Grady Board Asked to Have Indigent Patients Pay for Shortfalls

In a December 1st Medicaid Watch Report on State Medicaid and Health Cuts and Expansions, by Thomas P. McCormack, Grady is referred to as “Georgia's Safety Net.”

Concerns are expressed because of the $250 Million short fall which the indigent care of primarily Fulton & DeKalb Counties.Both Fulton and DeKalb Counties were asked for an additional $20 million. Fulton gave and additional $15 million and the DeKalb County and the State may offer an additional $5 million each.

Where is the $200 million promised by business leaders if Grady were to be privatized?

Promises to provide funding to continue Grady Memorial Hospital's indigent care services have not been kept. Who will pay the difference between what is needed and what is available?Grady's Chief Financial Officer thinks that the patients that used to benefit from free services, because they are indigent, should pay for the services themselves!According to a memorandum from the Grady Coalition, “Mike Ayers plans to ask for Board approval on January 5 to begin to require Fulton and DeKalb patients who earn between 126 and 200% of the federal poverty income to pay 40% of the cost of their care (up to 25% of annual income).

This means, for example, that a single person earning $13,001 per year before taxes, could be charged as much as $3250 a year, and a single person with a $26,000 income could be charged as much as $6500. At present, Fulton and DeKalb patients with incomes below 250% of the federal poverty guidelines receive free care.”

The memorandum continued... “Coalition has met and unanimously agreed to stand against the Grady Health System administration's proposal to cut thousands of low-income patients off the rolls of those receiving free care.

The Grady Coalition believes that implementing this proposal will jeopardize the health of thousands of patients. Many patients will not seek care due to the charges, resulting in suffering and death.

NCH Recommendation Re: Healthcare

National Coalition for the Homeless Recommends
Homeless Access to Recovery through Treatment Act

Background: The Homeless Access to Recovery through Treatment (HART) Act (H.R. 4129) is designed to increase access to mental health services and substance abuse programs to persons who are experiencing homelessness.

The HART Act would improve the state planning and implementation of the already existing programs to include preferences to those who are without housing and insure patient discharge from these programs systems into stable and appropriate housing. The bill would not make substantial changes to the programs, themselves. It would simply strengthen and expand federally funded programs that are currently working well, such as PATH and GBHI/THP, to be more inclusive of the needs of those without housing (including youth).

Status: Representatives Hilda Solis (D-CA), Julia Carson (D-IN), Jim Ramstad (R-MN) introduced the Homeless Access to Recovery through Treatment Act (H.R. 4129) in late 2007. The bill’s sponsors and advocates are seeking co-sponsors to establish a base of support for inclusion of the HART Act provisions within the larger Substance Abuse and Mental Health Services Administration (SAMHSA) reauthorization measure currently under development.

NCH, Recommendations: Ensure homeless people with addictions and mental illness receive the necessary treatment and assistance to help them recover and end their homeless conditions.

Recommendations to U.S. Representatives: Cosponsor the Homeless Access to Recovery through Treatment Act (HART Act, H.R. 4129).

Recommendations to U.S. Senators: Introduce or cosponsor a companion bill to the Homeless Access to Recovery through Treatment Act (HART Act, H.R. 4129).
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NCH lists reasons that persons who are experiencing homelessness should be guaranteed access to recovery through treatment:

• Addiction and mental illness – frequently co-occurring – often lead to and prolong homelessness and tend to be exacerbated by the experience.

• Among surveyed homeless people, 39 percent have some form of mental health problem, and SAMHSA estimates that between 20 percent and 25 percent meet criteria for serious mental illness. In addition, 38 percent of surveyed homeless people have an alcohol problem, and 26 percent report problems with other drugs.

• In 2004, more than 175,300 admissions (13 percent) to substance abuse treatment facilities were homeless at the time of admission.

• A person experiencing homelessness is more than twice as likely to have had five or more previous treatment episodes as their housed counterparts.

• Untreated addictions and mental illnesses present serious barriers to employment and permanent housing, perpetuating an ever-worsening cycle of poor physical health, hospitalization, social dysfunction, incarceration, poverty, and homelessness. These are tragic outcomes for homeless persons and their families; burdens on healthcare, social service, and corrections systems; and costs to taxpayers.

• Homelessness presents serious barriers to treatment for behavioral health conditions. People experiencing homelessness are impoverished, uninsured or underinsured, and often alone. Lack of documentation, lack of transportation, and difficulty adhering to treatment regimens prevent many homeless individuals from succeeding in mainstream behavioral health care, including in the public behavioral health care safety net systems established for persons without insurance. Due to monetary constraints and limited understanding of homelessness, many mainstream behavioral health service providers are unable to offer the full range of care necessary to address the complex needs of people experiencing homelessness. People experiencing homelessness present complex challenges for which most mainstream providers are ill equipped or untrained.

