospitals are the result of all gaping holes, political compromises and unintended consequences of decades of attempts to reform our health care system. Even in our noblest of efforts, we always seem to leave whole segments of our society behind. Donald Trump, in a candid moment earlier in the campaign when the media pushed him for more details about what his alternative to Obamacare would look like, frustratingly blurted, “Look, we won’t let people die in the streets, OK?” In some ways that’s been our baseline as a health care system from the start, which is why public hospitals were created. We don’t let our citizens die in the streets. They get sick in the street but, if they are lucky, we get them to a public hospital that hopefully will rescue them from dying before they return to the streets. That’s a harsh assessment, I know, and we do much better than that in many places thanks to the commitment of engaged local and state leaders, but there are too many places where the local public hospital seems expected to shoulder this burden on its own.
Four of the five hospitals profiled in your book are located in the South, and the role of Southern politicians in crafting U.S. health policy is explored throughout the book. Why a focus on the South?
Because the South is where the most problems are. Texas, Florida and Georgia lead the nation in the dubious distinction of having the most uninsured residents among all 50 states – mostly because all three have refused to expand Medicaid the way the ACA called for. Louisiana is high on the list too, but the new governor there is moving to try to expand Medicaid. Parkland Memorial Hospital in Dallas, Jackson Memorial in Miami, the University Medical Center in New Orleans (the replacement hospital for Charity) and, of course, Grady, all have to contend with a huge percentage of patients who are poor and uninsured and could be, should be, covered by Medicaid. That’s why I chose them.
Some public hospitals like Grady were established during segregation. The 1946 Hill-Burton Act, which catalyzed hospital construction, contained a provision permitting segregation in hospitals receiving federal funds. How does this legacy of segregation impact public hospitals today?
Hill-Burton was the first time federal law actually codified a separate-but-equal funding mechanism and it was inserted into the law specifically to get members of Congress from the South to go along. Rural hospitals around the South and more than a few in the suburbs were built in the 1950s and 60s with Hill-Burton money. Grady was rebuilt as a segregated hospital in 1958. After the enactment the Civil Rights Act in 1964 and Medicare in 1965 that changed. Segregated hospitals – public and private – stood to lose too much money that they would be getting for the care of previously uninsured elderly patients if they stayed segregated. But there is still a legacy to overcome. There’s a reason elderly Atlantans still refer to Grady as the Gradies, going back not that long ago to when there was a Black Grady and a White Grady, with black nurses taking care of black patients and white nurses taking care of white patients. It still complicates the public discussion about how best to finance and administer this particular public hospital. I suspect that goes on in a lot of communities around the South that share a similar legacy.
You write that public hospitals serve as a “pressure release valve” for our nation’s health system. What do you mean by this?
We often refer to these places as safety net hospitals. But I contend they are more than that. The existence of a single hospital in a community that is chartered or required to take in all patients regardless of ability to pay fundamentally alters the medical marketplace in that community. It allows those hospitals that compete with it to measure their anticipated level of charity care against their expected revenue from insured patients and come up with a formula that helps them stay healthy and able to grow. It is not that most of these competing hospitals don’t provide a responsible level of charity care. Most of them do. But it is always at a level they can afford to provide. Public hospitals operate on a totally different business model. They have to take all comers and the only way they can stay open is to get some level of funding from state and local taxes to offset their losses. Here’s another way of looking at it: If Grady had gone belly up in 2007 and 2008, all the uninsured and indigent patients it served would have swamped the emergency rooms of Piedmont, the Atlanta Medical Center, Northside, St. Joseph’s, Emory and DeKalb Medical as well as other hospitals, jeopardizing their ability to provide the level of services their business model calls for. The safety valve would have blown.
Information about Medicaid, the health care program intended to help finance care for low-income Americans, is interwoven throughout your book. How are the histories and fates of Medicaid and public hospitals intertwined?
