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Standalone rural ERs face a serious hurdle

Gov. Nathan Deal’s plan to help financially ailing rural hospitals, announced last month, has drawn strong praise from legislators and health industry leaders.

DCH Commissioner Clyde Reese

Clyde Reese

Deal proposed a change in licensing rules to permit a struggling rural hospital, or one that recently closed, to offer downsized services that would include an emergency department.

But a drawback has emerged – one that, if unchanged, may lower the chances of these freestanding ERs being built.

Such facilities, as proposed, would not be able to bill Medicare or Medicaid at the current hospital rates, but would have to bill those programs at a lower “provider’’ rate.

Clyde Reese, commissioner of the Department of Community Health, told GHN on Tuesday that it may take legislation, or regulatory approval from federal health officials, to create a format so these freestanding rural facilities would draw higher reimbursements than is now possible. full story

Drop in federal funds squeezes public health

The state budget recently delivered good news for Georgia public health: an overall increase in funding.

But behind those numbers are other numbers that have alarmed public health officials.

Dr. Georges Benjamin

Dr. Georges Benjamin

About 70 percent of the overall budget for the Department of Public Health comes from federal grants. And that federal money has seen significant reductions.

From fiscal 2012 to fiscal 2013, across all programs, Public Health lost about $25 million in federal money. And that drop has continued.

Almost all Health and Human Services and Homeland Security grants have been cut, said Dr. Patrick O’Neal, director of health protection for the Georgia Department of Public Health.

“It looks like we’re going to see ongoing [federal] cuts,’’ O’Neal told GHN in a recent interview. “It keeps us up at night.”

All states have suffered federal reductions to public health programs, according to the American Public Health Association. full story

Medicaid expansion: A tale of two Southern states

Annie Jones says she works hard and tries to keep fit, but she has high blood pressure, a condition that doctors have told her she inherited from her father.

The Sparta resident, who turned 60 this year, is worried about health care. Jones won’t reach Medicare age for another five years. She earns $10,000 a year as a part-time home health care worker and can’t afford her blood pressure medicine as well as the regular monitoring she needs.

Jeanna Buckler of Kentucky has qualified for Medicaid under expansion.

Jeanna Buckler of Kentucky has qualified for Medicaid under expansion.

Jones is one of up to 600,000 Georgians defined as the working poor  – those adults who earn less than 100 percent of the federal poverty level (FPL). (In 2014, that’s $11,670 for an individual and $23,850 for adults in a family of four.)

For the first time ever in Georgia, these adults would be eligible for Medicaid if the state expanded the program as authorized by the federal Affordable Care Act (ACA), also known as Obamacare.

The ACA originally made Medicaid expansion virtually mandatory for states. But the U.S. Supreme Court, while upholding the ACA in general, ruled that expansion must be optional. That made things complicated, because some other provisions of the law presupposed that Medicaid would be expanded.

Now the issue of expansion is being hashed out in the individual states.

In Georgia, Gov. Nathan Deal refuses to expand Medicaid, saying the state cannot afford it. The Republican-controlled General Assembly agrees with Deal and has even gone a step further. It passed legislation during the 2014 session that requires the Legislature, not just the governor, to approve any Medicaid expansion.

“They’re telling me I don’t deserve it,” Jones said of Medicaid. “When they say Georgia is just fine without expanding Medicaid, well, it’s just fine for them. I need some type of help. I can’t get it anywhere. It’s very stressful.”

If Jones made more than $11,670, she would be eligible for federal subsidies to buy private insurance through Georgia’s health care exchange, which is operated by the federal government as part of the ACA.

“I didn’t get enough money working part time, making minimum wage,” Jones said. She assists two home health care clients for 22 hours a week and is trying to get more work. “A lot of people are just like me, trying to make it. Where do you go?” full story

Athens’ medical discount plan in limbo

John Boyle, a 63-year-old Athens guitarist, has never bought health insurance. He credits good genes and good luck with keeping him healthy enough not to need it.

But now, a couple of years before he becomes eligible for Medicare, he is looking for a little extra health security.

“As I get older, I hope I can stay healthy,” he said. “It is a concern.”

YouTube Preview ImageLast year, a program designed with people like Boyle in mind was in the works in the Athens area. But now the organizers have put the plan on hold because they’re worried that it could actually discourage people from obtaining insurance under the Affordable Care Act.

(The ACA enrollment deadline for 2014 is Monday. That remains in effect, though the government said last week that people who have attempted the enrollment process and not been able to complete it will be allowed extra time, till about mid-April.)

full story

Letter to Editor: Gov. Deal’s views incorrect

As a retired health care executive and former state employee, I appreciated the GHN interview with Gov. Nathan Deal. So much so that I would like to comment on a few of the remarks he made.

Jack Bernard

Jack Bernard

He indicates that Medicaid expansion would add 620,000 people to our Medicaid rolls, implying it would clearly be a disaster for the state. Georgia’s uninsured rate, by the way, has been estimated at up to 22 percent, one of the highest in America.

The figures Deal cites regarding the cost of expansion are skewed. Expansion will create 70,000 jobs (mostly private sector). Deal fails to mention the objective Georgia State University study that made this projection. He further ignores the taxes that will be collected by the state, cities and counties as a result of this increased economic activity.

In fact, the Georgia Budget and Planning Institute has stated that, when these factors are taken into account, the net cost of expansion would be only $25 million a year, a very small amount when considering Georgia’s multibillion-dollar state budget. full story

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