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Medicaid Dominated when Governor’s Policy Advisors Took Questions

Mike Klein

Medicaid is a beast.  About one-in-five Georgians receives Medicaid health care.  That is 1.7 million people.  Fifty-nine percent of statewide births are Medicaid babies.  Another couple hundred thousand children are enrolled in PeachCare, the state children’s health insurance program.   Medicaid could grow by hundreds of thousands more if the U.S. Supreme Court upholds the federal health care reform law in its decision expected next month.

Not at all surprisingly, Medicaid redesign questions were abundant when three of Governor Nathan Deal’s advisors met with Georgia Children’s Advocacy Network members at the Freight Depot in Atlanta.  The advisors made no presentations and took questions for 90 minutes.

Health policy advisor Katie Rogers named telehealth reimbursement policies, portable electronic records, better outcomes for vulnerable children, physician shortages in some specialties, how to manage health care in counties that are medically underserved and treatment options for chronic childhood illnesses as part of the wide-ranging Medicaid redesign conversation.

Next month the U.S. Supreme Court will rule on constitutionality of the 2010 federal health care reform law.  If upheld the Patient Protection and Affordable Care Act provisions often known as ObamaCare could add 620,000 new Medicaid patients to the state program.  Rogers predicted, “People who haven’t had access to services are going to seek services probably very quickly.”

Georgia Medicaid cost $7.78 billion in fiscal year 2010, according to Kaiser State Health Facts.  Federal funds pay 66% and the state is responsible for the rest, about $2.7 billion.  Georgia Medicaid program redesign is being managed by the Department of Community Health with private partner assistance from Navigant. The project is described in a comprehensive design strategy report available on the DCH Medicaid website.

This project is so important to Georgia’s health care community that it is being closely monitored by many organizations outside government.  Cindy Zeldin is executive director at Georgians for a Healthy Future which advocates for improved statewide access to quality health care.

“The three buckets when we look at improving Medicaid would be one, just coverage, getting kids who are eligible but who are not enrolled today into the program so they at least have that front door access,” Zeldin told the Public Policy Foundation this week.

“Second, improving access to care, just making sure there is a mechanism to make sure that being in Medicaid means you can see a provider if you need to,” Zeldin said.  For instance, the state has no OB-GYN practitioners in 39 counties, which is an impediment to women’s health.

“Third would be improving outcomes and accountability, what you are asking managed care companies to report on and making sure you are measuring outcomes that ensure quality care.”

The Supreme Court opinion expected next month will also decide whether Georgia must create a health insurance exchange.  Last December a state report to Governor Deal said a private or quasi-governmental exchange would be preferable to one imposed by the federal government, but Georgia would prefer that it is not required to create any exchange.  Georgia opposes the federal health care reform law and it joined the suit that challenges the constitutionality.

“If the law is upheld as it stands now we will work very quickly to implement a state exchange,” Rogers said.  “If the law is not upheld the discussion will begin again on whether or not to move forward with a state exchange.  Part of the concern is without the individual mandate would people want to buy insurance through the exchange?”

Education and Public Safety Issues

Education and several public safety issues were also discussed during the open forum.

Education policy advisor Kristin Bernhard said several early childhood education programs lead the priority list heading into next year’s General Assembly.  Do not expect support for private school vouchers or increasing the age for compulsory school attendance from 16 to 18.

“The voucher conversation isn’t on the table for us,” Bernhard said.  “We’re more interested in increasing the quality of public education for all students everywhere.”  On compulsory school attendance she said, “The evidence is not necessarily compelling that raising the age of mandatory school attendance automatically results in an increased graduation rate.”

Education headlines over the next year will include incorporating the state’s version of new national core curriculum coursework, dual enrollment for middle school students taking high school courses or high school students taking college courses, tenth grade college readiness testing, and preparation to expand career pathways education now scheduled for fall 2013.

