Hos­pi­tals worry about fu­ture

No Med­i­caid ex­pan­sion in Ge­or­gia could hurt fi­nances

The Covington News - - Front page - GABRIEL KHOULI gkhouli@cov­news.com

Gov. Nathan Deal re­cently said he has no in­ten­tion of ex­pand­ing Med­i­caid in­sur­ance el­i­gi­bil­ity un­der Obama care in an ef­fort to save $4 bil­lion over the next decade, but state and lo­cal health of­fi­cials ques­tion whether the long-term costs of so many unin­sured pa­tients are greater.

New­ton Med­i­cal Cen­ter gave more than $27 mil­lion of free care to unin­sured pa­tients dur­ing the 2011 cal­en­dar year, a year in which the hospi­tal op­er­ated at a loss, as it did the year be­fore and as it most likely will again this year to the tune of $2.9 mil­lion.

Ex­panded Med­i­caid in­sur­ance wouldn’t come close to solv­ing all the hospi­tal’s ills, but about 25 per­cent of New­ton’s emer­gency room pa­tients in 2011 had Med­i­caid, while a sim­i­lar num­ber were unin­sured. The hos- pital is ex­pect­ing 13,000 unin­sured peo­ple to use the ER in 2012, ac­cord­ing to Chief Nurs­ing Of­fi­cer Patty Waller, who over­sees pa­tient care.

The hospi­tal loses money on out-pa­tient ac­tiv­i­ties, in­clud­ing the ER, even on peo­ple who have Med­i­caid, but it loses less, and the hospi­tal ac­tu­ally makes money on Med­i­caid pa­tients on in-pa­tient pro­ce­dures and ac­tiv­i­ties, Waller said.

Ca­role Mad­dux, who runs Good Sa­mar­i­tan Health and Well­ness Cen­ter in Pick­ens County for unin­sured peo­ple, said about 85 to 90 per­cent of her pa­tients would qual­ify for Med­i­caid in 2014 if Ge­or­gia were to ex­pand the pro­gram.

As im­por­tant as the bot­tom line, is the fact that the unin­sured epi­demic is turn­ing the health sys­tem on its head. The ER is meant to be a last line of de­fense, used for true emer­gen­cies, but it’s re­placed pri­mary care physi­cians for too many and is threat­en­ing some hos­pi­tals with bank­ruptcy.

In ad­di­tion, peo­ple with­out health in­sur­ance, pre­dictably, get more se­ri­ously sick more of­ten. They not only even­tu­ally cost a lot more to treat be­cause their con­di­tion wors­ens with­out med­i­cal over­sight, but they are also fre­quent re­peat vis­i­tors be­cause they can’t seek med­i­cal main­te­nance, which ul­ti­mately comes back and af­fects the bot­tom line.

“Emer­gency room care is some of the worst care — not be­cause there aren’t good doc­tors — be­cause you have spo­radic doc­tors look­ing at a sin­gle is­sue at a sin­gle time,” Waller said. “If you have Med­i­caid, you can go into an of­fice pre­ven­tive health, with a doc­tor see­ing pa­tients as a pa­tient, not as some­one who drops into the emer­gency room. Then those chronic con­di­tions, such as high blood pres­sure and di­a­betes don’t get to an ER-level cri­sis and we’ve taken care of health­ier peo­ple at a lower cost.

Waller said some stud­ies have found out that a very small per­cent­age of peo­ple make up the ma­jor costs of health care, be­cause they get very sick and are not be­ing fol­lowed med­i­cally through life.

“I’m not say­ing Gov. Deal was right or wrong, be­cause the cost would go up by hun­dreds of mil­lions of dol­lars and we’re al­ready in the hole. I un­der­stand the con­cern about cost, but the ques­tion has to be asked, which is more ex­pen­sive. Study af­ter study, shows that with pre­ven­tive costs you pay up front more, but you save so much (in the long run). The other ben­e­fit is cit­i­zens are health­ier and have a bet­ter life.”

An­other as­pect that could hurt hos­pi­tals is the fact that, in an­tic­i­pa­tion of see­ing the pool of in­sured pa­tients rise, the hos­pi­tals ac­cept cuts in Medi­care pay­ments and in pay­ments from a pro­gram that helps cover the cost of pro­vid­ing care to peo­ple with­out in­sur­ance. If the Med­i­caid pool isn’t ex­panded, Ge­or­gia hos­pi­tals will see their rev­enues de­cline even fur­ther.

