Addressing Medicaid Reforms—the Athens Health Assurance Program

Athens Clarke County has a large number of residents that would qualify for the benefits added under the Affordable Care Act, but Georgia’s decision to limit the expansion of these benefits may require Athens to come up with local solutions to the widespread healthcare needs.

As far as how a local Athens Health Assurance plan will address those who will not gain Medicaid under Gov. Deal’s denial of expansion, Alexandria Chambers of the Athens Health Network calls this “the million dollar question.”

According to the U.S. Census Bureau, 22.8 percent of Athens-Clarke county residents are uninsured this is higher than Georgia’s average and the national average.

The Affordable Care Act passed in the summer of 2012, sought to address the access disparity of healthcare to the poor. “The law put in motion the creation of a nationwide insurance system that would sharply reduce the number of Americans without coverage,” reported the New York Times.

Before the Affordable Care Act, Medicaid requirements designated certain categories of need that had to be met in order to receive Medicaid. Though requirements varied by state, common categories included people living with certain physical disabilities or pregnant women and children living below a designated poverty level.  Many low-income adults without children and some low-income parents whose children received benefits did not qualify for Medicaid coverage under previous Medicaid legislation.

New legislation from the Affordable Care Act provides Medicaid to all adults who earn up to 133 percent of the federal poverty level, but allows for states to decide whether or not to expand Medicaid coverage to include this entire new population of Medicaid recipients.

Georgia Governor Nathan Deal chose last summer not to expand Medicaid in Georgia. “I think that [Medicad expansion] is something our state cannot afford,” said Deal in an interview with the Atlanta Journal Constitution.

Deal’s decision reflected the beliefs of many other Republican governors at the time who did not believe the federal government would be able to fully provide the funds required for Medicaid expansion in each state.

“If Georgia expanded its Medicaid program according the the ACA, an additional 646,557 Georgians would be eligible for Medicaid by 2019,” said Monica Guaghan an assistance professor in the Health Policy and Management Department at the University of Georgia’s College of Public Health.

“I think that Georgia will continue to have a population that is unhealthier than other parts of the country,” said Guaghan. “The primary reason for this is a lack of political will within the state of Georgia to address social problems related to poverty.”

Some communities are looking to develop local healthcare programs to address the large number of people who will remain uninsured because of Deal’s decision to not expand Medicaid.

In Athens-Clarke County the Athens Health Network was created to provide services for the health needs of the uninsured and under-insured by bringing together multiple healthcare stakeholders in the Athens community.

Under their 2008 proposed recommendations, the Athens Health Network stated a need to “Create the OneAthens Healthcare Plan to serve the primary health care needs of the estimated 14,250 uninsured in Athens.”

Today the Athens Health Assurance program is being developed by executive director of the Athens Health Network Alexandria Chambers.

Chambers calls the Athens Health Networks Health Assurance program a “navigation system,” for those without insurance seeking healthcare services.

This program is not an insurance plan, said Chambers, and patients will still have to pay for the cost of services. What this program is providing is a facilitator between healthcare providers and the uninsured. “We are essentially acting as that broker for services, negotiating a discounted rate for people to pay.”

The Assurance program would provide patients with access to information and guidance on where to get primary care, how much it is going to cost, and how to go about making payments and filling out paperwork.

The Athens Health Assurance program is currently in the early stages of development and funding. The program has filed for nonprofit status and requested grants from partners, including Kaiser Permanente.

Once the program receives the funding it needs, there are three major pieces that must be developed in order to see the Health Assurance program come to term, said Chambers. Developing a network “of [healthcare] providers that would be willing to see our members at a discounted rate,” developing the resources needed to provide member services and implementing operations.

Currently in Athens there are three clinics that provide primary care to the uninsured. One of these clinics is the Mercy Health Center. Executive director at Mercy Health Center, Tracy Thompson sits on the board of the Athens Health Network and fully supports the creation of a health assurance program in Athens.

Thompson explained that the program would best serve the fairly healthy in the working poor population of Athens—to help them get the primary care that they otherwise could not afford. In order to implement a health assurance program in Athens the health network needs, “a few key physicians to buy into the program and good hospitals to buy-in,” said Thompson.

The program will work with people and help them plan for their health needs. People will have a better understanding of cost up front and they will be able to take the necessary steps to financially prepare to address these needs before they develop into debilitating problems that could prevent them from working and being able to afford the healthcare they need, said Thompson.

“Because Governor Deal at this time is choosing not to expand Medicaid coverage here in Georgia we will still have that number of people who would have been eligible [Under the Affordable Care Act] for Medicaid, but will not become eligible because there is not an expansion,” said Chambers. That is the target population the Athens Health Assurance program hopes to help.

If funded and put into action, the Athens Health Assurance plan would also provide a healthcare option for those receiving minimum government subsidies, those choosing to pay the 1 pecent tax and not purchase insurance, and undocumented immigrants who do not receive any benefits.

Just as the development of a local health assurance program is still in development the implementation of the Affordable Care Act is still under debate.

In recent weeks Republican Governors who previously choose to opt out of Medicaid expansions for their state changed their minds.

Most recently New Jersey’s Governor Chris Christie, previously an adversary to the Affordable Care Act, chose to accept the expansion of Medicaid in his state.

This raises the question as to the permanence of Deal’s decision on Medicaid expansion in Georgia and what Medicaid reforms will mean for local healthcare programs—particularly in communities like Athens where health accesses and disparity are prominent issues.