Also, Georgia admits that it has too many high school graduates who require remedial courses when they enter college.  “We know that students are graduating from high school not ready for college,” Bernhard told 100 Georgia Child Advocacy Network members.  Part of this discussion is how these students can be assisted by resources inside the state technical college system.

This week the Illinois Senate President proposed his state enact internet gaming legislation to get in front of a potential federal law that would grandfather existing state programs but prevent other states from creating new ones.  Do not expect anything like that in Georgia.

It is well documented that the lottery-funded HOPE scholarship, grant and pre-K programs can no longer afford to fully fund their commitments.  Governor Deal opposes a proposed casino-style project and Bernhard says, “What we’re looking at is what we can do to boost the existing revenue streams.”

Several folks applauded when public safety advisor Thomas Worthy said, “I have no doubt that we will probably see and definitely sign a juvenile code rewrite next year.”  HB 641 was a substantial effort to rewrite piecemeal juvenile laws that are decades old.  It passed the House but then was stopped before Senate consideration so more work could be done on cost.

“Everybody is in agreement on the policy side of things,” Worthy said.  “We are there.  The stakeholders are there.  Agencies are now there.  Now what we are tasked with doing is figuring out a way to not only pay for implementation but actually ascertain savings that will come under the bill.”  Worthy said consultation has begun with the Pew Center on the States; Pew assisted with criminal justice reform legislation that Governor Deal signed this month.

Worthy also acknowledged, “Not only do we have a horrible child trafficking problem within our state, (Interstate) 75 is used to move folks going to other states.”  This year HR 1151 in the General Assembly created a commission to study child trafficking and make recommendations.

(Mike Klein is Editor at the Georgia Public Policy Foundation)

May 17, 2012 Posted by | Uncategorized | , , , , , , , , , , | Leave a comment

What Should You Expect to Pay for Your Dog’s Knee Transplant?

Mike Klein

What should you expect to pay for your dog’s knee replacement?  Should what you pay for your dog to have his knees fixed bear any relationship to fixing your own knees?   What determines the cost for knee replacements, whether the surgery is done here or overseas?

Writing this week on his national Health Care Policy blog, health care economist John Goodman asked, “Why is the price of a knee replacement for a dog — involving the same technology and the same medical skills that are needed for humans — less than 1/6th the price a typical health insurance company pays for human operations?”

Goodman also posed this question: “How is a Canadian able to come to the United States and get a knee replacement for less than half of what Americans are paying?”

And this question:  “How are Canadians getting knee replacements in the U.S. able to pay only a few thousand dollars more than medical tourists pay in India, Singapore and Thailand – places where the price is supposed to be a fraction of what we typically pay in this country?”

There is very little national debate about dog health care costs but human health care is entirely another issue.  It fundamentally and deeply personally scares nearly everyone who might one day be forced to assume his or her own extreme health care costs or those for others, their loved ones.  And it is well documented that human health care costs are eating the economy, whether that economy be the private sector economy or the public sector economy.

John Goodman, President and Founder, National Center for Policy Analysis

Goodman – whose National Center for Policy Analysis created the health savings account idea – will participate in a medical malpractice reform panel and also deliver a keynote address at next week’s Georgia Public Policy Foundation legislative briefing. The Friday, September 30 conference is open to the public at the Cobb Energy Performing Arts Centre.

Goodman’s address, “Free Our Health Care Now,” is expected to build on ideas the NCPA founder published soon after President Barack Obama issued a challenge to U.S. House Republicans:  “If you have a better idea, show it to me.”  Goodman responded with a 10-point proposal in a Wall Street Journal commentary that was republished on the NCPA site.

Goodman’s response to Obama’s challenge:  Make insurance affordable through tax relief, make health insurance portable, meet the needs of the chronically ill, allow doctors and patients to control costs, don’t cut Medicare, protect early retirees, inform consumers, eliminate junk lawsuits, stop health care fraud, and make medical breakthroughs accessible to patients.

