You have reached your limit of free articles this month.

Enjoy unlimited access to myAJC.com

Starting at just 99¢ for 8 weeks.

GREAT REASONS TO SUBSCRIBE TODAY!

  • IN-DEPTH REPORTING
  • INTERACTIVE STORYTELLING
  • NEW TOPICS & COVERAGE
  • ePAPER
X

You have read of premium articles.

Get unlimited access to all of our breaking news, in-depth coverage and bonus content- exclusively for subscribers. Starting at just 99¢ for 8 weeks

X

Welcome to myAJC.com

This subscriber-only site gives you exclusive access to breaking news, in-depth coverage, exclusive interactives and bonus content.

You can read free articles of your choice a month that are only available on myAJC.com.

Medicaid experiment should foster dialogue


Editor’s note: The Georgia Department of Community Health declined an opportunity for equal space to respond on this topic.

Earlier this month, the Georgia Department of Community Health announced that it had abandoned plans — at least for now — to seek flexibility in Georgia’s Medicaid program to allow for expanded coverage and an innovative delivery-of-care model for the patient populations served by Grady Health System in Atlanta and Memorial Health in Savannah.

While this pilot program would have been fairly limited, it was designed with the changing health care landscape in mind and in the spirit of making the health system work better for patients. The proposal relied on an integrated care model with primary care medical homes, care coordination, data sharing and a focus on prevention. The costs to the state would have been nominal — negligible, even — as Grady offered to foot the bill. That this effort is not moving forward is a disappointment, but it should not be a conversation-ender.

For years, the nation’s uninsured rate appeared stuck at a stubbornly high level. This had implications for individuals and families who couldn’t access the care they needed, for communities and health systems that experienced spillover effects, and for overall health and productivity. Over the past year and a half, the tide has turned. The uninsured rate has steadily declined, and in some states it has plummeted to less than 5 percent.

It is a time of tremendous change in health care, yet this change is being felt unevenly. According to a recent Gallup-Healthways survey, states that both established their own health exchange (or a partnership exchange) and expanded Medicaid saw greater declines in their uninsured rates than states that did neither. States that viewed the changing health care landscape as an opportunity, and the Affordable Care Act as a toolbox, to improve coverage saw far better results than those who did not.

Many states taking this “opportunity and toolbox” approach are now building on the foundation of high coverage rates to invest in prevention, improve access to care and enhance value for consumers, often in collaboration with local health care stakeholders.

Kentucky, for example, has reduced its uninsured rate from over 20 percent to 9 percent since 2013. Combined with an intentional focus on prevention, this has translated to a more-than doubling of the number of screenings for breast, cervical and colon cancer and of dental and physical exams. Other states like Oregon are developing initiatives to contain costs, improve quality and achieve better price transparency for consumers.

Of course, not every promising initiative will be a smashing success, but the pace of innovation and advancement is historic for American health policy. Here in Georgia, approximately 500,000 people enrolled in coverage through the Health Insurance Marketplace, an exciting development that has helped bring our state’s uninsured rate down to just above 15 percent. In normal times, with all else being equal, this would be extraordinary.

And while this achievement is transformative for the people and communities impacted, these are not normal times for the health system. Georgia’s uninsured rate remains among the nation’s highest, and our health outcomes, among the nation’s poorest. Without a more deliberate focus on coverage, access, value and outcomes, Georgia risks falling further behind other parts of the country. We cannot continue to do less with less.

The demise of the Grady experiment, while a disappointment, should be a conversation starter about moving Georgia towards an “opportunity and toolbox” mindset. To date, our state has stayed on the sidelines while others have moved forward, but we don’t have to remain there.

The evidence is beginning to pour in from around the country, and we can take the most promising initiatives out there and use them to inform a uniquely Georgia approach. The clearest evidence we have shows us the decision by the majority of states (30 and counting) to expand Medicaid is foundational in transforming the health system. The Grady initiative, while not Medicaid expansion, was at its heart a delivery system reform that was predicated on moving its target population into coverage as a first and necessary step.

We cannot make progress as a state if 15 percent of our population is uninsured. Too many Georgians fall into a coverage gap our leaders can fix. Medicaid expansion should be on the table, not as a perfect solution, but as a necessary first step.

Cindy Zeldin is executive director of Georgians for a Healthy Future.


Reader Comments ...


Next Up in Opinion

Students pair up for prom by drawing names. No romance? Maybe, but no drama, either.
Students pair up for prom by drawing names. No romance? Maybe, but no drama, either.

You could hardly go anywhere in Atlanta this weekend without running into glamorous teenagers. Prom season is underway.
Readers Write: March 28

Only Dems benefit from large gov’t Democrats lose because they offer nothing to working Americans but higher taxes and more regulation that usually benefits campaign donors and crony capitalists like Warren Buffet. Their constituents are comprised mainly of those who benefit most from a larger and more intrusive government: Academia, public service...
Opinion: GOP’s tax-cut push may be Obamacare repeal all over again
Opinion: GOP’s tax-cut push may be Obamacare repeal all over again

Happier days. (AP) Three days later, it’s still hard to wrap your head around the magnitude of the Republican failure over Obamacare.
Opinion: Post-AHCA, how health reform can move forward in Georgia
Opinion: Post-AHCA, how health reform can move forward in Georgia

The fate of the GOP’s effort to repeal and replace Obamacare is in grave doubt. That doesn’t mean health reform is stuck in Georgia.
Opinion: Senate listened to student survivors of sexual assault; House mocked them.
Opinion: Senate listened to student survivors of sexual assault; House mocked them.

Sexual assault survivor and law student Grace Starling helped lead the fight against state Rep. Earl Ehrhart’s campus rape bill, which passed the House but failed to advance in a wary Senate. Starling says she learned a lot about politics and power in the process and shares those lessons in a guest column today. Ehrhart said the bill...
More Stories