Another event that’s moved online is the signature event for Georgians for a Healthy Future, Health Care Unscrambled, where experts, advocates and policymakers get together to talk about public health policy,…
Tag: coverage gap
This column was authored by Cindy Zeldin, Georgians for a Healthy Future’s Executive Director, and originally appeared in the Atlanta Journal-Constitution on September 28th, 2015.
Earlier this month, the Georgia Department of Community Health announced that it had abandoned plans — at least for now — to seek flexibility in Georgia’s Medicaid program to allow for expanded coverage and an innovative delivery-of-care model for the patient populations served by Grady Health System in Atlanta and Memorial Health in Savannah.
While this pilot program would have been fairly limited, it was designed with the changing health care landscape in mind and in the spirit of making the health system work better for patients. The proposal relied on an integrated care model with primary care medical homes, care coordination, data sharing and a focus on prevention. The costs to the state would have been nominal — negligible, even — as Grady offered to foot the bill. That this effort is not moving forward is a disappointment, but it should not be a conversation-ender.
For years, the nation’s uninsured rate appeared stuck at a stubbornly high level. This had implications for individuals and families who couldn’t access the care they needed, for communities and health systems that experienced spillover effects, and for overall health and productivity. Over the past year and a half, the tide has turned. The uninsured rate has steadily declined, and in some states it has plummeted to less than 5 percent.
It is a time of tremendous change in health care, yet this change is being felt unevenly. According to a recent Gallup-Healthways survey, states that both established their own health exchange (or a partnership exchange) and expanded Medicaid saw greater declines in their uninsured rates than states that did neither. States that viewed the changing health care landscape as an opportunity, and the Affordable Care Act as a toolbox, to improve coverage saw far better results than those who did not.
Many states taking this “opportunity and toolbox” approach are now building on the foundation of high coverage rates to invest in prevention, improve access to care and enhance value for consumers, often in collaboration with local health care stakeholders.
Kentucky, for example, has reduced its uninsured rate from over 20 percent to 9 percent since 2013. Combined with an intentional focus on prevention, this has translated to a more-than doubling of the number of screenings for breast, cervical and colon cancer and of dental and physical exams. Other states like Oregon are developing initiatives to contain costs, improve quality and achieve better price transparency for consumers.
Of course, not every promising initiative will be a smashing success, but the pace of innovation and advancement is historic for American health policy. Here in Georgia, approximately 500,000 people enrolled in coverage through the Health Insurance Marketplace, an exciting development that has helped bring our state’s uninsured rate down to just above 15 percent. In normal times, with all else being equal, this would be extraordinary.
And while this achievement is transformative for the people and communities impacted, these are not normal times for the health system. Georgia’s uninsured rate remains among the nation’s highest, and our health outcomes, among the nation’s poorest. Without a more deliberate focus on coverage, access, value and outcomes, Georgia risks falling further behind other parts of the country. We cannot continue to do less with less.
The demise of the Grady experiment, while a disappointment, should be a conversation starter about moving Georgia towards an “opportunity and toolbox” mindset. To date, our state has stayed on the sidelines while others have moved forward, but we don’t have to remain there.
The evidence is beginning to pour in from around the country, and we can take the most promising initiatives out there and use them to inform a uniquely Georgia approach. The clearest evidence we have shows us the decision by the majority of states (30 and counting) to expand Medicaid is foundational in transforming the health system. The Grady initiative, while not Medicaid expansion, was at its heart a delivery system reform that was predicated on moving its target population into coverage as a first and necessary step.
We cannot make progress as a state if 15 percent of our population is uninsured. Too many Georgians fall into a coverage gap our leaders can fix. Medicaid expansion should be on the table, not as a perfect solution, but as a necessary first step.
While Georgia has made little progress on closing its coverage gap, the subject is a hot topic elsewhere.
- Montana has closed its coverage gap! As the 29th state to close the gap, Montana will provide 70,000 Montanans with quality, affordable health care coverage. The state is currently working with CMS to gain approval for its expansion proposal.
- Face Off in Florida–The debate over closing the coverage gap is as hot as sunburnt skin after spring break! Floridians have seen a sudden and unexpected adjournment of the legislative session, a stand-off with HHS over the low-income pool (LIP), and their governor file suit against the federal government. The debate is far from over as the legislature plans to reconvene in June to complete their legislative responsibilities.
- Policy makers in both Alaska and Louisiana are discussing if and how to close their coverage gaps. While their legislators debate whether or not to close the coverage gap during a special session, polls show that Alaskans are hugely in favor of the policy. In Louisiana, Gov. Jindal remains opposed to the idea of closing his state’s coverage gap, but legislators are discussing their options.
While Montana closes its gap and other states think through their options, more and more studies are revealing that closing the coverage gap is good for states! It saves money in state budgets and facilitates job growth, especially in the health care sector. Families USA summarized the new data in a recent blog post.