- Associated Press - Wednesday, July 20, 2016

Recent editorials from Georgia newspapers:


July 19

The Brunswick News on state financial efficiency ratings:

The State of Georgia is to be commended for the recent release of financial efficiency ratings that attempt to establish each of the state’s school districts on a very important metric - bang for the buck.

The Glynn County School System scored a passing rating of 2.5 out of five stars. While that score may seem middling at best, the new system seems to penalize school districts that go the extra mile in trying to prepare the young minds in their care.

Each school district in Georgia received a Financial Efficiency Star Rating, which provides a measure of the district’s per-pupil spending in relation to the academic achievements of its students. Each rating is based on a three-year average of spending per student, which is then associated with the district’s College and Career Ready Performance Index (CCRPI).

The ratings fall between one-half to five stars. A five-star district has strong academic outcomes and low levels of expenses compared to other districts.

Superintendent Howard Mann said it’s important to keep in mind that the county’s school system is different from others of its size in the state, saying our district has variables which make our school system’s per-pupil spending rate higher.

“We are dedicated to delivering the best possible education for our students and offering the highest quality environment for our teachers, administrators and staff,” Mann said. Decoded, that means the district pays its teachers and staff more than other districts.

Other factors specific to Glynn County that affected the school system’s score include the Morningstar Academy, operated by Glynn County, which serves some of Georgia’s most in-need children and youth in a residential facility. Morningstar Academy also provides a special education program in conjunction with Glynn County Schools.

The Golden Isles Career Academy, a public charter school that offers career and work training through hands-on educational opportunities for high school students, also affected the rating, as nearly $2 million goes toward the career academy annually, said Andrea Preston, the school system’s assistant superintendent for finances.

Other factors include the school system’s decision to have police officers and nurses in every school, Preston said.

And unlike most school districts in Georgia, Glynn County pre-kindergarten teachers receive salaries that match those of a first-year teacher. Mann said this concept typically doesn’t play out in similar school systems.

The rating system could be improved by applying a more flexible approach to rating school systems that take the specific needs and practices of individual district and better accounts for the differences between them. As school officials said this week, the ratings correlate financial efficiency with student achievement. It is true that the basic way to excel in the current system is simply to spend fewer dollars. Efficient government leverages its resources to provide the best possible outcomes for the public.

The state’s efforts to evaluate spending vs. results in public schools is a good idea. Officials should work to perfect it to better account for local priorities, like those in Glynn County, that may seem to skew the results.




July 17

The Savannah Morning News on expanding Medicaid in Georgia:

The idea of expanding Medicaid in Georgia is an idea whose time has come, and it’s time for the state’s Republican leaders to seriously consider it.

The option to expand Medicaid to adults up to 138 percent of the federal poverty level, which most states have approved, would extend coverage to hundreds of thousands of low-income Georgians. A state has the option to decline or accept expansion of Medicaid, but its plan for expansion must get U.S. government approval to qualify for the additional federal funds.

Critics of expansion in Georgia say cost is their main concern. In his State of the State speech in January, Gov. Nathan Deal, a Republican, said expansion would have cost Georgia more than $200 million in the fiscal 2017 budget. “That number would only continue to grow exponentially,” he told a joint session of lawmakers. The GOP-controlled General Assembly, for its part, has passed a law making any future expansion harder to enact.

Yes, expansion could lead to higher costs in the future. But it also could mean some savings over the short term, as more federal dollars flow into Georgia.

There’s no question that expansion would be a boon to many of Georgia’s hospitals, especially those like Memorial Hospital in Savannah that treat a considerable number of Medicaid and poor patients.

The Georgia Republican Party, at its recent convention, passed a resolution calling for GOP legislators to “show their continued support of responsible state budgeting by publicly voting against and aggressively oppose any expansionary form of Medicaid pursuant to the Affordable Care Act (Obamacare) in the state of Georgia.”

Unfortunately, too many Republican leaders have framed the issue of Medicaid expansion as support for Obamacare, which is misleading. While people can freely debate the pros and the cons of the so-called Affordable Care Act, Georgians are still going to get sick and require medical care. And medical providers will still need to get paid for their services to cover their costs. Otherwise, some provider will have to cut back on services or close their doors.

The grim possibility that many Georgia hospitals may face closure, throwing people out of work and forcing Georgians to drive greater distances for needed care is causing some Republican lawmakers and other leaders to rethink their knee-jerk opposition to Medicaid expansion. They’re also looking at the experiences in other states that expanded their Medicaid programs. For example, Louisiana is banking on an extra $184 million in savings. Kentucky had data predicting an $800 million budget gain as its governor launched expansion there in 2014.

Meanwhile, a study released in March found that data in 11 states - Arkansas, California, Colorado, Kentucky, Michigan, New Mexico, Oregon, Maryland, Pennsylvania, Washington state, and West Virginia - and the District of Columbia confirm that states continue to realize savings and revenue gains as a result of expanding Medicaid. The study, sponsored by the Robert Wood Johnson Foundation and conducted by Manatt Health, concluded that every expansion state should expect to achieve savings related to previously Medicaid-eligible people being moved into the new adult group under expansion. The enhanced federal match for those individuals would be at least 90 percent, versus a current 67 percent in Georgia.