They are the key to understanding each other because Medicaid patients make up a large portion of the patients who go to these hospitals. When Medicaid was enacted in 1965 the theory was that with a health insurance program now in place for the poor and with Medicare available to the elderly, our nation’s public hospitals would finally start getting paid for many of the services they had been providing on a charity basis. But unlike Medicare, Medicaid was hampered – I would argue fundamentally flawed – by a series of compromises to get it through Congress. States were given a much bigger role in determining how poor you had to be to qualify for Medicaid, how much they wanted to pay doctors and hospitals to provide services for Medicaid patients and indeed whether they wanted to participate in the program at all. (Arizona didn’t join Medicaid until the 1980s.) The result was a checkerboard of health care programs for the poor around the country, based largely on what the states decide. And in the South, Medicaid has been chronically underfunded at the state level and treated more like a welfare program. This is how Southern politicians get away with calling it a failure. They starve it for funds, make it difficult for low-income people to get covered by it, grossly underpay doctors and hospitals that take patients covered by it and then decry the program for not working and being inefficient.
America’s health system is characterized by fragmentation. Why do you think this is and what is the role of public hospitals in a fragmented system?
We’ve all heard it before. America has a sick care system, not a health care system. And that system is based on who pays for sick care, not necessarily how we can more effectively pay for care to help keep people healthy. The good news is that the ACA is moving in the direction of breaking down some of the silos that have developed over the decades in how we deliver and pay for health care, with an emphasis on moving away from paying a fee for specific services and toward paying for overall wellness. That’s good. But it will take years to see results. Public hospitals will need to move in this direction as well – and some of them are. Cook County’s Medicaid Program (County Care) is coordinating care with its community hospital and clinic network and the federally funded community health centers in Chicago. The initial results look encouraging. If it works it will not only save lives but help control the rise in costs. But public hospitals must adapt to these new models and remain, in most large cities, the sole providers of costly essential services like trauma, HIV/AIDS and behavioral health for those who are still uninsured.
You write that, if public hospitals didn’t exist, “We would have to invent them.” What would an America without public hospitals look like?
It would be fascinating to see, wouldn’t it? Public hospitals were created one hundred to one hundred and fifty years ago when it became obvious that the charitable institutions in large American cities could not meet the demand for care caused by yellow fever, cholera, pestilence and other public health threats, not to mention the population growth in cities after the Civil War. The almshouses and infirmaries, often staffed by religious women and funded by churches and community groups, just could not keep up. I suspect the same would happen today if we came to rely exclusively on the nonprofit sector to take over the responsibility for caring for the poor and uninsured. Even if we became enlightened and created a system of true universal insurance for all Americans, there would still be a need for expensive specialty areas. Trauma care, infectious disease programs, severe, chronic mental health services – these essential services now almost exclusively provided by public hospitals – I would suspect they would require some level of local and state financing at a public facility that would go beyond what they can expect in the way of revenue from a public insurance plan.
Grady is featured prominently throughout the book. What did you learn about Grady by writing this book that you didn’t know before?
That it is even bigger and more complicated and harder to manage than I ever dreamed. I think the current administration there is doing a really good job at getting the hospital positioned to be everything it can be. The quality of the specialty services there – trauma, neuroscience, neonatology, burn care, sickle cell, infectious disease – has probably never been better, and they get well informed visiting Litchfield Neurofeedback to learn about the benefits of Neurofeedback Therapy. The cancer program there, in addition to being first rate at the acute care level, is making great strides in the community in the much-needed area of early detection and treatment. That will go a long way toward reducing the disparities that exist in morbidity and mortality between white and black, affluent and poor residents of our community. But the hospital is still heavily reliant on the business and philanthropic community to grow, especially when it comes to capital improvements and equipment. That’s all been private money since the comeback started. State and county officials have yet to step up to the plate to help. If they are willing to help the Braves and the Falcons build new venues, they must be willing to step up to help Georgia’s most important hospital build and grow and provide essential services.
What role does Grady serve in health care policy in the state of Georgia?