• A helpful, but ultimately inadequate, work-around to these mainstream system failures has been two federal behavioral health care programs targeted to persons experiencing homelessness – Projects for Assistance in Transition from Homelessness (PATH) and Grants for the Benefit of Homeless Individuals/Treatment for Homeless Persons (GBHI/THP).


For further information on the public policy recommendations of the National Coalition for the Homeless, contact the NCH public policy staff at:

info@nationalhomeless.org or 202.462.4822

OR: visit www.nationalhomeless.org.

OUR POLICY RE: HEALTHCARE:

Livable Wages, Safety Net Issues. OUR POLICY GOAL: To initiate and perpetuate universal access to a living wage and living-income support.

We believe that if a person works 40 hours per week, then he/she should be able to access basic housing. Existing federal guidelines have been used to determine what a living wage should be. The first guideline dictates that no more than 30% of a person's gross income should be spent on housing. The second is Fair Market Rents (FMR's), established by HUD, nationwide, for both rural and metropolitan areas. FMR's are based on the gross rent estimates, which include shelter rent and the cost of utilities, except for phone service. , Though the average livable wages for cities across the U.S. is calculated $12.75, federal minimum wage remains at $5.25.

Those with disabilities, or who are unable to work for other reasons, lack the resources to obtain or maintain decent housing. 40% of those without housing are working. Many who manage to maintain housing with low paying jobs, do so out of their food or health care budgets and budgets for other basic needs. This may explain why 42 million Americans are without health insurance and why one in four children, in Georgia, go to bed hungry. It explains why over 7 million Americans experienced homelessness last year and why millions are continually at risk of becoming homeless. The Task Force continually strives to educate and advocate for livable wages for all and for access to basic needs, including decent housing and quality health care for all [including those who cannot work].

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BELOW ARE A FEW ARTICLES RE: HEALTHCARE FROM OUR ARCHIVES THAT RELATE TO DIFFERENT ASPECTS OF HEALTHCARE AS IT RELATES TO POVERTY AND HOMELESSNESS...

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SOAR INTO ACTION! A Message From The National Healthcare for the Homeless Council

NHCHC ACTION PLAN FOR “SOAR”
[SSI/SSDI Outreach, Access, and Recovery program]

Schedule visits to educate Members about the SOAR Initiative: Despite the hard work of Senators and Representatives during this period to pass a range of appropriations bills through Committee, it is widely expected that unresolved differences between Congress and the Administration may force the government to operate under continuing resolutions until the new Congress passes appropriations bills early next year. This political strategy reduces the opportunity to gain targeted funding for the SOAR Initiative this year; however, it does provide a unique opportunity to build support for the program and educate Members about the relationships among poverty, disability, and homelessness.

August 11 marks the beginning of Summer Recess for the 110th Congress, when Members return to their home districts and often reach out to constituents to identify issues important to them. This is an opportune time educate your Members about the barriers your clients face when trying to obtain disability benefits and the promise of the SOAR Initiative in overcoming those obstacles. Although the 110th Congress is unlikely to make changes in funding, it nonetheless is imperative to educate your Member(s) about SSI and SOAR now to establish a stronger knowledge-base and contacts for future advocacy in the next Congressional session.

SOAR into Action!

• Invite your Member(s) of Congress to tour your clinic to facilitate a conversation about homelessness and the SOAR Initiative. Find out who represents you at www.house.gov or www.senate.gov or call the Capitol Switchboard at 202-224-3121. Call your Member at their local office and ask to speak to their scheduler or policy staffer. Explain the type of work you do and ask to schedule a meeting at your clinic.

• When you speak with your elected official or their representatives about SOAR, be

sure to emphasize the talking points listed below:

• Explain the obstacles that people experiencing homelessness face when trying to access SSI/SSDI benefits, such as lack of proper identification, not having a fixed address, incomplete medical records, transportation barriers that prevent individuals from keeping appointments, etc.

• Since its implementation, over the past 5 years in 34 states the SOAR Initiative has dramatically improved access to SSA disability benefits for homeless applicants.

• SSA data shows the average approval rate for initial applications from all applicants is only 37% and smaller studies indicate the approval rate for initial applications from homeless clients is only 10-15%.

• Preliminary 2008 data from 18 participating states suggest that SOAR is a model worthy of replication. A total of 66% of initial applications submitted through the SOAR program were approved and approval times were reduced, on average, to 88 days

Background on SOAR legislation: SOAR-ing through the Barriers: Improving Access to SSI/SSDI Benefits People without a regular place to stay face substantial barriers to participation in federal disability assistance programs that could help to end their homelessness. Such obstacles, well

known to providers at HCH projects, include the lack of acceptable identification, the absence of a fixed address, and incomplete medical records. Over the past three years, a promising federal initiative under the acronym SOAR (the SSI/SSDI Outreach, Access, and Recovery program) has substantially improved access to disability benefits for people experiencing homelessness. The effectiveness of this national program warrants its continuation and expansion. The National Council encourages Mobilizer readers to support the SOAR initiative.

