Georgia Tackling the Plight of the Un, and Under Insured

For those hoping state leaders will find a way to help pare down the number of uninsured Georgians, the doctors are in.

Whether their diagnoses and cures are the right ones depends on who you listen to. Among the major proposals in front of lawmakers is a move by Gov. Sonny Perdue to embrace high-deductible health care plans and accompanying health savings accounts. Also getting attention is a pair of proposals from Lt. Gov. Casey Cagle, one that would give a financial boost to free clinics and another that would provide more information to health-care consumers. Rounding out the bunch is a proposal by Insurance and Safety Fire Commissioner John Oxendine to force health insurance companies to get his approval before they can raise premiums.

Critics question how valuable some of those free-market ideas might be and focus on efforts to expand what they see as tried-and-true government programs, such as the joint state-federal Medicaid health insurance plan for lower-income Georgians.

All of the ideas are aimed at trying to get at least some of an estimated 1.7 million uninsured Georgians onto an insurance plan, or to at least tame costs so they can afford one if they choose.
Though legislative leaders haven't necessarily rallied behind a single idea yet, some are just happy the issue is being mentioned.

"We're just elated that this is on the table to figure out how to start addressing this," said Jimmy Lewis, the CEO of HomeTown Health, an organization of small and rural hospitals.

THE CHEAPEST PRODUCT ON THE MARKET

Mr. Perdue's major initiative is an effort to promote high-deductible health-care plans. Those plans don't provide as much coverage of routine visits to the doctor or other small medical costs. Instead, patients have to pay a more sizable deductible than under other plans, one usually met only because of a long-term illness or a major accident.

In return, they pay less in monthly premiums than for more traditional and comprehensive coverage.

Supporters say the high-deductible plans often bring in many workers who would otherwise be unable to afford health insurance.

"This will be the cheapest product on the market," said Rep. Mickey Channell, R-Greensboro, a key legislative voice on health-care issues and a sponsor of the House version of Mr. Perdue's proposal.

The governor's idea, which Mr. Oxendine has recently said was largely taken from his previous proposals, would exempt premium payments for the high-deductible plans from the state's premium tax and allow Georgians to claim the payments as deductions on their state income taxes if they're not already doing so on their federal taxes.

And it would change state laws that some read as barring rewards for healthy behaviors that many high-deductible plans use to help members build up their health savings accounts.
Those accounts allow members to save the money they need to cover the small-ticket medical costs until they reach the deductible.

Critics aren't sure the plans will work.

"The problem is that they don't really address the bulk of the uninsured population," said Timothy Sweeney, a senior health-care analyst at the private Georgia Budget and Policy Institute, which advocates more funding for social programs.

Even the high-deductible programs are financially out of reach for many lower-income families trying to find health care, critics say, and some who could already pay for insurance but don't because of the current high prices.

"A certain number of people might be able to get insurance," said Alan Essig, the institute's executive director. "But then there's a question of whether they could have afforded it anyway."
Mr. Channell counters that 30 percent to 35 percent of those who sign up for the plans nationwide are uninsured when they do so.

OTHER IDEAS

Both of Mr. Cagle's ideas seem to enjoy fairly broad support among those who follow health-care issues. One proposal would give grants of up to $30,000 toward planning a free clinic and up to $150,000 for existing clinics that work with lower-income patients.

The idea is that those clinics could provide some of the less-urgent and preventative care that would keep uninsured patients out of the emergency room, where the cost of care is far higher.
Mr. Sweeney cautions against seeing the clinics as a cure.

"Free care at a clinic certainly does not replace health insurance," he said.

A separate measure by Mr. Channell would give doctors a $25-an-hour tax credit for working at one of the clinics.

Mr. Cagle would also create a Georgia Health Marketplace, which would help consumers shop around for various health-care options.

Mr. Sweeney and Mr. Essig argue that the state might already have the best solution for its uninsured residents: Medicaid. Raising the eligibility rate could bring thousands of new people into the system, with the federal government picking up 60 percent of the costs.

"That may be a more effective way of enrolling people, getting people health care, than some of the more individual ways that we're talking about now," Mr. Essig said.

Some say there are problems with that approach. Expanding Medicaid would be expensive -- even with federal help -- and would likely rankle some of the free-market conservatives in the GOP-controlled Legislature. Mr. Channell said he thinks it is unlikely to pass.

Mr. Lewis of HomeTown Health said expanding Medicaid would exacerbate another problem. Hospitals now complain that they lose 15 cents for every dollar they spend treating Medicaid patients because of low reimbursement rates.

"It would just accelerate the demise of a number of providers and force them out of business," he said.