Today the Patient Protection and Affordable Care Act — sometimes referred to as Obama Care – remains under constant scrutiny from conservatives.  Twenty-eight states that consider it unconstitutional went to federal court and their case will most likely be decided by the U.S. Supreme Court sometime next year.

Incidentally, if you are still wondering about the comparative costs for dog and human knee transplant surgery, Goodman noted in this week’s blog that while humans generally spend the first couple days recovering in the hospital or in a nearby hotel, dogs usually recover in cages.  We are not aware of any new proposed policy for humans to also recover in cages.

Click here for more information and to register for the Friday, September 30 conference.

Other Conference Keynote Speakers:

Bernie Marcus

 

Bernie Marcus is co-founder of The Home Depot.  Along with his wife Billi, Marcus funded development and construction of the Georgia Aquarium which is one of the world’s leading aquarium research facilities.  The Marcus Institute in Atlanta provides comprehensive services to children and adolescents with developmental disabilities.  The Marcus Foundation also funded a state-of-the-art bio-terrorism unit at the Centers for Disease Control and Prevention.  Marcus will discuss “How to Make Georgia a Leader in Entrepreneurship and Innovation.”

 

 

Michael Horn

 

Michael Horn is co-founder and executive director of education at the Innosight Institute in Mountain View, California, south of San Francisco.  Clayton M. Christensen, Horn and Curtis W. Johnson are co-authors of “Disrupting Class: How Disruptive Innovation Will Change the Way the World Learns.”  Christensen, Horn and Jason Hwang co-founded the Innosight Institute four years ago to focus on health care and education policy research and writing.  Horn will discuss “The Promise of Online Learning.”

 

 

Lee Hicks

 

Lee Hicks is founder and chief executive officer of Atlanta-based C PORT Solutions which specializes in high end communications and video conference products for several industries including health care.  Clients include the Walt Disney Company, Proctor and Gamble, Toyota, Boeing, IBM, AT&T, Medtronic and Med Assets.  This year the Atlanta-based consumer giant Newell Rubbermaid and C PORT announced their partnership in a new health care division.  Hicks will discuss “Keeping Innovative Startup Companies and Jobs in Georgia.”

 

(Mike Klein is Editor at the Georgia Public Policy Foundation)

September 21, 2011 Posted by | Uncategorized | , , , , , , , , , | Leave a comment

Governor Deal Pledges to Save HOPE, Reform Corrections, Limit Spending

Mike Klein

Moments after Nathan Deal became the 82nd Governor of Georgia on Monday afternoon he predicted a more limited government that perhaps chooses different missions by vowing, “We must justify every cent that government extracts from our society.”

Deal’s inaugural address was predictably short on program specifics.  Those begin to come this week when the governor delivers his State of the State address and releases his first proposed budget, both on Wednesday.  His address focused on statewide unemployment, corrections system reform, education, the HOPE scholarship, transportation, water and health care.

“The lingering pain of this great recession in which we are still engulfed has underscored the urgency of re-examining the role of government in our lives,” said Deal, who served nine terms in Congress.  “The evolution of society has infringed on much of the elbow room that our ancestors enjoyed, and government has been asked to regulate our actions as we bump into each other in our frantic search for success.

“In times of economic prosperity we often ignore the costs and inconvenience of governmental paternalism.  But in times such as these with more than one of every ten of our employable citizens out of work we must justify every cent that government extracts from our economy.”

Deal said one-in-13 Georgians is under correctional control, meaning in custody, on probation or on parole, and he said it costs $3 million per day to operate the Department of Corrections.  “Yet every day criminals continue to inflict violence on our citizens and an alarming number of the perpetrators are juveniles,” the governor said.

“College students should be concerned about their grades, not whether they are going to be mugged on their way home from class.  Visitors to our cities should be treated as welcome guests, and protected.  Families should not live in fear of gang violence or drive-by shootings. But most of all, our dedicated law enforcement officers must not be target for criminals.  Anyone who harms one of them harms us all.”

