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The health care expansion question
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Expanding Medicaid under existing inflexible federal regulations would be unwise and irresponsible as a long-term solution for Georgia, but that doesn’t mean there are not more effective alternatives.

The question should not focus on whether to expand a specific program such as Medicaid. The question is how does Georgia best provide access to quality health care to our poorest citizens in a way that is fiscally sustainable. Put another way, Georgia’s response to covering the uninsured should be, “Yes, if we can spend the money in a flexible way that addresses underlying, fundamental health care problems, we are willing to accept federal assistance.” That is a more constructive response than, “No, we are not interested in your funds because your plan does more harm than good.”

Public hospitals are required to provide care to all who come into the emergency room, regardless of their ability to pay. Even if Medicaid did not exist, taxpayers and citizens would still be paying for health care for the poor and uninsured. The uninsured often pay a portion of the cost of their care, but the majority of the cost is left for the rest of America to pay through higher taxes and increased medical costs.

What is the right amount to spend on insurance coverage for the poor? At the least, we should be willing to spend what we already spend on uncompensated care. If the total cost of uncompensated care is about $2.8 billion and there are roughly 1.9 million uninsured Georgians, then that works out to about $1,500 per person in uncompensated care costs.

What if the federal government approved a waiver that would allow Georgia to offer every uninsured individual under the poverty line $1,500 to purchase private insurance? Arkansas’ Democrat Gov. Mike Beebe and its Republican Legislature recently proposed a similar plan. Georgia’s plan, however, could go further and require that if eligible individuals still cannot afford insurance or choose not to buy it, the funds would automatically go to the safety net providers in their community.

Benefits of this approach include:
• Hospitals that serve a disproportionate number of uninsured individuals would no longer be financially handicapped, and that may prevent many rural hospitals going out of business.
• With uncompensated costs covered, hospitals and physicians would no longer have to shift costs to other patients. This, in turn, should reduce the cost of private insurance for everyone, enabling more middle-income families to afford insurance. To the extent that state and local governments pay for uncompensated care, it would also allow for tax reductions.
• Taxpayers would save nearly $1 billion compared to the Affordable Care Act Medicaid expansion.

Through this plan Georgia could address the challenge of uncompensated care, put hospitals on a level playing field, dramatically enhance access to health care for the uninsured and provide funding for insurance to more than 600,000 uninsured Georgians.

Would the federal government go along? Just this week, an Athens Banner-Herald report quoted Health and Human Services Secretary Kathleen Sebelius as saying — during a visit to Atlanta — “We are very interested in entertaining a limited number of waivers.’’

She added that if the Arkansas waiver is approved, the federal government will provide funding for 100 percent of the tab, even if it costs more than a conventional Medicaid expansion.

This comprehensive solution addresses the costs of providing care to the uninsured, even those who would not be eligible under the Obamacare Medicaid expansion. The federal government accomplishes its goal of expanding access to care, and for hundreds of millions of dollars less a year. Georgia addresses its uninsured problem and puts its hospitals and physicians on more solid financial ground.

Rather than simply saying no to Medicaid expansion, Georgia should say “Yes, if ...” and challenge the federal government to approve a real solution rather than ideology.

(To view the full study, “Uncompensated Care and An Alternative to Medicaid Expansion,” go to

Kelly McCutchen is president of the Georgia Public Policy Foundation (, an independent think tank that proposes market-oriented approaches to public policy to improve the lives of Georgians.