Subscribe to Commentary


Complaints about health insurers’ ‘narrow networks’ are misleading

Premium increases for Georgia’s insurance exchange health plans beat regional and national rates, according to a recent study by the Urban Institute, cited by Georgia Health News.


Graham Thompson

This is good news, as many Georgians shopping on the exchange will see only a modest increase from 2014 options, and some rural parts of our state will experience a significant decrease.

What is driving this good news?

The study’s conclusion cites increased plan competition and “high-value” medical provider networks — used by health plans to reduce costs and provide incentives for high-quality and cost-effective care — as holding down premiums.

It should be noted that all Georgia Association of Health Plans (GAHP) members offer plans on the exchange, with three member plans offering options statewide, continuing our commitment to serve all Georgians. It should also be noted that high-value networks are working as an option for cost-conscious consumers.

Detractors often label high-value provider networks as “narrow networks.” Although there is no recognized definition of this term, lobbyists for high-cost doctors use it to portray some plans as insufficient.

The word we really should be focusing on is not “narrow,” but “affordable.” Consumers demand affordable options with access to doctors and hospitals with the best track record of delivering high-quality, cost-efficient care.

These plans are real, robust insurance products, as current federal and state laws ensure consumers have access to an array of physicians and hospitals and require coverage of “Essential Health Benefits.”

GAHP plan members are committed to providing timely, accurate information about doctors participating in all plans, utilizing websites and 800 numbers aimed at enhancing customer education.

Given the challenges of provider consolidation and health insurance taxes, health plans need the flexibility to offer high-value products as an option for Georgians to continue to hold down higher health plan premium increases.

If Georgians want a plan with a broader group of providers, they can pick such a plan. Those options are definitely available.

But if consumers are not picking plans with more providers — and most consumers are not — it’s simply because they favor high value over high cost.


Graham Thompson is executive director of the Georgia Association of Health Plans.

State’s benefits decisions hurting the health of the working poor

Before the ACA (Obamacare) was enacted, one in five Georgians were without insurance, one of the nation’s highest rates. But Gov. Nathan Deal and state legislative leaders have opposed the law, refusing to put together a state insurance exchange to help our citizens to get affordable health insurance policies.

Jack Bernard

Jack Bernard

Deal and the legislative leaders also have blocked expansion of Medicaid, although 60 percent of Georgians support this measure (per Schapiro Group poll) and our state now has the second-highest rate of uninsured people in the nation.

The case for expansion becomes even more compelling when one considers that expansion is 100 percent paid for by the feds for the first three years, eventually falling to a 90 percent federal share permanently. Further, a Georgia State University study finds expansion would create 70,000 sorely needed jobs in a state that has one the nation’s worst unemployment rates.

We currently have more than 850,000 uninsured Georgians. In 2014, Gallup issued a report which showed that states with full ACA implementation had a drop in the rate of the uninsured that was over three times as fast as that in states like Georgia, where expansion is resisted and where there is a refusal to accept federal monies for expansion.

Lately, the situation deteriorated even further. According to Deal’s proposed budget (now modified by the House, see below), part-time “non-certified” public school employees would lose their health care benefits in 2016. Who are these 11,500 people? They are the folks driving our children to school every day (bless them) and serving their lunches.

To make matters worse, many of these employees are not eligible for Medicaid, because Georgia decided not to expand the program to more of the working poor. They will also be ineligible for federal insurance premium subsidies, because the ACA assumed all states would be required to expand Medicaid and therefore ended the subsidies. (The Supreme Court has since said expansion can’t be required.) The state’s failure to expand Medicaid created a “gap.”

What would this situation mean for these employees and their families? Let’s take a look at a few real-life examples from the Augusta area:

John Palmer

John Palmer

Employee 1: She is fighting for her life, having fought breast, ovarian and lung cancer. Treatment has become more expensive with each occurrence. She goes for chemo and scans, but still reports to work every day she can. If her insurance is lost, there will be no treatments.

Employee 2: A bus driver’s husband had six heart attacks within 48 hours. During his ICU stay, doctors found severe inherited arterial coronary disease. There is no cure, only constant monitoring by physicians and multiple prescription medicines.