Georgia Governor Nathan Deal

The former state legislator from Gainesville promised violent and repeat offenders that, “We will make you pay for your crimes.  For other offenders who want to change their lives, we will provide the opportunity to do so with day reporting centers, drug, DUI and mental health courts, and expanded probation and treatment options.

“As a state we cannot afford to have so many of our citizens waste their lives because of addictions,” Deal said.  “It is draining our state treasury and it is depleting our work force.”

Deal praised his predecessors and “dedicated teachers and educators” but he noted Georgia K-12 public education “has failed to make the progress that we need.  This failure is a stain on our efforts to recruit businesses to our state and is a contributing factor to the frightening crime statistics that I previously mentioned.  High dropout rates and low graduation percentages are incompatible with my vision for the future of the state of Georgia.”

Deal sought to assure families who wonder about the long-term future of the financially challenged HOPE scholarship program.  “”I was not elected to make easy decisions but difficult ones,” Deal said.  “In this legislative session we will save HOPE for future generations.”

Deal emphasized the Savannah and Brunswick ports are Georgia’s link to an ever expanding international trade community.  “We will do our part to deepen the Savannah port in order to accommodate the larger vessels that will soon pass through the Panama Canal, but we must do more.  Our rail capacity and cargo routes must be improved and expanded.  We must not miss this opportunity to provide jobs for Georgians.”

The governor described Atlanta metro highway congestion as “a deterrent to job growth in the region.  If we do not solve this problem soon we will lose the businesses who want to expand or locate in our state.”

Deal also inherits the Tri-State Water War.  A federal court judge ruled Alabama, Florida and Georgia must reach agreement before July 2012 or Congress will impose a solution.  All three states have new Republican governors, but that does not ensure agreement.  All three states had Republican governors during Sonny Perdue’s eight years as Georgia governor.

Deal vowed the state will continue to negotiate but will also develop regional reservoirs.  “We are blessed with abundant water resources and we must use them wisely.”

The new governor was blunt in his assessment of federal health care policy, widely known as Obamacare.   “As governor I will resist the efforts of the federal government to mandate its solutions on our people, our businesses and our state government.”

The new governor assumed office three days after a special council issued the state’s most dramatic tax reform proposals in eighty years.  Legislative approval would reduce personal and corporate income tax rates, and make significant changes to sales taxes on products and services, including collection of sales tax on groceries.  He did not mention the tax proposals.

State of Georgia Seal

Fiscal issues will dominate every General Assembly conversation this session and dictate which priorities prevail.  The next state budget faces an estimated $2 billion shortfall.  Georgia will lose $1.2 billion in federal stimulus funds.  It must also repay $425 million to the federal government because the state has been borrowing federal dollars to write unemployment checks.

Deal inherits an economy that is taking tentative steps to rebound from recession.   Georgia’s 10.1% unemployment rate is still several percentage points higher than the national average.  State government revenue that plunged over two fiscal years has begun to recover with seven consecutive monthly year-to-year increases, but improvement will not balance the budget.

Deal returned to his leaner, more focused model of government in concluding remarks.  “State government should not be expected to provide for us what we can provide for ourselves,” he said. “Let us refocus state government on its core responsibilities and relieve our taxpayers of unnecessary programs.  Let us be frugal and wise.  Let us restore the confidence of our citizens in a government that is limited and efficient.”

The inaugural ceremony was held at the House chamber at the State Capitol.  Overnight snow and ice that paralyzed Georgia caused cancellation of the planned outside ceremony, a morning church service and the Philips Arena evening gala in downtown Atlanta.

Deal was joined by his wife Sandra.  Their daughter Katie sang “Georgia On My Mind.”  Their son, Hall County Superior Court Judge Jason Deal, administered the 47-word oath of office.  Dignitaries in the state House chamber included U.S. Senator Johnny Isakson, Congressman Phil Gingrey and Atlanta Mayor Kasim Reed.

