Jimmy Childre has a rare perspective on Georgia health care.
He owns two auto dealerships and provides health insurance to the people employed at them. At the same time, he serves as CEO of a Sandersville hospital.
As a small business owner, he has seen firsthand the rise in the cost of health care. But in his hospital position, he has seen an increase in the number of uninsured patients in the emergency room of Washington County Regional Medical Center.
Childre is a member of a state advisory committee, appointed by Gov. Nathan Deal, that voted Tuesday to develop recommendations for legislation that would create a Georgia insurance exchange, which is required under the health reform law.
The vote came just four days after a federal appeals court in Atlanta struck down a central provision of that law: the requirement that individuals buy health insurance. The 11th Circuit Court of Appeals upheld the rest of the Affordable Care Act, including a vast expansion of Medicaid.
Georgia is one of 26 states suing over the reform law, and it was their case that the 11th Circuit ruled on. All the various challenges to the law are likely to be resolved eventually by the U.S. Supreme Court.
The state’s advisory committee on exchanges has chosen to continue work on developing an exchange for small business and individuals, despite the uncertain prospects of federal health reform.
”It makes good sense for individuals and small businesses to come together to buy insurance, regardless of the federal law,’’ said Rep. Pat Gardner (D-Atlanta). “We need to be flexible enough … to create a risk pool that works.’’
Childre said after the meeting that developing a new health insurance marketplace is worthwhile, no matter what the Supreme Court decides.
The current market is not working effectively, Childre said. An exchange, he said, could provide multiple health plans for people to choose from, unlike the slim choices offered now to a small business and its employees.
Childre has had to raise deductibles and co-pays for dealership employees to offset rising costs. Meanwhile, the Sandersville hospital’s ER visits have climbed from 8,800 in 2002 to 13,000 now, with many people losing private coverage in the area, he said.
“If an exchange facilitates the marketplace, where more individuals will have insurance, it will be a success,’’ Childre said. “It can bring together buyers [of health care] and sellers.’’
Insurance exchanges are envisioned as online shopping malls where individuals can compare and buy coverage. Their purpose is to boost the insurance-buying power of individual consumers and small businesses, where insurers would compete on quality and price.
Much of the Georgia committee’s attention has focused on small businesses. But Cindy Zeldin of the consumer advocacy group Georgians for a Healthy Future insisted that an exchange for individuals is also needed.
The reform law, she said, provides tax credits for people to buy coverage, along with insurance reforms and a Medicaid expansion.
“You need the Affordable Care Act to do an individual exchange right,’’ she said.
The advisory committee will now break into subgroups to develop recommendations on governance, operations and finance, and insurance markets.
Figuring out how exchanges will be governed is the biggest issue, said Cindy Gillespie of McKenna Long & Aldridge, who’s a consultant to the exchange panel. Possibilities include creating a government-run exchange, or one run by the private market, or a hybrid model.
Gillespie noted that some states have adopted language that would sunset their exchanges if health reform is declared unconstitutional.
The Georgia panel, in fact, created a subcommittee to devise plans on what to do if the health reform law is struck down or gutted.
The idea for a contingency plan panel was pushed by Ronald Bachman, CEO of Heathcare Visions.
The current market is dysfunctional, said Bachman, who’s a senior fellow of the Center for Health Transformation. “Georgia needs to create a more effective model,’’ he said. “If the federal bill fails, the responsibility for health reform goes back to the states.’’