Federal Disability Assistance – Out of Reach -The Social Security Administration (SSA) oversees two entitlement programs designed to provide financial support to individuals with disabilities. Supplemental Security Income (SSI) is a needs-based program that provides a modest maximum income of $637 a month (in 2008) to individuals with disabilities who lack stable employment histories, while Social Security Disability Income (SSDI) is related to earnings history and the amount an individual has paid into the Social Security system. Most recipients of SSI or SSDI qualify for government health insurance under Medicaid and/or Medicare. In 39 states and the District of Columbia, recipients of SSI also meet eligibility criteria for Medicaid. Persons who qualify for SSI or SSDI are also more likely than others to obtain available subsidized housing, including supportive housing.

Unfortunately, accessing these entitlements is especially challenging for people experiencing

homelessness; final determination of eligibility often occurs years after the initial application.

According to the Social Security Advisory Board Annual Report 2006, only 37% of all SSI/SSDI

applications nationwide are initially approved. For homeless applicants, a mere 10-15% are

determined disabled upon the initial application.1 Strikingly, more than 60% of initial denials are

overturned following a substantial appeals process averaging two to three years. This lengthy

delay only further compromises the health and stability of applicants.

1 Dennis D, Perret Y, Seaman A, Wells S. (2006). Expediting Access to SSA Disability Benefits: Promising Practices for People Who Are Homeless. Delmar, NY: Policy Research Associates, Inc.

SSI/SSDI Outreach, Access, and Recovery - Recognizing the importance of financial assistance to the overall health and well being of people with disabilities, the federal government implemented the interagency SOAR program to reduce the delay between application and receipt of benefits for eligible homeless applicants. A partnership between the Departments of Health and Human Services and Housing and Urban Development, the SOAR initiative is a multifaceted approach to improve the quality of initial applications while streamlining the state and local processes through which disability is determined. Strategic components include a “train the trainer” model to equip service providers

with the tools necessary to complete effective and well-documented applications, strategic planning among states and communities to expedite the claims of homeless applicants, and technical assistance and outcomes evaluation for states and localities.

SOAR-ing Results - Following implementation in 34 states over the past three years, the SOAR initiative has dramatically improved access to SSA disability benefits for homeless applicants. Preliminary 2008 data from 18 participating states suggest that SOAR is a model worthy of replication. In a complete inversion of national data, a surprising 66% of applications submitted through the SOAR program were initially approved, and approval times were reduced, on average, to just 88 days. A SOAR pilot project in New York cut the average approval time to 59 days. In Nashville, Tennessee—home to the National Council—a remarkable 98% of all SSA disability applicants in their SOAR project were approved upon initial application.

Many involved in the SOAR process believe the results are simply too promising to be ignored. Advocates are urging Congress to appropriate $5 million to expand the program to all 50 states and to develop advanced training materials to help applicants and their service providers to more effectively navigate the SSI/SSDI application process. The National Council calls upon Congress to enable all states to “do what works” by funding an expansion of the SOAR initiative.

2008 Georgia Health Disparities Report "Community Conversations"

The Office of Health Improvement will host a series of Community Conversations in various cities throughout Georgia. These “Conversations” will share information and obtain feedback about the Health Disparities Report 2008: A County-Level Look at Health Outcomes for Minorities in Georgia that was released on April 18, 2008.

Developed and presented by the Georgia Department of Community Health’s Office of Health Improvement and its Minority Health Advisory Council (MHAC), this inaugural report gives an account of the health status of Georgia’s minority populations by county, and aims to identify inequality in health care and outcomes, and to encourage action towards health equality for all Georgians.

Who are we talking to?
- Local Government Leaders - Health Care Providers/Professionals
- Business Leaders - Community Organizations
- Chamber Officials - Concerned Citizens

What are the objectives for the Conversations?
1. Does your county understand the issue of health disparities and how it affects the community?
2. What do people think about their county scores and how they fared?
3 Are there reasons for success or failures in their various communities?
4. In what ways can communities address the reduction and elimination of health disparities? Are they interested in forming local health equity coalitions?
5. How can we engage non-healthcare advocates on the issue?

Community Conversations Locations and Dates (First-Round):
Augusta: May 28th, 1PM to 3PM, Richmond County Health Department
Columbus: May 29th, 1PM to 3PM, Columbus State University
Cordele: June 3rd, 1PM to 3PM, City of Cordele Community Club House
Albany: June 4th, 10AM to 12PM, Phoebe Northwest
Fort Valley: June 11th, 1PM to 3PM, Fort Valley State University, Pettigrew Cntr
Athens: June 12th, 10AM – 12PM, ACC Health Dept./N. Harris Street
Valdosta: June 19th, 10AM – 12 PM, Valdosta Tech
Gainesville: June 24th, 1PM to 3PM, DHR , Thompson Bridge Office
Brunswick: July 18th, 10AM – 12PM, Southeast GA Health Systems

Additional Community Conversations will be held throughout the summer in Griffin, Dublin, Atlanta, and Lyons.Locations and dates will be announced.