Expansion would also bring in additional revenue from existing insurer or provider taxes, the study added.

No similar study of potential savings from Medicaid expansion has been done in Georgia, industry experts say. But the findings of such an analysis look favorable. “I am confident it would show significant savings,” said Bill Custer, a health insurance expert at Georgia State University.

In Georgia, much of the savings would come from adult mental health and substance abuse funding, experts say. That’s now dominated by state dollars. The state budget for adult mental health services is more than $350 million for this fiscal year.

Many of those patients have low incomes and are currently uninsured and would qualify for the new coverage, experts say.

In addition to savings, there would be other important benefits. Drug addicts and people suffering from mental illness would be more likely to get the treatment they need, potentially boosting public safety.

And therein lies the problem. Georgia’s Republican leaders must look beyond blind opposition to President Obama when it comes to Medicaid expansion. They must eliminate the political rhetoric and instead focus on the bottom line.

Supporting Medicaid expansion at this juncture does not equate to supporting Obamacare. But to go beyond partisan politics will require an honest, independent and apolitical assessment of what expansion would mean for Georgia.

The time to do this is now, as there is no guarantee the additional federal dollars will be around forever.

In addition, GOP leaders should consider where many of those federal dollars come from - the pockets of every taxpayer in Georgia. Instead of shipping that money off to other states that have expanded their Medicaid programs, it seems to make more sense to expand Medicaid here and keep those dollars closer to home.

The issue of Medicaid expansion must be focused on what’s best for Georgia, not national politics or what may be best for the Republican Party.




July 15

The Telegraph of Macon on the Commonwealth Fund’s Scorecard on Local Health System Performance:

Health researchers have been ringing alarm bells for decades about several aspects of this region and the health of its residents. The 2016 edition of the Commonwealth Fund’s Scorecard on Local Health System Performance continues to bear this out. Each metropolitan area is evaluated on 36 criteria divided into four areas: Access and affordability; prevention and treatment; avoidable hospital use; and costs and healthy lives.

Of the 306 communities measured, most of the communities scoring at the bottom are in the South. In fact, of the 20 lowest scoring communities, 15 are in the South. Louisiana has six cities ranked low: Shreveport, Lake Charles, Lafayette, Alexandria, Houma and Monroe. Mississippi not only has the lowest scoring city, Hattiesburg, but four others near the bottom - Oxford, Gulfport, Meridian and Jackson.

We would like to say how well Georgia is doing on this scorecard, and many of the cities have improved scores, but when you’re near the bottom, there’s nothing to brag about. Macon is at 294. For the sake of this scorecard, Macon is defined as all of Middle Georgia, with a population of 721,275. Rome is 298, Albany is 256, Savannah is 247, Augusta is 229 and Columbus is 207. Atlanta, at 189, has the best ranking in the state.

None of this should be a surprise. Researchers found that states where more people were covered by health insurance scored better. The study said, “As noted previously, Jonesboro, Arkansas, where almost half the population has low incomes, had the largest decline in uninsured rates between 2012 and 2014. Three lower-income areas saw the largest reduction (9 percentage points) in the share of Medicare beneficiaries receiving high-risk prescription medications, exceeding the national rate of improvement.”

Another area of measurement was the 30-day readmission rates for Medicare beneficiaries, and the scorecard showed more improvement in that area across the country with low-income residents.

In Georgia, one of the issues that will arise again in the next legislative session is whether or not Georgia should expand its Medicaid program. In 2014, Gov. Nathan Deal signed House Bill 990, which took the power to expand Medicaid from the governor’s office and gave it to the General Assembly. He also signed House Bill 943, which prohibited state or local governments from lobbying for Medicaid expansion or from creating state-run insurance exchanges. It forced the University of Georgia to shut down its health insurance navigator program.

The reason the issue will arise again is because the Georgia health care system is in crisis. Large urban hospitals are hurting and rural hospitals are closing. Even Deal, according to the Atlanta Journal-Constitution said, “I still have the same concerns. And you won’t see anyone advocating a wholesale Medicaid expansion, but I do think there will be variations that will be discussed, and I look forward to talking to members of the General Assembly.”

According to the Georgia Budget and Policy Institute, Georgia has some of the strictest eligibility standards of Medicaid in the nation. A family of three can’t earn more than $7,600 annually and qualify, and for what the state does spend, it’s dead last in the nation.

What would Middle Georgia look like if it improved its performance to the level of the best-performing local area for scorecard indicators?

- Fewer premature deaths (before age 75) would occur from causes that are potentially treatable or preventable with timely and appropriate care.

- 383 fewer hospital readmissions would occur among Medicare beneficiaries (age 65 and older).

- 6,236 fewer emergency visits for nonemergent or primary-care-treatable conditions would occur among Medicare beneficiaries.

- 66,201 fewer adults (ages 18-64) would have lost six or more teeth because of tooth decay, infection, or gum disease.

The entire scorecard is on the group’s website and you can download area-specific data from the 306 communities. We are fortunate in Middle Georgia to have highly capable medical centers close by, but even within our area there are hospitals that are barely hanging on. There are thousands of Georgians who live outside the “Golden Hour” from a medical facility that could save their lives.

While there are many preventive things we can do individually to assure our own health, we have to look to our elected leadership to ensure the health of our health care facilities.



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