State of Health Care in Georgia
Marcus Downs
Director of Government Relations/GAMPAC Director
of the
Medical Association of Georgia
Medical Association
of Georgia
Founded in 1849
Leading voice for medical profession in Georgia
Nearly 7,000 members
MAG creates value for every physician in Georgia because MAG
represents every physician in Georgia
 Leader in state legal and legislative arenas
 Members include solo physicians, small group physicians,
multispecialty physicians, health system physicians, as well as
academic institutions
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Building a Better State of Health Since 1849
Discussion Topics
 State of Health Care in Georgia
 Medicaid Expansion
 Questions
Building a Better State of Health Since 1849
State of Health Care in Georgia
 Physicians and Health Care Providers
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Rapid consolidation of the marketplace
More employment under systems or multispecialty groups
Loss of private practice
Rapid growth of Accountable Care Organizations
Emphasis on physician and provider shortages
 Health Insurance Industry
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Wellstar/Piedmont Insurance Plan
Aetna purchases Coventry
Wellpoint purchases Amerigroup
Interest in MEWA/Association Plans on the rise
Building a Better State of Health Since 1849
State of Health Care in Georgia
 Budget/Medicaid
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$19.8 billion dollar budget
Hospital management fee to fill $700 million hole
Physician and provider cuts of .74% recommended but restored
Primary care being Medicare rates in Medicaid through 2014
15% drop in physician participation since 2009
Building a Better State of Health Since 1849
State of Health Care in Georgia
 Tort Reform
 2005 tort reform (SB 3) improved environment in GA
 New medical malpractice claims opened decreased from 2004 (1128) to
2011 (837)
 Indemnity and defense costs decreased from $94.5 million (2004) to $74.9
million (2011)
 47% increase in market competition among professional liability carriers
 Total statewide premium decrease 24% since tort reform
 MagMutual premiums decreased 40% since tort reform
 More solutions
 Provider Shield Act – HB 499
 Challenges to Tort Reform
 SB 141 – Jackson Healthcare
Building a Better State of Health Since 1849
State of Health Care in Georgia
 Pain Clinics
 Documented problem in GA with surrounding states having tough laws
 Georgia Composite Medical Board addressed with initial Pain Management
Rules and Unprofessional Conduct
 Rep. Tom Weldon introduced a bill aimed at Pain Clinics (HB 178)
 Must be owned by physician
 50% patient population requirement
 Telemedicine
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Georgia seen as leader with the Partnership for Telehealth – Paula Guy
Georgia Composite Medical Board addressing rules for telemedicine
Goal to increase more access
More input from big business
Building a Better State of Health Since 1849
State of Health Care in Georgia
 Implementation of PPACA/Federal Requirements in Georgia
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Medicaid expansion – No
Health insurance exchanges – federal
Medical loss ratio – initial waiver
Children on parent’s policy up to age 26
No more annual and life time limits on health insurance policies
Primary care being paid Medicare rates in Medicaid
EMR satisfaction/”meaningful use” a problem
Building a Better State of Health Since 1849
Medicaid Expansion
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Will cover those who earn less than 133 percent FPL ($14,403 for single)
600,000 new enrollees expected in Georgia in 2014
Federal government will cover 100 percent of costs for first two years, 90
percent thereafter
Represents additional costs for states, and health care already accounts for 18
percent of Georgia’s budget
Governor Nathan Deal said NO to expansion
MAG Position:
 Support innovations and modifications in the Medicaid program, balancing
the needs of GA uninsured patients with the need to achieve a sustainable
solution to the budget shortfalls and expected financial challenges in the
years to come
Medicaid Expansion
 Pros
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Healthier population
Assist physician and provider bottom lines
Studies cite approximately 3500 lives saved over 10 years
Tax money going to other states
Disproportionate Share Hospital allotment going away
State can expand Medicaid at anytime and get out
Bill Custer, economist at Georgia State University
 Generate 70,000 new jobs
 Georgia economy would boost $8.2 billion per year
 State and local tax revenue by more than $275 million annually
Medicaid Expansion
 Cons
 Cost to state is approximately $4.5 billion
 State will continue to fund if federal government defaults on
obligation
 Expanding a broken system does not solve problem
 Just because have insurance card does not insure access
 Oregon report – no significant improvement in health
 Woodwork effect – 159,000 individuals already eligible but not
participating
 Increased Scope of Practice Battles
Medicaid Expansion in Georgia
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New money translates into well-compensated health professionals, which
stimulates the overall economy
Georgia cost of care for uninsured is <$2 billion per year
Care provided in most expensive places (ER visits) at most expensive time (late
in an episode of illness)
Cost to employers- $71m to $107m if Georgia does not expand Mediciad
Need for statistics on physicians and uncompensated care
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Georgia physicians receive .69 per $1.
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2007 Study funded by the Kaiser Family Foundation- from 0% to $3.2billion nationally
Every
Every
Every
Every
Every
$20 hair cut= $13.80
$2,000 speaking engagement= $1,380
$20,000 vehicle sold= $13,800
$200,000 home sold= $138,000
$2,000,000 legal settlement= $1,380,000
Doctors accepting Medicaid has decreased by 15.9% over the past 3 years
Medicaid Expansion
Source: www.advisory.com, Updated June 14, 2013
Building a Better State of Health Since 1849
State Decisions
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Not Participating (13)
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Leaning toward Not Participating (6)
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Wyoming- Officials will recommend that Wyoming not participate but the position could change in
the future and has asked for others to keep an open mind about this issue.
Participating (26)
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Affordability
North Carolina- Officials conducted a comprehensive analysis to determine the advantages and
disadvantages of expanding Medicaid and the right type of exchange option. It concluded that it is
“abundantly clear that North Carolina is not ready to expand the Medicaid system and that we should
use the federal exchange.”
“Participate but will re-evaluate” (Fl), “Forced to accept reality” (Nv), “Will reverse decision” (Oh)
Arizona, Florida, Michigan, Nevada, New Jersey, Ohio
Leaning toward Participating (1)
Participating through Alternatives (4)
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Use Medicaid dollars to purchase private insurance plans
Arkansas
For more information…
www.mag.org
404-797-0488 (Cell Phone)
Look for the “Medical Association of Georgia” on Facebook
Marcus Downs, Director of Government Relations mdowns@mag.org
Building a Better State of Health Since 1849