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Healthcare experts weigh in on Medicaid expansion
by Caroline Young
February 15, 2013 12:40 PM | 2239 views | 0 0 comments | 9 9 recommendations | email to a friend | print
Special / The Carter Center<br>
Panelist Cindy Zeldin, executive director of Georgians for a Healthy Future, speaks as, from left, fellow panelists Ronald Bachman, president and CEO of Healthcare Visions Inc.; Frank Bonati, executive director of Gateway Behavioral Health; and Tim Sweeney, director of health policy for the Georgia Budget and Policy Institute; and facilitator Thomas H. Bornemann, director of the Carter Center Mental Health Program; look on.
Special / The Carter Center
Panelist Cindy Zeldin, executive director of Georgians for a Healthy Future, speaks as, from left, fellow panelists Ronald Bachman, president and CEO of Healthcare Visions Inc.; Frank Bonati, executive director of Gateway Behavioral Health; and Tim Sweeney, director of health policy for the Georgia Budget and Policy Institute; and facilitator Thomas H. Bornemann, director of the Carter Center Mental Health Program; look on.
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Nearly 2 million Georgians are uninsured.

The number grew by about 700,000 over the last decade.

“Medicare and Medicaid are the biggest reasons why people are not uninsured,” Tim Sweeney, director of health policy at the Georgia Budget and Policy Institute, said Thursday at a public policy forum at the Carter Center near downtown Atlanta.

With the expansion of Medicaid under the Affordable Care Act, which goes into full effect in January, there will be a national Medicaid minimum eligibility level of 133 percent of the federal poverty level, which is updated annually. For example, it was $22,350 for a family of four in 2011.

Sweeney said expanding Medicaid, which Gov. Nathan Deal is against for Georgia, creates new jobs and increases economic outputs.

Specifically, he said 56,000 new jobs would be created statewide, generating a projected $65 billion in new economic activity in Georgia.

“Taxpayers would get more back than they’re going to pay for it,” Sweeney said. “It’s a fraction of a percent of the federal budget [of $36.9 billion] to expand converge.”

He said the state’s budget is $4.5 billion.

“It’s going to be really hard to address unmet healthcare needs with just state funds,” Sweeney said. “Federal funding will enable Georgia to serve more people.”

Right now, Georgia ranks fifth in the country for the most uninsured people, according to Cindy Zeldin, executive director of the nonprofit Georgians for a Healthy future.

“Some of the other ones are some of the biggest states — Florida, California, Texas and New York,” Zeldin said. “And our eligibility levels are very low.”

She is a proponent of Medicaid expansion, she said, because an estimated 650,000 Georgians could gain coverage if it happened.

“The state of Georgia, as of now, will not move forward with Medicaid expansion in the U.S. … People would remain uninsured without access to health services and mental services,” Zeldin said. “People with low incomes disproportionately lack access to job-based health insurance … and purchasing a private individual policy is cost prohibitive [for them].”

Twenty-eight percent of predominately low-wage firms offer coverage versus 77 percent of predominately high-wage firms, she said.

Zeldin said expansion improves health access and outcomes, and people with Medicaid are more likely to have a usual source of care compared to the uninsured.

And according to the New England Journal of Medicine, mortality rates were lower in states which expanded coverage compared to neighboring states that did not, she said.

However, Ronald Bachman, president and CEO of Atlanta-based Healthcare Visions Inc., explained why expansion is “not such a great idea.”

He said he believes in “equal coverage, access and quality of care and treatment for all, but not equal to just insurance cards — insurance to real care and treatment.”

And expanding Medicaid to “the working poor,” Bachman said, is not the answer.

“We have a significant need to cover and expand mental health benefits,” he said.

Bachman said there are about 348,000 adults and 180,000 children with mental health problems in Georgia.

He said the answer is to put more integrated care into the private system, not expand Medicaid.

“If we don’t treat mental health, you’re going to pay for a lot more,” Bachman said.

Mental health problems like depression and anxiety can negatively affect companies, he said, and CEOs are beginning to understand the need for integrated care solutions, instead of just lowering healthcare costs.

Bachman said some of the main healthcare access issues are inadequate numbers of providers, low Medicare and Medicaid reimbursements and minimal integrations of mental health in primary care.

Plus, fewer doctors are accepting Medicaid because of things like low reimbursements and difficult patient referral, he said. 84 percent of doctors experience problems in referrals, which are important for patients to be referred to mental health specialists, Bachman added.

“Thirty-one percent of doctors nationally will not accept Medicaid. Adding so many Medicaid [recipients], where are they going to get care?” he said.

Bachman said Medicaid pays less than any other form of insurance.

“Adding more people to losses is not going to improve the situation,” he said.

Contradicting Zeldin’s statements, Bachman said children with Medicaid have worse access to care than uninsured children.

“Medicaid patients are 13 percent more likely to die in hospitals than those with no insurance,” he said. “Clearly, giving people Medicaid cards is not the same as providing mental health care and treatment. The better solution is to improve access to care in the private market through government or private exchanges.”

He said the insurance market needs to be reformed, and has proposed the need to the General Assembly.

“They don’t want to move on it. It ought to change,” he said. “I said, ‘In a … supposedly conservative [state], if you can’t find a solution to healthcare that is in front of you, then you deserve national healthcare. Don’t complain about it.’”
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