Employee 3: She takes an array of medications for severe COPD, seeing specialists several times a year. Even a minor cold or allergy flare-up can force her into the hospital.

Under political pressure, the House has recently reworked this portion of the Deal budget, leaving the school workers’ benefits in, but dumping the cost ($102,825,000) on local governments and local taxpayers. Our state elected officials have generally managed to shortchange education, teachers and education support personnel over the last decade. This trend continues in the latest budget. We will soon see how the Georgia Senate will handle this item.

We all understand the need for fiscal responsibility, but do we want to balance the state budget on the backs of the working poor and educators? We can, and should, expect more from our elected officials.


Jack Bernard was the first director of health planning for the state of Georgia. He also was an executive with several national health care firms and an elected official.

John Palmer is a Georgia public school teacher and spokesperson for TRAGIC, an educational advocacy group.


Shunning productive Georgia workers is bad for us all

For individuals with developmental disabilities, the typical choices after finishing high school — getting a job or going to college — are difficult to accomplish, if not impossible. There are thousands of Georgians with developmental disabilities, and the unemployment rate for this group is more than 85 percent.

Kathy Keeley

Kathy Keeley

As the 2015 Georgia General Assembly begins working on the budget, advocacy groups are like ours are asking legislators for an increase in appropriation of state funds of $1.96 million in the FY 2016 Department of Behavioral Health and Developmental Disabilities budget. This would fund a program covering “supported employment” for students with developmental disabilities transitioning out of high school.

Supported employment is an individualized approach to match individuals with developmental disabilities with employment opportunities in typical workplaces in the community. The goal is to have them working alongside people without disabilities earning minimum wage or above.

In fiscal 2015, DBHDD authorized just $10.9 million for supported employment services, but the need far exceeds what that amount can provide. Current waiting lists can be as long as nine years or more through waiver-based services.

Currently, Georgia lags far behind the rest of the nation in helping people with disabilities find gainful employment. Developmental disabilities are defined as severe, lifelong disabilities that limit critical life functions that occur before the age 22. They include autism, Down syndrome, and cerebral palsy, among many others.

For every $1 spent on helping individuals by investing in supported employment programs, the state gets an economic return of $1.61. Beyond that, the return to the workers and their families is incalculable. It means the difference between a life of isolation at home and full participation in the world of work and the community.

Without this program, these students would likely finish high school, only to return home and sit on the couch, waiting until they qualify for a Medicaid waiver to pay for their services.

Through our “HireAbility” campaign, All About Developmental Disabilities is educating Georgia’s employers, dispelling their fears and preconceptions about hiring individuals with developmental disabilities. Some employers worry that these employees will not be able to keep up with the pace of work or that their customers will disapprove.

In fact, the opposite is true. Studies have shown the benefits of hiring people with developmental disabilities. Lower turnover, lower absenteeism rates, strong job loyalty, increased employee morale, and enhanced corporate image are just a few of the benefits when employers hire people with disabilities.

Many Georgia employers have experienced the benefits of hard-working, reliable, committed and caring workers who often can outperform their non-disabled peers. Publix, Walgreens, the Home Depot, the Georgia Aquarium, PF Chang’s, Kroger, and Hamilton Health Care in Dalton can testify to the strengths and abilities of these workers.

It’s vital for us to work together to make sure job opportunities exist for all. This funding will allow individuals with developmental disabilities to experience the satisfaction and economic security that only a job can provide. By focusing on their abilities, not their disabilities, we can promote workplace success and improve lives.

Kathy Keeley is the executive director for All About Developmental Disabilities (


A smarter way to make health care more available in Georgia

Kelly McCutchen

Kelly McCutchen

Georgia, like many states, faces a host of health care challenges: access to care, too many people without health insurance, failing rural hospitals and unsustainable health care spending that is crowding out other priorities – for government and for families.

The debate over how to address these challenges has Georgia seemingly stuck between two options: Expand a government program (Medicaid) with its own long list of challenges . . . or do nothing. It is a false choice; Georgia has an opportunity to put forth a better solution.

