Health Care Shakeout Begins

June 29, 2012

by Larry Peterson, Savannah Morning News

Increasing insurance coverage isn’t the same as more access to health care or figuring out how to pay for it. So said Georgia experts concerning Thursday’s U.S. Supreme Court ruling on President Barack Obama’s health care law. Some local medical institutions are ahead of the curve in implementing the law, they said, but state government isn’t. If the law survives the political challenge posed by this year’s elections, most agreed, there will be plenty to like.

“It’s going to be good for everybody,” said Toni Miles, head of the Institute of Gerontology at the College of Public Health at the University of Georgia.

Insurance companies, said Miles and others, won’t be able to deny coverage because of a pre-existing condition or make women or people over 50 pay more. Millions of young people, they added, will still be able to stay on their family’s plan until they’re 26. There will be no more limits on lifetime or calendar-year benefits. The list goes on. But, in Georgia and elsewhere, other experts said, there will be a bottleneck as millions of previously uninsured people get coverage.

“Increasing the demand doesn’t do a whole lot to increase the supply,” said Phaedra Corso, head of UGA’s Department of Policy and Management at the College of Public Health.

Mills Fleming, a lawyer with Savannah-based HunterMaclean who specializes in health care issues, agreed. “Increasing coverage doesn’t increase access,” Fleming said. The problem, he and Corso said, is a shortage of primary care doctors, which will worsen as new patients flood the system. Facing six-figure educational debt, they said, new doctors gravitate toward higher-paying specialties.

Corso said some provisions of the new law help primary-care doctors with their debt and increase reimbursement for federally subsidized care. “It’s a step in the right direction, but it’s not enough,” she said. It would help, Corso added, if Georgia nurses had more authority to prescribe medicines — something the state has resisted so far.

At least in the short run, many people will wait longer to see a doctor, Fleming said.

Like others, Paul Hinchey, president and CEO at St. Joseph’s/Candler hospitals, said he likes expanding coverage but worries about costs. “What is not clear to me,” Hinchey said, “is how that’s going to paid for. It’s not going to be paid for by reducing payments to doctors and hospitals any more than they’re facing now.” Hinchey speculated that some “taxing entity” might offset some of the additional costs. “I still think there is a disconnect between what this is going to cost and how it’s going to be funded,” he said. “And that’s a concern for me.”

Corso said the one feature of the law the Supreme Court invalidated might also drive up costs. The court said the federal government can’t withhold Medicaid funds from states that won’t expand eligibility to cover more uninsured people. Initially, Washington, D.C., would pick up the whole tab, but eventually states would have to bear some of the burden.

UGA’s Miles and others see that as a potential boon to hundreds of thousands of working poor who would get care they now lack. But they acknowledged that financially strapped state governments in Georgia and elsewhere may not be able to afford their shares. As states opt out, the federal government likely will have to provide more money for coverage, Corso said “It is going to have re-evaluate what it will all cost,” she added.

Fleming said the costs may be eased under incentives offered under the new law. Hospitals and other medical facilities will be encouraged to consolidate care and improve quality by stressing preventive care, he said. Earlier intervention, Fleming added, means fewer hospital stays and operations — and lower costs.

Even before the ruling, local medical facilities were starting to adapt to the new law. St. Joseph’s/Candler, Hinchey said, has been expanding hours at two community clinics that treat indigent people. More significantly, he said, it’s moving ahead with a program that stresses prevention. Among other things, it includes computerized management of prescriptions and making sure people keep their appointments and take their medicines. “We’re doing it partly because of the law,” he said, “but also because it’s the right thing to do.”

State Rep. Ben Watson, a doctor at SouthCoast Medical Group, said the practice is one of 40 groups the federal government has picked to participate in a similar program. Watson disagrees with the ruling, but supports the SouthCoast initiative. “We hope this will help us provide better care for high-risk patients and reduce costs, too,” he said.

Mills said Memorial University Medical Center, Chatham County’s major provider of care for uninsured people, also has been pro-active. “They’re doing a tremendous job,” Fleming said.

Memorial said in a statement it “has been actively planning for the implementation of this health care law, and today’s ruling simply means that we should continue to do so.”

Meanwhile, Corso said, Georgia state government has failed to set up the “exchanges” the law says will make insurance available to small business and individuals. Barring a special session of the legislature this year — which she called “very unlikely” — no exchange will be in place by 2014, she said. That means the federal government will establish one in Georgia without any input from Georgians.

“There is no way of telling what it will look like,” she said. Corso regards the law as a work in progress. “There is a lot there. It does wonders for public health. Does it go all the way? Absolutely not. It’s not a fix-all act. We need to increase supply and reduce costs. It’s really only the first step.”


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