“The de­ci­sion by the gover­nor yes­ter­day cer­tainly puts us in a spot where we have the cuts but we still don’t have the cov­er­age,” pre­vi­ously said Kevin Bloye, spokesman for the Ge­or­gia Hospi­tal As­so­ci­a­tion.

Bloye said the gover­nor un­der­stand that “hos­pi­tals are sort of in a co­nun­drum” with­out the ex­pan­sion and said the hos­pi­tals plan to work with Deal to find a way to keep health care strong statewide.

Bloye said the state’s hos­pi­tals now pro­vide about $ 1 bil­lion in un­com­pen­sated care.

Brian Robin­son, Deal’s spokesman, said the gover­nor wants to im­prove health care in Ge­or­gia — and he is hop­ing the Novem­ber elec­tions might even­tu­ally lead to al­ter­na­tives to the Af­ford­able Care Act.

“We’re still hope­ful that the Amer­i­can peo­ple will de­mand change in this up­com­ing elec­tion and Congress can de­liver change,” Robin­son said.

In ad­di­tion, Robin­son said pre­vi­ously the gover­nor might agree to ex­pand Med­i­caid if the fed­eral gov­ern­ment gave Ge­or­gia a “block grant” of money and the free­dom to tai­lor the pro­gram as it saw fit — none of which is cur­rently in the health care law. U. S. Rep. Paul Broun, R- Athens, told The News that block grant pro­gram is in his plan, and he whole­heart­edly sup­ported Gov. Deal’s de­ci­sion.

“The fix for an un­sus­tain­able pro­gram is not to make it even more un­sus­tain­able,” Robin­son said.

State Sen. Rick Jeff ares, R- Lo­cust Grove, said the state al­ready faces a $ 300 mil­lion short­fall for Med­i­caid next year alone, and the state sim­ply can’t af­ford ad­di­tional costs.

He echoed the gover­nor’s hope that Congress would ul­ti­mately re­peal Obama care.

Rep. Doug Holt, R- So­cial Circle, and Rep. Pam Dick­er­son, D- Cony­ers, de­clined to com­ment as they are still study­ing the is­sue.

How does Med­i­caid work?

Med­i­caid is gov­ern­ment health in­sur­ance for low- in­come Amer­i­cans, mostly chil­dren. It is fi­nanced jointly by the fed­eral gov­ern­ment and the states, with the state’s share based on per- capita in­come. Poorer states pay a smaller por­tion of their Med­i­caid spend­ing than wealth­ier states.

Ini­tially, the Af­ford­able Care Act of 2010 re­quired that states, be­gin­ning in 2014, cover any­one in house­holds earn­ing up to 133 per­cent of the fed­eral poverty level.

But the U. S. Supreme Court ruled in June that ex­pan­sion must be op­tional. Repub­li­can Govs. Rick Scott of Florida, Bobby Jin­dal of Louisiana, Phil Bryant of Mis­sis­sippi, Nikki Ha­ley of South Carolina and Rick Perry of Texas have said they will not ex­pand their pro­grams.

Un­der the law, the feds would pay be­tween 90 and 100 per­cent of the cost of the Med­i­caid ex­pan­sion, which would add 650,000 Ge­or­gians to the pro­gram’s rolls, which are cur­rently around 1.5 mil­lion. But even with the fed­eral gov­ern­ment cov­er­ing so much of the cost, Ge­or­gia projects its share of the ex­pan­sion would reach $ 4 bil­lion over 10 years.

The As­so­ci­ated Press and re­porter Danielle Ever­son con­trib­uted to this story.

file photo /The Cov­ing­ton News

This busy scene at the nurses’ sta­tion for the New­ton Med­i­cal Cen­ter emer­gency room isn’t go­ing any­where if the num­ber of unin­sured pa­tients doesn’t drop, a feat that be­comes more un­likely if Gov. Nathan Deal stands be­hind his plan to not ac­cept the fed­eral ex­pan­sion of Med­i­caid.

File photo/the Cov­ing­ton News

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