State of Health Care in Georgia

1. State of Health Care in Georgia Marcus Downs Director of Government Relations/GAMPAC Director of the Medical Association of Georgia

2. 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 Building a Better State of Health Since 1849

3. Discussion Topics State of Health Care in Georgia Medicaid Expansion Questions Building a Better State of Health Since 1849

4. State of Health Care in Georgia • Physicians and Health Care Providers • 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 • 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

5. State of Health Care in Georgia • Budget/Medicaid • $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

6. 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

7. 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 • 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

8. State of Health Care in Georgia • Implementation of PPACA/Federal Requirements in Georgia • 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

9. Medicaid Expansion • 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

10. Medicaid Expansion • Pros • 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

11. 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

12. Medicaid Expansion in Georgia • 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 • 2007 Study funded by the Kaiser Family Foundation- from 0% to $3.2billion nationally • Georgia physicians receive .69 per $1. • Every $20 hair cut= $13.80 • Every $2,000 speaking engagement= $1,380 • Every $20,000 vehicle sold= $13,800 • Every $200,000 home sold= $138,000 • Every $2,000,000 legal settlement= $1,380,000 • Doctors accepting Medicaid has decreased by 15.9% over the past 3 years

13. Medicaid ExpansionSource: www.advisory.com, Updated June 14, 2013 Building a Better State of Health Since 1849

14. State Decisions • Not Participating (13) • 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.” • Leaning toward Not Participating (6) • 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) • “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) • Use Medicaid dollars to purchase private insurance plans • Arkansas

15. 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