by Georgia Center for Opportunity | Jul 24, 2014
This is the sixth entry in a series of posts highlighting GCO’s new report – Increasing Access to Quality Healthcare for Low-Income Uninsured Georgians. The first entry provided an overview of the report, the second looked at Georgia’s healthcare safety net, the third explained the impact of uninsurance, the fourth focused on Medicaid and the Affordable Care Act, and the fifth highlighted challenges to expanding access to healthcare.
While there are significant challenges to providing low-income uninsured Georgians with quality healthcare, there are cost-efficient, state-based solutions Georgia can implement in the short-term that can positively impact health outcomes for Georgians in the coverage gap.
Provide State Government Support for Georgia’s Charity Clinics
The state’s 96 clinics served more than 183,000 unique patients and saved the state over $200 million in 2012 while not receiving any state funding. However, other state governments do financially support their charity clinics. Virginia provides $3.5 million to its 53 clinics; Ohio gives $435,000 for 46 clinics; West Virginia provides $4.3 million to 11 clinics; and South Carolina recently approved $2 million for 51 clinics.[i]
The state’s existing charity clinics have the capacity to serve more patients, but funding and unnecessary state restrictions limit their ability to meet their full potential. The Georgia Charitable Care Network requested a $2 million appropriation from the Georgia legislature in 2014.[ii] Since clinics’ can provide $7 worth of services for every $1 spent, this relatively small amount of government funding would allow clinics to be open more hours and serve an estimated 100,000 additional patients.[iii] With the increase in funds, the expansion in capacity could take place at many clinics with little delay, providing much needed care to Georgia’s most vulnerable citizens. However, funding for Georgia’s charity clinics was not included in the state’s FY 2015 budget.
While a $2 million appropriation would allow Georgia’s current clinics to serve more patients, over 40 percent of counties do not have a charity clinic. A larger appropriation would allow for the Georgia Charitable Care Network to help underserved communities open new clinics. Since many rural areas have limited access to care, new clinics could have a significant impact on communities across the state.
In 2015, the state should provide $10 million in funding to support the dramatic expansion of current clinics and the creation of new ones in underserved communities. Compared to the $2.1 billion cost of Medicaid expansion over ten years, this appropriation is affordable for the state and sustainable in the long-term while still expanding access to quality healthcare to a significant portion of the state’s low-income uninsured population.
Expand Telemedicine into Charity Clinics
Telemedicine is the provision of care through real-time interactive communication between the patient and provider from one site to another via electronic communications. The electronic communication – which usually includes at least video and audio – allows a provider to care for a patient at a different location. Telemedicine can be used to provide primary and specialty care, remote patient monitoring, and medical education. Care through telemedicine can take place at hospitals, clinics, community health centers, nursing homes, and schools.[iv]
Telemedicine has improved access to care for many individuals – especially those in rural areas that have a physician shortage – because instead of traveling across the state to see a provider, a patient can go to a local clinic or hospital and be connected with a provider located anywhere in the state. Telemedicine has been shown to reduce the cost of healthcare and increase efficiency through better management of chronic diseases, reduced travel times, shared health professional staffing, and fewer or shorter hospital stays.[v]
Georgia has one of the most robust and developed telemedicine networks in the country, but Georgia’s charity clinics are not currently using telemedicine. Utilizing telemedicine in the clinics would enhance their ability to deliver services. Setting up telemedicine presentation sites in charity clinics would allow providers to volunteer their time at clinics across the state without leaving their office. This would be especially beneficial to individuals who live in rural areas and often do not have access to specialty care.
Charity clinics currently do not have the capital to purchase the technology and infrastructure required for telemedicine, which is relatively inexpensive given the benefit it provides.[vi] The Georgia legislature should include funding to pilot the use of telemedicine in its charity clinic appropriation.
Modernize Nurse Practitioner Laws and Regulations
Many nurse practitioners and other mid-level providers deliver care to patients at charity clinics as employees or volunteers. However, the ability of NPs to provide care is limited by Georgia’s restrictive laws and regulations.