To obtain a copy of the report, please visit our website at www.dch.georgia.gov or you may e-mail us at gahealthequity@dch.ga.gov to request a copy.

Privatization of Grady Hospital Commences Despite Unmet Conditions

By Jonathan Springston, Senior Staff Writer, Atlanta Progressive News (5/19/08)

(APN) ATLANTA – The Fulton-DeKalb Hospital Authority (FDHA) officially transferred operations of the Grady Health System to the new 501(c)(3), the Grady Memorial Hospital Corporation (GMHC), on Monday, May 19, 2008.

The lease will commence on May 20, 2008, and all Grady employees will transfer under the control of the GMHC with their current jobs and salaries and the GMHC will be responsible for the operations of the health system.

However, the FDHA inexplicably moved forward without a specification from the State of Georgia regarding the amount of trauma funding Grady will receive, despite an April 7, 2008, letter, in which FDHA Chairwoman Pam Stephenson said such specification would be a precondition to the transfer.

In the April 7 letter to the GMHC, Stephenson wrote, "I hereby execute the lease on behalf of the [FDHA] subject to the condition that clarification…be received by the [FDHA] regarding the amount and level of funds available to Grady Memorial Hospital for fiscal years 2008 and 2009."
"Such clarification satisfactory to the [FDHA] shall be required prior to the acceptance of a commencement certificate under the lease by the [FDHA]," she concluded.

But Stephenson, who also serves as Grady CEO and GMHC Vice Chair, told Atlanta Progressive News on Monday that the FDHA "decided to move forward" without knowing how much of the $58 million Grady would receive.

The $58 million was appropriated for the 2008 fiscal year, so the money has to be divided no later than June 30, Stephenson told APN.

She appeared confident Grady would know how much it is going to get and receive that amount on or before June 30, but offered no explanation for why the lease was moving forward despite her previous statements.

This is not the first time the conditions surrounding the privatization of Grady Hospital have shifted or simply disappeared.

As previously reported by Atlanta Progressive News, it was stipulated in the original FDHA resolution leading to the formation of the GMHC that numerous state legislators and officials would need to sign letters promising Grady funding. That condition vanished when the FDHA and other parties voted on the lease.

Grady still faces a number of issues in the near future, namely figuring out how to obtain more funding for its Level I trauma center, the only such hospital in north Georgia.

The Georgia General Assembly failed to pass legislation this Session that would have pumped millions of annual dollars into all of Georgia’s trauma hospitals, including Grady.

Lawmakers did succeed in amending the fiscal year 2008 budget to include a one-time payment of $58 million to be shared by all of Georgia’s trauma hospitals.

The Trauma Care Network Commission, a State committee charged with determining how much of this $58 million each trauma hospital in Georgia is to receive, canceled its May 15, 2008, meeting for unknown reasons, APN learned Monday.

That Commission was supposed to determine how the money was to be divided at that meeting.
As a result, the lease will take effect without Grady knowing how much of the $58 million it will receive.

Over the coming months, both Boards will continue to work with lawmakers to obtain continued trauma funding, Stephenson said.

APN SEEKS GMHC’S TAX-EXEMPT APPLICATION

APN delivered a written request Monday to Grady legal counsel and registered agent, Timothy Jefferson, requesting to inspect the GMHC's application to the IRS seeking recognition of tax-exempt status.

Federal law requires a tax-exempt organization to provide any member of the public access to their IRS recognition application for inspection on that same business day, unless extenuating circumstances exist, in which cases the organization must provide it on the next business day.
APN previously requested the application months ago and was told at that time it did not exist. Now that the application was approved, APN has made several phonecalls to the GMHC to identify the person who had access to the document.

APN requested an appointment to view the documents under federal law; however, Jefferson insisted he would treat the request as an Open Records Act request under Georgia law, because he said the document did not exist in physical form and he needed time to print it out.
APN expects to be able to view this document later this week and will report on its findings.
If not, APN is prepared to take further steps. APN let the GMHC know that a corporation which does not comply with the law can be exposed to extensive fines from the IRS.

PRIVATIZED GRADY APPEARS TO MOVE FORWARD

"Tomorrow begins a new chapter in Grady’s history," A.D. "Pete" Correll, Chairman of the GMHC, said in a press release.

"The [GMHC] has a singular focus - to preserve Grady’s historic mission as a safety-net hospital for this region by getting Grady the funding it needs," he added. "The first infusion is already on its way. And in the weeks and months ahead, we will be calling on the broader community to do its part to rally around this critical resource we all depend on."

Correll appeared Monday during the regular meeting of the FDHA as a “special guest” and said the Robert W. Woodruff Foundation would deposit $50 million in the form of Coca-Cola stock into the Community Foundation for Greater Atlanta on May 20, 2008.

