These are extremely uncertain times. The partisan and political divides, more akin to tribalism than ideological debates, have frozen our political leadership in a... We need to move from chaos to health security

These are extremely uncertain times. The partisan and political divides, more akin to tribalism than ideological debates, have frozen our political leadership in a perpetual state of dysfunction. Uncertainty and failure to ensure access to health care have consequences, often life-and-death consequences, for real people.

At the national level, despite years of “repeal and replace” rhetoric, the Republican-led Congress has been unable to pass repeal of the Affordable Care Act when it got the chance. And fortunately so, because the replacement health care bills not only threatened to undermine insurance coverage for 20 million people, they would have deconstructed the Medicaid program, a federal-state partnership since 1965 providing life-saving services and supports to low income families, elderly, and people with disabilities. Even Gov. Nathan Deal, a longtime critic of the ACA, said the proposed bills would be “punishing” to our state.

Meanwhile, the Trump administration has stopped federal Cost Sharing Reduction (CSR) payments that make private plans affordable for low-income families. This decision will raise insurance premiums, increase the number of uninsured, and increase the federal deficit — a lose-lose-lose, by any measure.


Leaders in Washington let funding lapse for some of the most critical programs here in Georgia. Funding for the Children’s Health Insurance Program (CHIP) covering 130,000 Georgia children, Community Health Centers (supporting 34 health centers in Georgia), and Disproportionate Share Hospital (DSH) payments, supporting hospitals like Grady in Atlanta that provide care for those without insurance, expired on Sept. 30.

In a rare show of bipartisan leadership, Senate committees have drafted bills to help stabilize the individual insurance market by restoring CSR payments and reauthorizing funding for CHIP. Georgia’s senior senator, Johnny Isakson, is a co-sponsor on both bills. Without action on these bills and funding for DSH, Georgia children and families will lose their health coverage and security.

Chaos in Washington distracts us from the political dysfunction and lost opportunities here in Georgia. Because the state has chosen not to expand Medicaid under the Affordable Care Act, more than 300,000 low-income Georgians, the majority working in low-paying jobs that don’t provide coverage, remain in the coverage gap, without affordable health insurance options.

Beyond the health consequences of these people being uninsured, we have passed up on billions of dollars of federal support to expand coverage and support our state’s health system. That’s $12 billion dollars to-date that could have prevented rural hospitals from closing, stabilized our public safety net hospitals, helped us address the opioid crisis, and improved access to care as well as health and life opportunities for over 300,000 Georgians.

This inflow of federal funding was projected to lead to 50,000 new jobs, equivalent to the job growth from Amazon building a second headquarters in Georgia. Inaction in the face of need is harmful. Today, many Georgians are reaping the harm that has been sown through inaction. Inaction is no longer acceptable. We must keep our leadership accountable.

It is time to focus on the issues that matter most to our state. As voters choose their leaders in 2018, it’s time to think again about expanding Medicaid in our state. Expansion is critically important for health care access, to support rural hospitals, and for job creation.

It’s time for each of us to step up, get informed, and ensure that our state moves toward a healthy and prosperous future. Inaction is no longer acceptable.


Dr. Harry J. Heiman is a family physician and health policy expert in Atlanta. He practiced family medicine in Marietta for more than 20 years. From 2009 to 2017, he directed the Division of Health Policy at the Satcher Health Leadership Institute at Morehouse School of Medicine. He is currently a faculty member at the Georgia State University School of Public Health in the Division of Health Management and Policy.

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Dr. Harry J. Heiman

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