Georgia should join the one-third of states that provide full practice authority to NPs. By implementing the licensing model recommended by the National Council of State Boards of Nursing and the Institute of Medicine, NPs will be able to provide the high level of care that they are educated and prepared to provide at charity clinics and other healthcare facilities across the state.[vii]
While many physician associations have opposed these reforms, a 2012 study found no evidence of differences in primary care physician earnings between states that provide NPs with full practice authority and those that maintain practice barriers.[viii] Since the literature on NPs finds no reason to be concerned with the quality of care provided by NPs and it should not impact Georgia’s physicians’ earnings, there is little to no reason for the state to continue to limit the care NPs can provide.
Reinstate Sales Tax Exemption for Charity Clinics
Many healthcare providers are exempt from the payment of Georgia’s sales and use tax, including licensed nonprofit in-patient general hospitals, mental hospitals, nursing homes, and hospices.[ix] From 2008 to 2010, Georgia’s volunteer health clinics were also exempt from Georgia sales tax on medical and office supplies and other purchases.[x]
Given the amount and quality of care charity clinics deliver and the savings this care provides to the state, Georgia should reinstate the sales tax exemption to provide the clinics with more resources to serve individuals in need of care.
Replace the Lost Federal DSH Funds with State Dollars
Many hospitals have expressed concern about the upcoming loss of DSH funds. In 2016, Georgia hospitals will lose an estimated $26 million in federal funds for uncompensated care. The federal funding loss increases to $40 million in 2017 and $111 million in 2018.[xi]
DSH funds are an important source of revenue for many of the state’s hospitals, and the federal reduction could cause some of the hospitals to cut services or completely close. To support this essential component of the state’s safety-net, the state should replace the lost federal funding. Since implementing the above recommendations to support the state’s charity clinics and other state and federal health policies could reduce the amount of uncompensated care provided by hospitals, the state may not need to replace the full amount of lost federal funding. Thus, the state should work with hospitals to identify the amount of uncompensated care they provide and to calculate the amount of state funding needed for hospitals to maintain services.
[i] Georgia Charitable Care Network, “Partners in Georgia’s Safety Net.”
[ii] John Sparks, “Stabilizing the Healthcare Safety Net: A Partnership with Free and Charitable Clinics,” Georgia Charitable Care Network, Presentation to Georgia General Assembly Joint Study Committee on Medicaid Reform, November 18, 2013, video of testimony found at http://www.house.ga.gov/Committees/en-US/MedicaidReform.aspx.
[iii] GCO interview with Donna Lopper, Georgia Charitable Care Network, December 9, 2013.
[vi] GCO interview with Jeffrey Kesler, Georgia Partnership for Telehealth, March 13, 2014.
[xi] Georgia Hospital Association, Hospitals 101, 28.
by Kimberly Sawatka | Mar 1, 2014
Elementary pupils outside classroom talking to teacher. Courtesy: nspt4kids.com
Hidden beneath academic benchmarks, league tables, and other measures of success in education, are the relationships and personal traits that fuel positive and negative outcomes for students. Attending the College Access Challenge Grant Georgia Conference earlier this week, I realized this theme as presenters with extremely challenging backgrounds–such as one man who was abandoned at a bus station when he was 5 years old–shared their stories of trial and triumph. Relationships–both the ones we build with others, and the one we nurture with ourselves–are the true challenge of preparing students to be successful in school and in life.
Prefacing the College Access Challenge Grant Georgia Conference, Georgia Center for Opportunity hosted a meeting focused on the non-academic needs of students earlier this week. Presenters Reginald Beaty and Tony Owens, independent consultants and Co-Deans of Students at Paine College in Augusta, Ga, enlightened the College and Career Pathways working group with trend leading research on non-cognitive variables.
If I just lost you, non-cognitive variables, more commonly referred to as “soft-skills,” are the qualities such as self-awareness, resilience, and even time management that bridge testable knowledge with actual successful outcomes. Notable scholars such as Angela Duckworth, and William Sedlacek, Ph.D have led the conversation on how these skills can be fostered within traditional and nontraditional school settings to transform individual students’ mindsets to ensure they are better prepared to overcome adverse learning challenges.
