1. Health Coverage in Georgia and the Impact of Expanding Coverage Through Medicaid Timothy Sweeney Director of Health tsweeney@gbpi.org GAMHPAC Meeting October 16, 2012

2. the 5th largest number of uninsured individuals in the nation at nearly 1.9 million an uninsured population that grew by 700,000 in the last 10 years (60% increase) Photo Credit: Excelencia in Education www.edexcelencia.org Georgia has…

3. How are Georgians Insured?

4. Employer-sponsored Insurance Dominant method of private health coverage where employers and workers share the costs 52.4% 5.8 million Individual Insurance More costly method of private health insurance Medicare Federally funded public program, serves Americans over 65 Medicaid State and federally funded program, serves low-income kids, pregnant women, individuals with disabilities, very low-income adults No Insurance Coverage 8.0% 782,600 11.0% 1.1 million 13.7% 1.3 million 19.6% 1.9 million

5. Health Coverage (and Type) Varies Greatly by Age and Family Income

6. Public Programs Reduce Uninsured for Children and Elderly (2011) 29% $2.6 billion 71% $5.2 billion Source: 2011 American Community Survey data compiled by GBPI

7. Working Age Adults Depend on Private Coverage More than other Age Groups Low-Income Adults Often Uninsured Family Income as a Percent of Poverty, 2011 Source: 2011 American Community Survey data compiled by GBPI

8. Health Coverage for Children and Adults Low-Income Kids Far More Likely to be Covered than Adults at Same Income Family Income as a Percent of Poverty, 2010 Source: U.S. Census figures compiled by Custer & Ketsche, PhDs, GSU Center for Health Services Research

9. Public Programs Maintained Coverage for Kids & Elderly Employer Coverage is Declining (in GA and US) Key issue for small business & low-wage workers Photo Credit. University of British Columbia Coverage Trends in Last Decade Adult Uninsured Rates Climbing

10. Coverage Trends Over Time – Adults 18-64 Employer Coverage Declines Offset by Increased Public Coverage Source: U.S. Census figures compiled by GBPI

11. Coverage Trends Over Time Low-Income Kids Far More Likely to be Covered than their Parents Source: U.S. Census figures compiled by GBPI

12. A Closer Look at Georgia’s Medicaid and PeachCare Programs Illustrates Gaps

13. Current Eligibility for Medicaid and PeachCare Focused on Children (Poverty = $11,200 for individual, $19,100 for family of three)

14. Federal Funds Pay 100% of the Costs for 3 Years Federal funds pay at least 90% in the long term Photo Credit. University of British Columbia ACA Expands Medicaid to Fill Coverage Gaps Expands Eligibility to Adults up to 138% of Poverty Level About $15k for individual; $26k for family of three Other Key Changes: Higher Primary Care Payment Rates 12-Month Eligibility Determinations Federal Funding for Computer Upgrades

15. Optional Medicaid Expansion Under ACA (Poverty = $11,200 for individual, $19,100 for family of three)

16. Supreme Court Ruling Creates a Wrinkle: Medicaid Expansion Now a State Option Photo Credit. University of British Columbia

17. Examining the Decision in Georgia Election Year Uncertainty Muddles Issue Delay Decision Past November Uncertainty Surrounding Existing Medicaid Program Ongoing “redesign” efforts, program underfunded Structural State Budget Deficit Complicates Issue State Revenue among lowest in nation (50 th per-capita) State is underfunding current program Budgetary costs are easier to quantify than savings, economic benefits, or social benefits

18. Medicaid Funding Fails to Keep Pace With Enrollment Growth Since Recession (2008)

19. State Projects $4.5 B / 10 yrs Includes $2 B not dependent on expansion Does not count savings in state programs serving uninsured Expansion costs amount to <2% state spending over 10 yrs Photo Credit. University of British Columbia A Closer Look At State’s Numbers Predicts 600,000 Newly Covered Georgians Includes nearly 100,000 kids already eligible Represents one-third of currently uncovered Georgians Assumes New Enrollees to be 17% More Expensive Problematic assumption, could inflate forecast by >$300 million / 10 years

20. Federal Funds Cover Bulk of Expansion Costs 10-Year Coverage Related Costs – State Share ≈ 7.5 percent of total New State spending ≈ 1-2 Percent of Total State Budget Source: State Cost Estimates

21. Economic Impact of Expansion in Georgia Dramatic Impact in Short Term (2014-16) No state costs for newly eligible More than $7.4 B in new federal funds New Spending Benefits Providers, Overall System Could reduce uncompensated care by > $2 B / yr Economic Benefits & State Savings Will Offset Some Costs New economic activity will generate some state revenues State will save on programs serving uninsured Georgians Reduced uncompensated care will benefit privately insured and employers who sponsor coverage

22. Mental Health Services Part of Expansion Medicaid would cover mental health services For new enrollees Federal funds could ease burden on state and local governments Projecting Savings is Difficult; Need State Cooperation Broad Implications of Expanded Access to MH/SA Services Increased coverage of adults increases access to care State will save on programs serving uninsured Georgians Reduced uncompensated care will benefit privately insured and employers who sponsor coverage

23. THANK YOU. LET’S KEEP IN TOUCH. About the Georgia Budget & Policy Institute GBPI seeks to build a more prosperous Georgia. We rigorously analyze budget and tax policies and provide education to inspire informed debate and responsible decision-making, advancing our vision of a state in which economic opportunity and well-being are shared among all. GBPI is an independent, nonpartisan nonprofit founded in 2004. www.gbpi.org 404.420.1324 @gabudget www.facebook.com/gabudget