Transcript Slide 1

Expanding Medicaid in
Georgia
Cindy Zeldin
Executive Director, Georgians for a Healthy Future
Georgia Supportive Housing Association Conference
November 13, 2012
The Big Picture, The Big Opportunity:
Covering the Uninsured
Overall, in Georgia:
• About 1.9 million uninsured; one-fifth of the population and onefourth of working-age adults
• Georgia consistently ranks in the top 10 among the states in number
and percentage of uninsured
• Overall distribution of the uninsured in Georgia by income:
• <100% FPL……. 45%
9%
11%
• 100-138% FPL… 12%
45%
• 139-250% FPL… 23%
• 251-399% FPL…. 11%
23%
• 400% FPL+ 8%......9%
12%
Source: CPS data, 2-year average ’09 – ‘10 (Kaiser State Health Facts)
ACA: Overall Approach to Coverage
• Everyone is eligible for something (citizens and most
legal immigrants)
•Maintain employment-based health insurance system
•Expand Medicaid for low-income individuals and families
•Restructure the individual and small group health
insurance marketplace through exchanges and new
regulations
•Individual mandate
Why Does Coverage Matter?
• Access to the health care system
•Financial protection against high medical costs
•Overwhelming evidence that insurance facilitates
better access to care and better health outcomes;
increases productivity; saves lives
•Amenable to public policy intervention
Why Expand Medicaid?
• People with low-incomes disproportionately lack access
to job-based health insurance (nationally, 28% of
predominately low-wage firms offer v. 77% of
predominately high-wage firms)*
• Purchasing a private, individual policy is cost-prohibitive
for people with very low incomes
•Medicaid is an existing program; many states have used
it as a vehicle to expand coverage for low-income families
over the past 20 years
* Source: Kaiser Family Foundation Employer Health Benefits 2012 Survey
Why Expand Medicaid, cont’d?
• Improves health access and outcomes:
•Oregon health insurance experiment: Medicaid more likely to have a
usual source of care and to get preventive care than their uninsured
counterparts (Source: National Bureau of Economic Research)
•New England Journal of Medicine study: states that expanded Medicaid
saw lower mortality rates than neighboring states that did not, after
controlling for a range of factors (Source: New England Journal of Medicine)
• Reduces the burden of uncompensated care
•Federal funds coming into the health care economy have a stimulative
effect: economic impact of $72 billion ($16 in impact from federal
dollars for every $1 in state funds) (Source: AJC, University of Georgia)
* Source: Kaiser Family Foundation Employer Health Benefits 2012 Survey
Who would be newly eligible for
Medicaid?
•Creates a new eligibility category for Medicaid based solely on
income
•Eligible individuals include those with incomes up to 138% FPL
($15,028 for an individual or $25,571 for a family of 3), Medicaideligible regardless of “category”
•Estimated 645,000 – 900,000 new Medicaid enrollees by 2019
(mostly childless adults) in Georgia
Medicaid Expansion, cont’d
•Expansion initially financed with 100% federal dollars (2014-2016)
and then scales down such that by 2020 and thereafter the
expansion population is 90% federally financed
• Increased enrollment will lead to a 28.9% increase in federal
spending and 2.7% increase in state spending relative to baseline
(Source: KFF)
•Temporary increase in Medicaid reimbursement rates for primary
care providers to parity with Medicare rates (federally financed) for
two years, beginning this year
What did SCOTUS say about Medicaid?
• The carrot is constitutional, but not the stick
•It is overly coercive to withhold all of a state’s
Medicaid funds for failing to expand to 138% FPL
•The Medicaid expansion stands but HHS can only
enforce it by withholding funds for the expansion
population if a state does not adopt it, making it
effectively “optional” for states
What are the implications for
coverage?
• Congress authorized tax credits for the purchase
of private health insurance through the exchange
only for people with incomes above the poverty
level
• If states expand Medicaid, they retain the spirit of
the ACA; everyone has a pathway to coverage
• If a state chooses not to expand Medicaid,
inequities within states and disparities across states
will ensue
This sets up a “Coverage Gap”
Source: Center for American Progress
Cover Georgia
• Good for consumers, good for health care system, good
for the economy
•Can improve access to health care; can help ameliorate
disparities
• Georgia taxpayers pay federal income taxes, and this
money will go to other states if it doesn’t come back to
Georgia
•No deadline for states to join and states can withdraw
from the expansion if it isn’t working for them
Questions & Follow Up
Contact me at:
[email protected] or 404-418-6179