Paring my experience at the conference with the meeting on non-cognitive variables, I gained 2 important take-aways this week:
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Personal experiences with adversity can build “soft-skills” such as self-perception and grit (the ability to preserve past challenges to reach long-term goals) that aid academic success. However, the framing of these vital skills in a negative context can potentially render them useless to students.
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Actively working to connect with students on an individual level, in some cases weeding through the traumas of a student’s life, can change the context through which students utilize these traits to close achievement gaps and reach personal redemption.
Ruby K. Payne, Ph.D notes in her acclaimed book A Framework for Understanding Poverty, that “support systems are simply networks of relationships.” From both meetings, the consensus was that more streamlined support systems are needed to empower students, and there is still much debate around how to deliver a more relationship-focused infrastructure. Seeking a solution for this issue will continue to be at the heart of the College and Career Pathways working group.
by Georgia Center for Opportunity | Feb 11, 2014
Georgia State Capitol image via Wikipedia
By Jacob Stubbs, GCO Legislative Intern
While I was a government major as an undergraduate, I had never really encountered anything close to actual politics. This is not necessarily a bad thing, for I was quite interested in the philosophical systems that underlie the beliefs that shape political action. With this focus, I did not take the general classes over political parties, the legislative branch, etc.
Following my time as an undergraduate, I served as a Fellow at the John Jay Institute where I read more political theory and continued to discuss the philosophy that underlies political science. When GCO approved my internship, I was quite nervous about actually encountering practical applications of political science. My professional mentors were all in agreement that this internship would be a great experience for me to finally be able to come down from the clouds and actually apply what I had been learning in a practical way.
When I started work at the Capitol, I realized that, despite my reading and research for the previous few weeks, my impression of how the political system worked was rather off base. For example, I was not aware of the amount of lobbyists that I would encounter. Reflecting on this with Eric Cochling, GCO’s Vice President of Policy Advancement, I was told that there were about 1000 lobbyists currently registered in the state of Georgia. Certainly, I would not have initially guessed this.
Though I did not expect to hear politicians talking about Plato’s Just City in Speech and its anti-utopian warnings, I was still a little surprised at how practical the discussions actually were. It makes sense that any discussion of Plato or Aristotle or virtue ethics would be out of place when you’re trying to determine how much money the state should allocate toward education expenditures. That being said, there have been certain “theoretical” discussions in some of the committee meetings I’ve attended thus far, such as issues of federalism, private property, and the extent of free speech. Furthermore, even deeper theoretical issues such as personal autonomy and privacy, have begun to make an appearance. Sorting through these issues on a more practical level has been refreshingly instructive in furthering my political education.
In terms of the legislative process, I have been quite amazed at how democratic everything actually is. Average citizens can come to committee hearings and register to give testimony as to how the bill at hand would affect them and their life. In one recent committee hearing, I heard concerns voiced from people whose case led to the bill’s introduction, as well as parents and various professional organizations who would be affected by the provisions in the bill. While I am sure that there is a certain forum for this in Washington, the fact that my family or neighbors can step into one of these committees to give their opinion on the legislation truly shows that state politics influences our everyday lives more than we may think.
The range of the General Assembly’s influence is not a bad thing, in my opinion. Recently, I asked a lobbyist if he had ever considered working in Washington. He expressed his love of state politics and assured me that the state politicians are intensely concerned with bettering the lives and situations of their constituents, not winning some political argument or jockeying for a better committee appointment. This lobbyist’s impressions helped reassure me that I was not naïve in my assessment of the political climate under the Gold Dome. While there may be some intense disagreements about the best ways to go about healthcare and other policy concerns, these disagreements reflect a care for the common man and a love for the particular. Certainly, the national political scene can quickly leave one jaded; however, my experience under the Gold Dome thus far has reinvigorated my interest in politics and my faith in the political process.
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Jacob Stubbs is a Georgia native who graduated from Berry College in May 2013 with a double major in Government and Philosophy. He has recently completed a fellowship at the John Jay Institute in Philadelphia, PA, and is currently serving as the legislative intern at Georgia Center for Opportunity. Following his time at GCO, Jacob is hoping to seek further graduate education in either political science or philosophy.
by Eric Cochling | Feb 10, 2014
A bill to privatize most of the state’s child welfare services was introduced this week by Senator Unterman (R-Buford). The legislation, Senate Bill 350, would require the Department of Family and Children Services (DFCS) to develop a plan by January of 2015 by which is would contract with a limited number of regional lead agencies to provide the vast majority of child welfare services that are now, at least in part, offered by the state. The program would be phased in over the course of two years.