The state needs to recognize Grady is a statewide institution, if for no other reason than it is the training ground for about one in every four doctors practicing in Georgia. I’ve often wondered whether the state’s relationship with Grady would be different if it had been affiliated with a state medical school instead of Emory and Morehouse – two private medical schools. Perhaps then it would have paid more attention to it. Even though Grady gets patients from almost every one of Georgia 159 counties, it isn’t realistic to think the state must subsidize indigent patient care there, but it could do much better and providing funding for the specialty services that Grady provides to all Georgians – trauma care, burn care, infectious diseases, etc. And, of course, it should expand Medicaid coverage so that Grady and all other hospitals in the state that have a heavy load of uninsured patients will at least have an opportunity to recoup some of their costs.
Where do you think Georgia is headed on health care policy?
I think we’ll expand Medicaid. Eventually. After President Obama is in the rear view mirror. We’ll call it something else so it doesn’t sound like it is part of Obamacare. But we will have squandered $3 to 5 billion and 100 percent federal funding to make this impetuous political statement, and no telling how many Georgians – one study puts it at 1,200 lives a year – who died because they lived in a state where they should have, but were kept from, enrolling in Medicaid. With a little political vision – and the help of advocates and experts – my hope is that we could create a Medicaid program that isn’t so fragmented; that fully integrates primary care and acute, hospital care; that reorganizes local hospitals and health departments into a true public health system that helps people stay healthy and when they get sick have no barriers to the care that they need. That shouldn’t be a pipe dream in a country as wealthy and smart as ours. That should be a working reality. On the other hand, try to visit what is a medium.
Georgians for a Healthy Future staff attended the Connections 2016 conference hosted by the Healthcare Georgia Foundation on March 29th and 30th. The conference, held every other year, is an opportunity to network and learn from Georgia’s health and public health practitioners, professionals, advocates, and experts.
This year’s conference theme was partnerships, and in keeping with that theme, GHF was invited to present on how we use coalition building and mobilization as a strategy for policy change at the state level. Cindy shared how our history created an organizational environment that fosters and supports the development of strategic partnerships and coalitions. Laura added to that with an overview of GHF’s five coalitions, a coalition case study, and a review of some selected best practices in coalition development and management. You can see their presentation here.
As a result of the two-day conference, GHF staff came away with new contacts to partner with in the future and new ideas about what partnership might look like. The conference also provided the opportunity to network with existing partners, learn about their emerging work, and identify ways to collaborate moving forward.
If you would like to partner with GHF or join any of our five coalitions, contact Laura Colbert, Director of Outreach and Partnerships, at email@example.com.
- The Access to Care and Equity (ACE) coalition focuses on ensuring that coverage translates to access to care and has been working most recently on the issue of network adequacy
- The Cover Georgia coalition advocates for closing Georgia’s coverage gap that leaves 300,000 Georgians without a coverage option
- The Georgia Enrollment Assister Resource (GEAR) Network connects people and organizations working to help consumers enroll in coverage
- The Health Advocates coalition is open to health advocates representing non-profit organizations who want to coordinate efforts with other advocates
- The Preventing Youth Substance Use Disorders coalition works together to raise awareness about and advocate for a public health approach to preventing addiction
Do you or does your organization work directly with consumers to help get them covered? Do people in your community come to you with questions about how to make sense of their health insurance? If so, GEAR is for you! Please join us for a webinar to introduce the new Georgia Enrollment Assistance Resource Network — GEAR! GEAR is the new central hub of resources for Georgia’s enrollment assisters and stakeholders who work to educate people on their health and health coverage options. GEAR is full of handouts, interactive consumer tools, important updates, and other materials that will help enrollment assisters and community organizations better educate Georgians on health insurance enrollment, health insurance literacy, and more.
Want to learn more about GEAR and how you and/or your organization can benefit? Join us on October 19th for a webinar where we will demonstrate how to access GEAR and review some of the materials that can be found there. We will also get your feedback about other resources you would like to see included on GEAR in the future. GEAR is built to help more Georgians connect to health coverage and we want it to work for you!
You can register for the October 19th GEAR webinar here.
At Georgians for a Healthy Future, we pride ourselves on strong partnerships. Over the past few years, we have been collaborating with Georgia Equality and the Health Initiative to ensure that the health care needs of LGBT Georgians are not neglected.