It won’t be easy. You start with the high hurdle of political acceptance by conservatives in Georgia and liberals in Washington. But it’s worth the effort. What if Georgia became the leader in creating innovative ways to provide better health for more people at lower cost?

There are three principles to keep in mind:

First, at a minimum, we should be willing to spend what we are already spending, but in a more rational manner. Hundreds of millions of dollars are spent annually in Georgia on uncompensated care for the uninsured. The uninsured may not have insurance, but they do get sick. One way or another we all pay for their care in a way that is terribly inefficient.

Second, money should follow people. Yes, we need to make sure we support the institutions and providers that make up our safety net, but the solutions should be people-centered instead of institution-centered.

Third, innovation requires flexibility and choices. Micromanaging every last detail is a recipe for the dismal status quo.

Keeping these principles in mind, what if we convert the funds we spend subsidizing the care of the uninsured (after the fact) into vouchers or refundable tax credits? Low-income individuals could use these funds to buy into an employer’s plan or purchase private insurance. The amount could be adjusted by age and health status, providing purchasing power for older and sicker individuals and creating an opportunity for cost savings by keeping these people healthy.

Flow of funds to the safety net

But what if these low-income individuals can’t find insurance at a price they can afford? Or what if they simply choose not to sign up? The unused funds should follow the people to where they get their care: the safety net providers in each community. Instead of seeing low-income uninsured patients or patients with Medicaid’s low reimbursement rates, rural hospitals and clinics would see patients with private insurance coverage or receive a predictable flow of funds to subsidize the care. Even if no one signed up for insurance in the first year, needed funding would immediately flow to safety net providers. Eventually, these newly empowered low-income individuals would create the customer demand for new ways to provide access to affordable health care.

Georgia is the perfect state to allow the powers of disruptive innovation to attack our health care challenges. Georgia already is a leader in telehealth and health information technology. We have one of the largest and most successful charity care networks in the nation. Visit almost any technology incubator in Georgia and you are likely to find a startup company focused on using technology to provide better care to people with chronic diseases. Combining these assets in unique ways could make Georgia a leader in solving the nation’s health care problems, too.

This initiative would require approval from the General Assembly and the governor, then a waiver from the federal government. Copying the successful model of Georgia’s criminal justice reforms, a bipartisan commission could be tasked with hammering out the details of the proposal. This approach resulted in the criminal justice reform bills passing the General Assembly unanimously. Broad, bipartisan support of a health care reform bill would make a veto from the federal government very difficult.

The cost of the program would be less than what the federal government is willing to spend on Medicaid expansion, so Georgia would be in good position to limit the cost to the state’s taxpayers.

Georgia’s Republicans and Democrats can work together to solve this long-term problem and, in the process, empower individuals and local communities. If it’s successful, both sides could claim some political credit. More importantly, it would improve the lives and health of hundreds of thousands of Georgians.


Kelly McCutchen is president and chief executive officer of the Georgia Public Policy Foundation. He is a native of Ellijay,  and a graduate of Georgia Tech.  He writes on education, tax, health care and economic policy.



Don’t scrap the Constitution just to save the Affordable Care Act

Rep. Jason Spencer

Rep. Jason Spencer

Professor Erin C. Fuse Brown’s Orwellian defense of a counter-textual interpretation of the Affordable Care Act (ACA) regarding eligibility for federal tax subsidies would invite an epidemic of lawlessness throughout the Executive Branch. She would torture the word “State” to include “federal government” to promote health care policies she champions. But nothing good has ever come from her “the ends justify the means” attitude towards statutory interpretation.

Robert Bolt’s “A Man for All Seasons” said it all in this exchange between Roper and Sir Thomas More:

Roper: So now you’d give the devil the benefit of law?

More: Yes. What would you do? Cut a great road through the law to get after the devil?

Roper: I’d cut down every law in England to do that.

More: Oh, and when the last law was down, and the devil turned on you, where would you hide, Roper, all the laws being flat? This country is planted thick with laws from coast to coast, man’s laws not God’s, and if you cut them down — and you’re just the man to do it — do you really think that you could stand upright in the winds that would blow then? Yes, I’d give the devil the benefit of the law, for my own safety’s sake.