Mike Klein is Editor at the Georgia Public Policy Foundation.

January 10, 2011 Posted by | Uncategorized | , , , , , , , , , , , , | Leave a comment

Debt Commission: Restore Public Option, Reduce Mortgage Deduction

The bipartisan National Commission on Fiscal Responsibility and Reform appointed by President Barack Obama caught nearly everyone by surprise Wednesday with its unexpected release of a draft report.  The White House said the traveling President would not comment until the Commission’s work is complete, which was already anticipated sometime next month.

Here is a link to the complete 50-page report.

Notably, the Commission draft report buries one of its potentially biggest and most controversial headlines:  “Add a robust public option and/or all-payer system in the exchange” to achieve long-term health care savings.  The very first mention of that idea is found on page 36. Continue reading

November 10, 2010 Posted by | Uncategorized | , , , , , , , , | Leave a comment

GOP Power Play, Obamacare, Space Taxis and Newt!

Friday morning’s Atlanta Journal-Constitution headline that screamed “Governor seeks a shake-up” was counter-punched by the next morning’s headline “Critics pound Perdue plan.”  The November headline should say “Voters KO GOP Power Grab Plan.”  This was a bad idea from the start.  And if it’s such a good idea now, why didn’t we hear about this until Sonny Perdue’s eighth year in office?

The basic plan goes like this: Perdue proposed that starting after 2014 elections the governor would appoint four currently elected officials: commissioners at labor, education and insurance, along with state superintendent of education.  This will ostensibly make for better, more efficient government and ensure that really good people hold those jobs. Continue reading

February 7, 2010 Posted by | Uncategorized | , , , , , , , , , , , , , , , , , , , , , , , | Leave a comment

Health Care Reform: Drink Red Wine!

Atlanta Mike Pix_Press_Club_189_-_Version_2Everyone is right about health care.  It is the biggest, scariest thing out there.  This week I attended a health care reform discussion whose panelists included the vice chairman of a prestigious international corporation, a university health care policy researcher, an insurance industry representative and a successful businessman who employs about two dozen people.

None of them expect a really great, game changing result from current Washington paralysis.  All four agree health care insurance reform should focus on rewarding preventive health care, but they don’t see that in the current conversation that often resembles a train wreck.  They do not trust the process or the likely outcome. Continue reading

October 7, 2009 Posted by | Uncategorized | , , , , , , , , , , | Leave a comment

Obama Care: More Questions Need Answers

Atlanta Mike Pix_Press_Club_189_-_Version_2President Barack Obama addressed Congress and We The People last evening with one primary task at hand: Wrestle control of the health care conversation back into his corner.  This was, everyone agreed in advance, the most important speech of his fledgling presidency.  It was also Obama’s final chance to demonstrate that he could be above the recent fray that made summer very ugly.

While vowing to “build on what works” and promising seniors that he would protect Medicare, the president strongly endorsed the so-called “public option” plan while also advocating for a new “insurance exchange” that could be in place within four years. Continue reading

September 9, 2009 Posted by | Uncategorized | , , , , , , , , , , , | Leave a comment

Obama Must Control His Message

Atlanta Mike Pix_Press_Club_189_-_Version_2Messaging rules the world.  Everything is about how you present content, the focus you create for the target audience, what you want the audience to remember and what you want it to ignore.  Do messages right and you sell stuff.  Do messages wrong and nobody buys your stuff.

President Barack Obama badly needs to sell stuff but he has world class message problems.  This is fairly stunning. First, let’s give credit where due: Obama created the sharpest, high technology, most sophisticated campaign ever.  Ronald Reagan and Bill Clinton were good.  Obama was over-the-top exceptional.  He created a new standard that left John McCain flailing. Continue reading

September 5, 2009 Posted by | Uncategorized | , , , , , , , , , , , , | Leave a comment