The $50 million is the first of several installments of $200 million promised by the Woodruff Foundation to be doled out over four years for capital improvements.

The GMHC has also pledged to raise an additional $100 million over four years for capital improvements.

"It’s been a long journey…but we’ve reached the goal line," Correll said Monday. "We have given this hospital a chance. We have given this hospital a future."

GRADY CEO SEARCH

Stephenson has served as Interim CEO at Grady since January 2008 after officials fired Otis Story for unknown reasons.

Story filed a lawsuit against the FDHA two weeks ago in Fulton County Superior Court in which he asserts Stephenson had him fired so she could take his job, The Atlanta Journal-Constitution newspaper (AJC) reported May 12, 2008.

The AJC obtained a dismissal letter from Stephenson to Story that claims Story did not provide good leadership and made decisions without getting approval from the FDHA.
Story is seeking $1.8 million in severance pay, a $60,000 signing bonus, and unspecified punitive damages, according to the AJC.

Meanwhile, critics contend Stephenson has a conflict of interest by serving in three posts at Grady: CEO, FDHA Chair, and GMHC Vice Chair.

A Search Committee has spoken to about 30 candidates for the permanent CEO position and hopes to hire one by the end of June, Correll said last week.

Stephenson has said publicly that while she is interested in staying on as CEO, she will not make a formal announcement on whether she has applied for the post.

Correll is scheduled to speak with reporters May 20 in his downtown office about the transfer. The GMHC will hold its first meeting as the Grady Health System operator on June 2, 2008.

About the author:
Jonathan Springston is a Senior Staff Writer for Atlanta Progressive News. He may be reached at jonathan@atlantaprogressivenews.com

Legislative Action Alert

- From Families USA

As the economy worsens, the President is steadfast in cutting public programs.

This time on the chopping block: Medicaid.

The Administration proposed rule changes that would cut Medicaid funding at a time when people need it most. But the House of Representatives recently overcame partisan politics to vote against the Medicaid cuts. Thanks to your grassroots efforts, the House bill passed with a veto-proof margin.

The Administration is working hard to prevent that from happening in the Senate.
Tell your Senators to preserve Medicaid and oppose harmful regulations. Send an email or call them directly at 1-800-828-0498.

To take action online... go to: http://ga3.org/campaign/badmedicine_email

The President has already threatened to veto this legislation. If he has his way, a number of critical services will be lost, including rehabilitation services, school-based transportation, and administrative services.

If left unopposed, the Administration's actions will also serve as a giant anti-stimulus package because the cuts will ripple through every state's economy – leading to losses in jobs, and drops in wages and business activity.

Your Senators need to hear from you about the need to support legislation blocking these terrible regulations from going into effect.

Act now by calling 1-800-828-0498, or by sending an email to your Senators.

Our senators, in Georgia, are:

Johnny Isakson
120 Russell Senate Office Building
Washington, DC 20510

Saxby Chambliss
416 Russell Senate Office Building
Washington, DC 20510

Your grassroots efforts were successful in the House. Now we must turn our attention to the Senate where a veto-proof majority is required to avoid another Presidential veto.

Thank you

Tax Cuts for the Insurance Industry Will Do Little to Help Georgia’s Uninsured

GEORGIA BUDGET & POLICY PRIORITIES INSTITUTE COMMENTARY ON HB 977:
By Timothy Sweeney, Sr. Healthcare Analyst

On the 40th and final day of the 2008 Georgia Legislative session, the state Senate came to an agreement with a House proposal to give a sweeping tax break to insurance companies selling high deductible health plans. Based on the fiscal note for these provisions, House Bill (HB) 977 would extend $146 million in tax breaks to insurance companies over the next 5 years, though if you believe the coverage gains touted by the proponents of the legislation, the benefits to the insurance industry, and the costs to state and local governments, would be far greater.

Unfortunately for all Georgians, however, the bill passed by the Legislature does not meaningfully address the fact that most of Georgia’s 1.6 million individuals without health insurance simply cannot afford it. Rather, HB 977 will do little more than motivate individuals who already have health insurance to switch to a different type of product.

Make no mistake, this bill was not about health coverage. Health insurers are already selling high deductible health plans, and while only a small number of individuals choose these products over traditional, comprehensive coverage, consumers have plenty of access to these products. Instead, this bill provides a significant tax break to insurance companies – a tax break that will increase insurance industry profits on plans that are already in place.

Proponents of HB 977 stated that it would cover 500,000 uninsured Georgians, yet have provided no numbers to support this assertion. Certainly, the experts who calculated the official fiscal note did not forecast such coverage gains. Closer analysis of this fiscal note indicates that coverage gains could be closer to 7,500 – merely 1.5% of the amount claimed by supporters. This is because the bulk of the benefits of this legislation flow directly to insurance companies, while the modest $250 small business tax credit pales in comparison to the actual cost of health insurance, which averages roughly $10,000 for family coverage in Georgia. Regarding the employer tax credit, the fiscal note stated that, “the expected take up in insurance due to this provision is small.”

