End of the Year Wrap up in Georgia Law and Medicine
Georgia Refuses to Expand Medicaid and Attempts a More Costly, Less Coverage Medicaid Waiver Instead
Georgia Governor Brian Kemp finalized health care proposals for a Medicaid waiver request rather than electing to expand Medicaid under the Affordable Care Act. The Center for Budget and Policy Priorities confirms that the cost of the waiver would equal that of expansion and yet cover 400,000 fewer eligible citizens. Georgia’s Medicaid Waiver also included a work requirement that did not provide for an exemption for those with a disability, serious illness or care-giving responsibilities. Further, the waiver did not include federal funding since it does not fall under the Affordable Care Act. Under the Affordable Care Act, the federal government pays for 100% of the expansion for the first five years and 90% of the expansion after that. Effectively, Georgia would spend less money to cover more people if it went with the Medicaid Expansion plan provided under the Affordable Care Act
Measles Returns to Georgia
Thanks to the anti-vaccination crowd, the formerly eradicated in first world countries disease – measles — rears its ugly head again. Measles was declared eliminated in 2000 until a surge in anti-vaccination sentiment arose. In 2019, Georgia reported 18 cases of measles, including 11 cases in Cobb County from unvaccinated individuals. Measles is a highly contagious disease that can be fatal. Vaccines are a safe, highly effective public health solution to a public scourge. According to the CDC (Center for Disease Control), the disease kills one in every one thousand individuals.
Gaps in Georgia Laws and Funding Leave Elderly Patients Subject to Abuse/Neglect
This year the Atlanta Journal Constitution covered elder abuse/neglect at private nursing facilities, assisted living communities and large personal care homes. The staffing requirements for memory care units are one caregiver for every 15 residents during the day and one for 25 residents at night. While training for dementia is required to be completed in 6 months; high turnovers in staffing often leave caregivers untrained. Georgia’s Department of Community Health oversees senior care homes and other health care facilities. There are a limited number of inspectors to oversee these assisted living communities and personal care homes. The AJC reports there is one staff person for every 95 personal care homes. Fines and sanctions for violations tend to be low-ranging and ineffective. As a result, violators tend to continue without much accountability for violations. This year we expect to see legislation from the House Health and Human Services Committee to correct these problems.
HIV Hits Georgia Hard
Georgia is ranked No. 3 in HIV risk in the nation. Georgia leads with new diagnoses among all states with 30 per 100,000 citizens. Seven of the 10 states with the highest HIV risk are in the South. Georgia and its neighboring states share poverty, lack of access to healthcare (due to state refusal to expand Medicaid) and shortage of personnel in rural areas that contribute to high HIV/AIDS numbers. Georgia is ranked number 6 in nation for highest AIDS death rates. Grady Hospital plans a $38 million renovation of its HIV/AIDs facility. The Ponce Center and its onsite affiliates provide medical and support services to approximately 5000 eligible men, women and children living with HIV/AIDS. Georgia did approve a bill earlier this year that would allow for needle exchange programs. Another bill allowed for the distribution of a pre-exposure prophylaxis drug for people at a high risk of getting HIV/AIDS.
Georgia’s Health Insurance Marketplace Stabilizes
Georgia uses the federally run health insurance exchange at healthcare.gov. Open enrollment for 2020 health plans has ended although residents with qualifying events can still enroll. The next open enrollment period is November 1, 2020. In 2019, 417,000 Georgians enrolled in the ACA. In 2020, 464,041 people enrolled. An estimated 267,000 people fall in the coverage gap caused because subsidies for ACA cover wage-earners and Georgia did not expand Medicaid to cover those without income. Two new insurers, Oscar and CareSource, joined the provider list. The other providers are Alliant, Ambetter, Blue Cross/Blue Shield of Georgia and Kaiser. The years 2017 and 2018 logged substantial premium increases when the Trump administration decided to eliminate CSR (cost share reductions) funding and the elimination of the individual mandate penalty.