While lead agencies would be allowed to provide up to 35 percent of the services needed within a region, the law would require that they contract with other local agencies to provide the majority of services.
Contracts between the state and lead agencies would be for five years with DFCS having the ability to extend the contract for an additional three years. While DFCS would no longer be a direct service provider, it would remain responsibility for providing oversight of the contracted agencies.
As an incentive to agencies to find suitable permanent placements for children in their care, the law would fund agencies with per-child payments for a maximum of six months. After six months agencies would be required to pick up the tab for children that remain in their care. Likewise, agencies would not be eligible for per child payments for any child returning to the agency within 12 months of a permanent placement.
The reform is modeled after similar efforts in Florida and more than a dozen other states over the last couple of decades and has been driven by Georgia’s continued failures to adequately serve the children in its care.
While privatization is supported by many state leaders, including the Governor and Lt. Governor, opponents to the change say that it is being done too quickly and without considering ways to reform the system without privatization.
Evidence from Florida and other states shows that privatization can have beneficial effects, including improved safety for the children in care and a reduction in the number of children in state custody.
Yesterday, the legislation was favorably voted out of the Healthcare Delivery Subcommittee of the Senate Health and Human Services Committee. A stakeholder meeting was expected to be held today.
by Georgia Center for Opportunity | Feb 7, 2014
In a recent article addressing school choice alternatives – particularly the Georgia Tax Credit Scholarship program and its $58 million annual cap – some integral details regarding the execution of various school choice alternatives were somewhat blended together. We thought we’d take a minute to unpack some details about school choice and public funding of education.
First, the Tuition Tax Credit program is not a voucher program; rather, it simply allows individuals and corporations to donate money to Student Scholarship Organizations (SSO’s) that award scholarships to kids to attend private schools. A large number of these kids come from poorer families. Individuals or corporations contributing to SSO’s are eligible to receive dollar-for-dollar tax credits against their Georgia income tax liability for that year.
Second, those scholarships can only be used for private schools, not for homeschooling and not for charter schools. In fact, charter schools ARE public schools. So for what it’s worth, when a child leaves a traditional public school in order to attend a charter school, by definition, all the money being used to educate that child is still being spent by a public school.
Finally, it’s important to know that when a child leaves a traditional public school, the school no longer has the financial burden associated with educating that child. Additionally, the child rarely takes all of the money with him/her; a portion of the money – how much depends upon the program – stays at the original school. Typically, the amount the school keeps is not greater than the amount that is lost, but it hardly matters because they are keeping some portion of the money designated to educate a child who is no longer there. That means that on a “per pupil” basis, the school does have more money after a child leaves to take advantage of one of the state’s school choice programs.
Given the span of time in which the tax credit cap was met, it is apparent that Georgians are eager to exercise choice when it comes to seeking the best educational options for their children. As previously discussed, this high demand is no surprise but there are still many Georgia students in need of the opportunities presented by programs like the tax credit scholarship.
by gaopp | Feb 7, 2014
Roads Cleared, News Coverage Still Encountering Snow Related Congestion
While last week’s winter weather is in the rear view mirror, the postmortem evaluation of the government’s response continues to receive considerable coverage. The General Assembly, however, has moved right back into business as usual.
Legislation, Study Committees, and Rumors to Watch
– Education –
Senate Bill 288 moved through senate without opposition. The bill from Sen. Charlie Bethel (R-Dalton) would prohibit public schools from participating in interscholastic athletic events officiated by outside organizations, such as The Georgia High School Association, unless those third party groups release annual financial reports.
In December we learned that the GA Dept. of Education will be launching a College and Career Pathways initiative, which will require students to select a career path that will shape their high school course work. Rep. Eddie Lumsden (R-Armuchee) introduced House Bill 766, the “Work Based Learning Act”, which would permit schools – in collaboration with the Department of Labor and the Technical College System of Georgia – to award secondary credit for approved off campus work to students 16 and over.