While debates on the likelihood of significant coverage gains never took place at the capitol, one thing is for certain – should even a portion of the stated coverage gains actually occur, the tax cuts to the insurance companies would far exceed the $146 million estimated in the fiscal note.
While many states across the country continue to pursue meaningful coverage expansions targeted at low-income children, families, and other uninsured populations, Georgia’s answer to all policy troubles continues to be tax cuts. Supporters of HB 977 admitted that it is “no silver bullet” and that high deductible plans “are not for everyone.” On these points they are correct, yet sadly they fail to grasp how meaningless these tax cuts will be for the vast majority of the 1.6 million uninsured Georgians who will still be unable to afford health insurance, and who will continue to watch as health insurers rake in staggering profits.

The current economic slowdown and the resulting effect on state revenues will make it difficult to fund the Medicaid and Peachcare programs even without a tax cut such as is contained in HB 977. What do we say to the low-income pregnant women, children, elderly and disabled who might lose coverage while insurance companies are lining their pockets with tax breaks?

Healthcare reform in Georgia needs more voices at the table than just the big insurance companies and the brokers who sell their policies. For these reasons the Governor should veto HB 977.

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For a more detailed discussion of the provisions of HB 977 and the health policy implications of encouraging high deductible health plans, please see the recently issued GBPI reports titled Analysis of HB 977: High Deductible Tax Incentives and Insurance Law Changes, which can be found here, and Examining the Effects of Legislation Promoting High Deductible Health Plans, which can be found here. Both reports can also be found at www.gbpi.org.

The Georgia Budget and Policy Institute (GBPI) is an independent, nonprofit, non-partisan organization engaged in research and education on the fiscal and economic health of the state of Georgia. The GBPI provides reliable, accessible and timely analyses to promote greater state government fiscal accountability as a way to improve services to Georgians in need and to promote quality of life for all Georgians.

Housing is Health Care

From the National Health Care for the Homeless Council

The primary and essential function of housing, to provide a safe and sheltered space, is absolutely fundamental to the people’s health and well being.– Dearbhal Murphy

Human rights theory holds that all particular rights are universal, indivisible and interdependent and interrelated. As Americans begin to pay more attention to human rights as the proper conceptual framework for our struggle to end homelessness,2 we are coming to understand the interdependence of human rights in very practical – not just theoretical – terms. In particular, we are recognizing that housing is health care, and that extension of both rights, together, is necessary for ending homelessness.

The centrality of housing to issues of homelessness is no news. The earliest stirrings of the movement to end homelessness in the United States was the “Housing Now” march in Washington DC in 1989. The movement’s mantra was “Housing! Housing! Housing!”

The US faced an emergent crisis that was firmly rooted in huge reductions to the budget of the federal Department of Housing and Urban Development under President Ronald Reagan; between 1980 and 1987, $45 billion for subsidized or publicly-owned housing was lost.3 Advocates sought restoration of major public investment in housing for the poor, but won only the shallow victory of the McKinney Homeless Assistance Act, intended to provide emergency shelter and services to the masses, who were now living on the streets.

In the decades since, most activists’ energy has focused on responding to the emergency needs of homeless people, and a gargantuan homeless services industry has emerged – now well over $2 billion in federal expenditures, and growing; the writer admits to being part of that industry as Executive Director of the National Health Care for the Homeless Council.

Housing has not been altogether forgotten in those intervening decades. The National Low Income Housing Coalition has stood stalwartly for the creation of new affordable housing on a necessarily massive scale. The real action, however, has been in the federal tax system, which provides housing subsidies through tax write-off for mortgage interest deductions for homeowners – an entitlement for the wealthy that was worth $122 billion in 2006.

Meanwhile, rental housing has become steadily less affordable and scarcer for poor people, and the crisis of homelessness has deepened. In 2005, for the first time, there was no jurisdiction in America where a full-time, minimum-wage worker could afford a one-room apartment.

Meanwhile, homelessness and ill health have been locked in an on-going cycle of cause and effect, spiraling constantly downward.

• Poor health puts one at risk for homelessness. Half of all personal bankruptcies in the US are caused by health problems,6 too often and too quickly leading to eviction and homelessness. Dispossessed people often land with friends or family at first, but their living arrangements are tenuous, and break down particularly quickly for those with mental health or substance abuse problems.

• Homelessness puts one at risk for poor health. Exposure to infection, to the elements, and to the violence of the streets is common. Lack of control over nutrition or personal hygiene or sleep demeans and debilitates homeless people. Risky survival behaviors are the currency of the streets. The psychological toll is as dire as the physical.

• Furthermore, homelessness complicates efforts to treat illnesses and injuries. Neither health care financing nor the structure of the health care delivery system is attuned to the particular needs of homeless people.

The outcomes are disastrous: homeless people suffer all illnesses at three to six times the rates experienced by others, have higher death rates, and have dramatically lower life expectancy.

