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.