The health policy role of a county commissioner is much more complicated than most people realize. As a member of a board of commissioners, you have to make decisions based on the needs of your community, rather than on increasing the organization’s bottom line, as for-profit companies do.
What are a county’s health care responsibilities?
First, every county has the growing expense of inmate health care, mandated by law. Second, although counties in Georgia are not legally required to fund indigent care in hospitals and elsewhere, many do, either because of political pressures or just because it is the humane thing to do. There is no other way to provide needed care to low-income taxpayers who fall between the cracks, making very little money, but too much for Medicaid.
Here are some specifics:
A June 2013 count showed 36,584 inmates in county jails in our state. (The figures fluctuate considerably every day.) A number of them receive inpatient medical services that could be reimbursed by Medicaid, especially if the state’s Medicaid program is expanded under the Affordable Care Act.
Inmates who leave state or local facilities (more than a 24-hour stay) for treatment in local hospitals can currently get their bills paid by Medicaid if they meet the very low income requirements. Louisiana, California, Mississippi, Nebraska, North Carolina, Oklahoma, Washington, Pennsylvania, Arkansas, Colorado, Delaware, Michigan and Georgia (to a small extent) are all using existing Medicaid (not the ACA expansion) this way for state prisoners.
Medicaid is primarily used for childbirth services, cancer treatment, and care for liver and heart disease.
North Carolina saves $10 million annually in the state budget alone. Georgia uses existing Medicaid to save $1 million yearly for state prisoners, according to the state Department of Corrections.
With expanded Medicaid, anyone with an income below 133 percent of the federal poverty line would become eligible under the ACA, and many more inmates (state and local) would be eligible in Georgia. Georgia would save even more if the program were emphasized and made a state and local priority, as it is in North Carolina.
The ACA is lowering hospitals’ governmental DSH (Disproportionate Share Hospital) reimbursements for low-income patients by $22 billion over 10 years. However, hospitals were told that these decreases were to be offset by having Medicaid cover patients who were then being served but not paid for (by private insurance, Medicaid or Medicare). When the U.S. Supreme Court ruled that states could opt out of expansion, that offset was no longer assured, but it continues to be a good idea.
For example, Grady Memorial Hospital says it would have at least 30,000 more medical indigents covered by the expansion. These patients are now paid for through local tax money via annual budget transfers from Fulton and DeKalb counties totaling $61 million. And it’s not just big-city facilities that are affected.
On a typical day, my small county has a handful of inpatients in our hospital, Jasper Memorial in Monticello. Our county currently gives the local hospital about $300,000 a year and has given them double that in many past years. Hospitals like these will need even more money from local property taxes if Medicaid is not expanded.
Under the ACA, the feds pick up 100 percent of Medicaid expansion costs for 3 years, with that federal contribution gradually falling to 90 percent after a number of years. The bottom line is crystal clear. The financial positives of expanding Medicaid in Georgia far exceed the negatives.
Will Gov. Nathan Deal make the decision based on the facts, or will he continue to let right-wing ideology and fear of being “primaried” get in the way? Time will tell.
Jack Bernard was the first director of Health Planning for the state of Georgia. He also served as a senior level executive with numerous national health care firms, including Humana, NME (now Tenet), Premier, and MedAssets.
Bernard served on the Jasper County Board of Commissioners from 2005 to 2012. He has been on numerous committees and boards, including the Jasper County Board of Health, and chaired the state Tax and Property Tax Committees of the Association of County Commissioners of Georgia.
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