The McKinney Act provided the same sort of partial response to the health needs of homeless people as it did to their need for shelter and housing. It provided funding for a system of safety-net clinics that has steadily grown to 185 projects throughout the nation, worth $170 million and serving 600,000 homeless persons per year. The system is vital to their wellbeing, but it reaches only a fraction of the 3.5 million persons thought to experience homelessness each year, and it does not provide specialty care or hospitalization. Major deficiencies remain in mental health and substance abuse care for homeless persons and others.

Although the majority of Americans support a system of universal health insurance that would pay for comprehensive health care for everyone, 15.9% of the population, 46.6 million Americans, are uninsured: a million more are added each year. 71% of Health Care for the Homeless clients are uninsured. The growing rights-based movement for universal health care faces strong resistance from insurance, pharmaceutical and other industries that profit obscenely from the current inhumane system.

A new and widely-accepted approach to these problems has emerged. “Housing First”declares that first, and above all, a homeless persons needs housing.10 This new emphasis differs from “Housing! Housing! Housing!” in its focus on resolving individuals’ homelessness, rather than on the broad systemic deficits and political decisions that drive mass homelessness.

The US government promotes Housing First approaches in its “chronic homeless” initiative, which targets single individuals who have been homeless for a long time and who have a disabling condition (that is, a health condition, and likely several health conditions). Housing First moves homeless people directly from the streets into Permanent Supportive Housing where treatment services are readily available, but participation in such services is not mandatory.

The premise of Housing First is that housing will improve the new tenants’ health and social status, will improve their use of primary care and outpatient services, and will reduce their utilization of hospitals, jails and emergency services (thereby reducing costs). At its heart, Housing First claims that housing IS health care.

The HIV/AIDS community in the US has long promoted the notion of housing as health care, and research from that constituency is beginning to validate this common-sense idea.. The 2005 National Housing and HIV/AIDS Research Summit concluded that “recent studies . . . show strong correlations between improved housing status and reduced HIV risk, improved access to medical care and better health outcomes.”

Preliminary findings of a major study by the Centers for Disease Control and Prevention, reported at the same Research Summit in 2006, suggest that, controlling for all other variables, housing itself may improve the health of persons living with HIV or AIDS.

National AIDS Housing Coalition. Housing is the foundation of HIV prevention and treatment: results of the national housing and HIV/AIDS research summit. Washington DC, 2005.

Housing improves health for the same reasons that homelessness is deleterious. A clean, dry, secure environment is fundamental to personal hygiene (including wound care and dressing changes), medication storage (refrigeration of insulin, safe storage of needles), and protection from assault and the elements. Private space allows for the establishment of stable personal relationships; housing has been shown to reduce risky sexual behaviors.12 A stable residence facilitates effective interaction with others, including treatment providers and social support systems, and increases adherence to treatment plans including regular meals and keeping appointments. Housing may reduce anxiety and consequently reduce stress-related illnesses.13 In these ways, housing both promotes healing and prevents the onset of new illnesses.

Housing must be considered a first-line response to the personal health problems of homeless individuals. Moreover, the creation of additional affordable housing must be understood as a critical public health responsibility, for the control of communicable disease and for efficient and effective health care planning and spending. Public health has long understood the role of housing as a determinant of health, and has played an historic role in developing and enforcing housing standards.14 The known health effects of modern mass homelessness demand that public health renew and broaden its advocacy role to insist that affordable housing is a necessary prerequisite to eliminate homelessness.

A practical and comprehensive understanding of health necessarily includes housing and other social factors. Ultimately, these factors must be considered together in the political and funding arenas. Divided funding streams and uncoordinated policy-making must yield to unified budgets and synchronized policies which will promote – in the language of the World Health Organization – “a state of complete physical, mental and social well being”.15 A growing human rights movement offers new hope that this can be accomplished.

John Lozier / Executive Director
National Health Care for the Homeless Council
PO Box 60427 / Nashville TN 37206 USA
www.nhchc.org

Facts On The Cost Of Health Care

From: The National Coalition on Health Care

Introduction - By several measures, health care spending continues to rise at the fastest rate in our history.

In 2007, total national health expenditures were expected to rise 6.9 percent — two times the rate of inflation.1 Total spending was $2.3 TRILLION in 2007, or $7600 per person.1 Total health care spending represented 16 percent of the gross domestic product (GDP).

U.S. health care spending is expected to increase at similar levels for the next decade reaching $4.2 TRILLION in 2016, or 20 percent of GDP.

In 2007, employer health insurance premiums increased by 6.1 percent - two times the rate of inflation. The annual premium for an employer health plan covering a family of four averaged nearly $12,100. The annual premium for single coverage averaged over $4,400.

Experts agree that our health care system is riddled with inefficiencies, excessive administrative expenses, inflated prices, poor management, and inappropriate care, waste and fraud. These problems significantly increase the cost of medical care and health insurance for employers and workers and affect the security of families.