Sen. Mike Dugan’s (R-Carrollton) Senate Bill 283 passed the Senate and moved to the House this week. The bill would authorize schools to educate students regarding “traditional winter celebrations,” and officially permit the use of “traditional greetings” like “Merry Christmas” and “Happy Hanukkah.” It’s a distressing sign of the times that a bill like this is considered necessary.
– Child Welfare –
Sen. Tommie Williams (R- Lyons) is encouraging support of “Ava’s Law” (House Bill 309 & Senate Bill 191), which would require Georgia private insurance companies to cover treatment for autism. According to the CDC, autism spectrum disorders affect 1 in 88 children. Gov. Deal’s 2015 budget included proposed funding for such coverage in the State Employee Health Plan, though neither the Governor’s proposal nor this legislation would result in coverage under Medicaid or PeachCare.
A bill to privatize most of the state’s child welfare services was introduced this week by Senator Unterman (R-Buford). The legislation, Senate Bill 350, would require the Department of Family and Children Services (DFCS) to develop a plan by January of 2015 by which it would contract with a limited number of regional lead agencies to provide the vast majority of child welfare services that are now, at least in part, offered by the state. The program would be phased in over the course of two years.
While lead agencies would be allowed to provide up to 35 percent of the services needed within a region, the law would require that they contract with other local agencies to provide the majority of services.
Contracts between the state and lead agencies would be for five years with DFCS having the ability to extend the contract for an additional three years. While DFCS would no longer be a direct service provider, it would retain responsibility for providing oversight of the contracted agencies.
As an incentive to agencies to find suitable permanent placements for children in their care, the law would fund agencies with per-child payments for a maximum of six months. After six months agencies would be required to pick up the tab for children that remain in their care. Likewise, agencies would not be eligible for per child payments for any child returning to the agency within 12 months of a permanent placement.
The reform is modeled after similar efforts in Florida and more than a dozen other states over the last couple of decades and has been driven by Georgia’s continued failures to adequately serve the children in its care.
While privatization is supported by many state leaders, including the Governor and Lt. Governor, opponents to the change say that it is being done too quickly and without considering ways to reform the system without privatization.
Evidence from Florida and other states shows that privatization can have beneficial effects, including improved safety for the children in care and a reduction in the number of children in state custody.
Yesterday, the legislation was favorably voted out of the Healthcare Delivery Subcommittee of the Senate Health and Human Services Committee. A stakeholder meeting was expected to be held today.
– Welfare Reform –
Representing an extension of a 2012 law requiring mandatory drug testing for Georgia welfare recipients, Rep. Greg Morris (R-Vidalia) has introduced House Bill 772 which would impose the same standard for receipt of Food Stamps. This will be an interesting piece of legislation to watch, as a Federal Court overturned similar legislation in Florida.
– Ethics and Government Reform –
Sen. Josh McKoon (R-Columbus), Chairman of the Senate Judiciary Committee, is part of a coalition proposing some interesting changes. Two have received attention in the past week: First is a request to require conference committee reports be filed by day’s end of the 39th day of legislative session. This seems a wise and rational move, as it would protect Georgians from having to pass a bill in order to find out what is in it. In addition, Senate Resolution 7 would allocate permanent funding that would provide for the separation of the Georgia ethics commission from the office of the Governor.
Upcoming Events
Our friends at the American Federation for Children are hosting a nonpartisan candidate training school in Atlanta on February 22nd. The training is free but requires registration to attend. For more information, please see this flyer for the event or email Brian Pleva to register.
Ironic
Despite last week’s encounter with snow, Georgia is not the state you expect to be producing Winter Olympic medalists. However, as the Sochi Games kick off today, the Peach State is indeed represented by Douglasville native Elana Meyers, who will be seeking her second Olympic metal in Bobsledding.
After last week many Georgians likely have a new found respect for those able to control a vehicle on ice at high rates of speed. Check out Meyers’ team’s story of determination and perseverance here, and be sure to tune in to cheer her on as she represents our great State.
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Thanks to Jamie Lord, our director of government affairs, and Jacob Stubbs, our legislative intern and John Jay Fellowship alumnus for their able contributions to this update.