No ambiguity

The case of King v. Burwell pending in the U.S. Supreme Court is not complex. Congress stipulated in the ACA that federal tax subsidies would be limited to individuals who purchased health insurance through an “[e]xchange established by the State.” There is no more ambiguity in the word “State” than there is in the meaning of the word “is.”

In more than 220 years of legislating, Congress has never treated “State” as synonymous with “federal government.” Indeed, the distinction between the two is the foundation of our system of federalism celebrated in the Tenth Amendment: “The powers not delegated to the United States by the Constitution, nor prohibited by it to the States, are reserved to the States respectively, or to the people.”

Decisions of the Supreme Court embracing the “plain meaning” doctrine of statutory construction overflow like the Nile. Words should be interpreted according to their ordinary meaning in common parlance unless the result would be absurd.

There is nothing absurd or quixotic about confining federal tax subsidies to health insurance purchased over exchanges established by States. It encourages them to establish exchanges to relieve the federal government of the burden of stepping into the breach. Thus, Jonathan Gruber, a prominent advocate for the ACA, elaborated, “if you’re a state and you don’t set up an exchange, that means your citizens don’t get their tax credits.” He further amplified that, “if your governor doesn’t set up an exchange, you’re losing hundreds of millions of dollars of tax credits to be delivered to your citizens.”

‘Intellectually untidy’

Ms. Fuse Brown argues that interpreting “State” according to its plain meaning would undercut other provisions of the ACA. But she is hoisted on her own petard. To interpret “State” to include “federal government” as she urges would render the congressional policy of encouraging States to establish their own exchanges meaningless.

Congress routinely enacts legislation that is intellectually untidy because of sloth or otherwise. The ACA is but one example. Then House Speaker Nancy Pelosi (D-Calif.) confessed “we have to pass the bill so that you can find out what is in it.” It is not the business of the U.S. Supreme Court to force intellectual tidiness on a statute like the ACA, as befuddling as a Jackson Pollock painting.

Professor Fuse Brown correctly observes that Chevron v. National Resources Defense Council calls for judicial deference to agency interpretations of ambiguous statutory terms it is entrusted with enforcing. The Internal Revenue Service, an echo chamber of President Barack Obama, has predictably interpreted the term “State” in the ACA to include the federal government. But that zaniness should command no deference under Chevron because there is no ambiguity in the word “State.” Deference in these circumstances would do violence to the Constitution’s separation of powers by authorizing unelected partisan bureaucrats to usurp the legislative function of Congress.

Professor Fuse Brown would have the Supreme Court play the role of Platonic Guardians to save Congress from ineptitude or blunders. But the Founding Fathers endorsed self-government, not Plato’s Republic. If Congress believes it erred in the ACA in confining federal tax subsidies to health insurance purchased over State exchanges, it can amend the law to include exchanges operated by the federal government. Ms. Fuse Brown scorns that constitutional approach because she knows the Republican-controlled 114th Congress disagrees with her health policy preferences. But her remedy under our democratic dispensation is to work towards electing a Congress that will enact her views into law, not to vandalize the Constitution.

Antidote to ACA

Finally, the professor’s doomsday vision of Georgia without federal tax subsidies is overwrought. A lapse in the individual or employer health insurance mandate under the ACA in Georgia would mean that less expensive and more efficient health care would emerge through free-market incentives and options like Christian Health Care Ministries (CHCM), where the individual is empowered to make decisions without the threat of stiff fines imposed by the ACA.

CHCM is a perfect free-market antidote to the prohibitive cost of the ACA. The ACA is sending health care premiums soaring with or without federal tax subsidies, and a different approach is urgently needed for all Georgians.

If the ACA is so affordable, then why do the costs need vast federal subsidies?

Georgians can afford free-market prices. They cannot afford a lawless Executive Branch.


State Rep. Jason Spencer represents District 180, which includes Camden, Charlton, and Ware counties. Rep. Spencer is the author of the Georgia Health Care Freedom Act that was introduced as House Bill 707 during the 2014 Legislative Session, but was ultimately passed by amending House Bill 943. The Georgia Health Care Freedom Act prohibits the state of Georgia from creating a health insurance exchange.

  • Sign up for our mailing list.