These partnerships brought Whitney Griggs, GHF’s Consumer Education Specialist, to Savannah on September 12th for the annual Savannah Pride Festival. Together with the Health Initiative, Whitney distributed information related to LGBT health care needs and spoke to festival attendees about how to enroll in health insurance. Of particular interest was our joint fact sheet with Georgia Equality on Transgender Health Care. Some of the festival attendees who picked up this fact sheet shared stories of having been denied coverage due to being trans-identified in the past, but who can now get coverage that meets their needs because of the Affordable Care Act. People that stopped by the table were also interested to learn that health care services must be provided regardless of gender identity or expression. This means that health insurance plans must cover transition-related care, as long as that care is covered for cisgendered people under on the same plan. So services such as hormone replacement therapy and gender-specific care (like mammograms and prostate exams) must be covered if they are covered for other people enrolled in the same plan.
Whitney also gave out some tips for trans-identified folks to keep in mind when enrolling in health insurance:
- On all enrollment forms, check the sex box that matches the sex you believe is on file with the Social Security Administration.
- Some important questions to ask include:
- Is hormone replacement therapy covered?
- Is my doctor included in the plan’s network?
- Is there a network of trans-friendly doctors and/or doctors who have training working with or currently serve trans clients?
- Are reconstructive surgeries covered?
All in all, it was great day in Savannah (despite the rain) and people learned a lot from GHF and the Health Initiative.
If you have a specific question about LGBT health care and health insurance, feel free to reach out to Whitney Griggs at firstname.lastname@example.org or the Health Initiative at (404) 688-2524
May 13, 2015 from 11:30 to 2:00
Georgia Railroad Freight Depot; Blue Room
Sign up here!
More than half a million Georgians signed up for health insurance during the open enrollment period that ended this past February (OE2). These strong enrollment numbers mean that more Georgians have access to the health care services they need and the peace of mind that comes from knowing that they are covered. What drove this success story for health care consumers in Georgia? Please join us for a conversation with representatives of the organizations most active in OE2 to learn lessons about their strategies, successes, and challenges that you can apply to your work. After their presentations, you will have the opportunity to ask your most pressing questions about health coverage in Georgia. Lunch will be provided.
Enroll America: Danté McKay, Georgia State Director
GHF: Whitney Griggs, Consumer Education Specialist
InsureGA: Sarah Sessoms, Executive Director
SEEDCO: Lisa Stein, Vice President Work and Family Supports
US Dept. of Health & Human Services: Dr. Pamela Roshell, Region 4 Director
While this is a free event, please RSVP so we can order enough food.
Please join us on Wednesday, March 25, from 8:45 am to mid-day for a morning of advocacy! GHF will provide individuals and organizations with the opportunity to advocate for the important health issues that matter to you in the closing days of this legislative session. You may want to advocate for closing the coverage gap, Medicaid payment parity, raising the tobacco tax, the Family Care Act, rural health care access, or another health policy issue. You’re all invited to participate! We’ll provide breakfast, an advocacy training, and an opportunity to share and network with other health advocates.
January is an exciting month for GHF and Georgia! With the start of the legislative session, advocates across the state will be hard at work educating our legislators and working for the changes we need to improve the health of all Georgians. GHF is no exception!
Our 5th Annual Health Care Unscrambled event is January 15th. For more information on the event, sponsorship opportunities, and ticket prices, click here.
Coverage Day at the Capitol. Please join us on the morning of January 27th to talk with your legislators about why closing the coverage gap is important to you. If you haven’t spoken with your legislators before, we will provide training and talking points to help guide you through the process. If you would like to participate, RSVP to Laura Colbert at email@example.com.
Webinar: Health Care Policy and Advocacy for the 2015 Legislative Session, 2015. For those of you who can’t make it to Health Care Unscrambled for the unveiling of GHF’s 2015 policy priorities or want to know how to better advocate for health in Georgia, join us for our first-ever advocacy webinar! To register for the free webinar, click here.