National Health Care Spending

· In 2007, health care spending in the United States reached $2.3 trillion, and was projected to reach $3 trillion in 2011. Health care spending is projected to reach $4.2 trillion by 2016.

· Health care spending is 4.3 times the amount spent on national defense.

· In 2005, the United States spent 16 percent of its gross domestic product (GDP) on health care. It is projected that the percentage will reach 20 percent by 2016.

· Although nearly 47 million Americans are uninsured, the United States spends more on health care than other industrialized nations, and those countries provide health insurance to all their citizens.

· Health care spending accounted for 10.9 percent of the GDP in Switzerland, 10.7 percent in Germany, 9.7 percent in Canada and 9.5 percent in France, according to the Organization for Economic Cooperation and Development.

Employer and Employee Health Insurance Costs

· Premiums for employer-based health insurance rose by 6.1 percent in 2007. Small employers saw their premiums, on average, increase 5.5 percent. Firms with less than 24 workers, experienced an increase of 6.8 percent.2

· The annual premium that a health insurer charges an employer for a health plan covering a family of four averaged $12,100 in 2007. Workers contributed nearly $3,300, or 10 percent more than they did in 2006.2 The annual premiums for family coverage significantly eclipsed the gross earnings for a full-time, minimum-wage worker ($10,712).

· Workers are now paying $1,400 more in premiums annually for family coverage than they did in 2000.

· Since 2000, employment-based health insurance premiums have increased 100 percent, compared to cumulative inflation of 24 percent and cumulative wage growth of 21 percent during the same period.

· Health insurance expenses are the fastest growing cost component for employers. Unless something changes dramatically, health insurance costs will overtake profits by 2008.

· According to the Kaiser Family Foundation and the Health Research and Educational Trust, premiums for employer-sponsored health insurance in the United States have been rising four times faster on average than workers’ earnings since 2000.

· The average employee contribution to company-provided health insurance has increased more than 143 percent since 2000. Average out-of-pocket costs for deductibles, co-payments for medications, and co-insurance for physician and hospital visits rose 115 percent during the same period.

· The percentage of Americans under age 65 whose family-level, out-of-pocket spending for health care, including health insurance, that exceeds $2,000 a year, rose from 37.3 percent in 1996 to 43.1 percent in 2003 - a 16 percent increase.

The Impact of Rising Health Care Costs

· National surveys show that the primary reason people are uninsured is the high cost of health insurance coverage.

· Economists have found that rising health care costs correlate to drops in health insurance coverage.

· Nearly one-quarter (23 percent) of the uninsured reported changing their way of life significantly in order to pay medical bills.

· In a Wall Street Journal-NBC Survey almost 50 percent of the American public say the cost of health care is their number one economic concern.

· In a USA Today/ABC News survey, 80 percent of Americans said that they were dissatisfied (60 percent were very dissatisfied) with high national health care spending.

· Rising health care costs is the top personal pocketbook concern for Democratic voters (45%) and Republicans (35%), well ahead of higher taxes or retirement security.

· One in four Americans say their family has had a problem paying for medical care during the past year, up 7 percentage points over the past nine years. Nearly 30 percent say someone in their family has delayed medical care in the past year, a new high based on recent polling. Most say the medical condition was at least somewhat serious.

· A recent study by Harvard University researchers found that the average out-of-pocket medical debt for those who filed for bankruptcy was $12,000. The study noted that 68 percent of those who filed for bankruptcy had health insurance. In addition, the study found that 50 percent of all bankruptcy filings were partly the result of medical expenses. Every 30 seconds in the United States someone files for bankruptcy in the aftermath of a serious health problem.

· One half of workers in the lowest-compensation jobs and one-half of workers in mid range-compensation jobs either had problems with medical bills in a 12-month period or were paying off accrued debt. One-quarter of workers in higher-compensated positions also reported problems with medical bills or were paying off accrued debt.

NOTES:

· If one member of a family is uninsured and has an accident, a hospital stay, or a costly medical treatment, the resulting medical bills can affect the economic stability of the whole family.15

· A new survey shows that more than 25 percent said that housing problems resulted from medical debt, including the inability to make rent or mortgage payments and the development of bad credit ratings.16

· A survey of Iowa consumers found that in order to cope with rising health insurance costs, 86 percent said they had cut back on how much they could save, and 44 percent said that they have cut back on food and heating expenses.17

· Retiring elderly couples will need $200,000 in savings just to pay for the most basic medical coverage.18 Many experts believe that this figure is conservative and that $300,000 may be a more realistic number.

· According to a recent report, the United States has $480 billion in excess spending each year in comparison to Western European nations that have universal health insurance coverage. The costs are mainly associated with excess administrative costs and poorer quality of care.19

· The United States spends six times more per capita on the administration of the health care system than its peer Western European nations.19

Time for Action on Reining in Health Care Costs -Policymakers and government officials agree that health care costs must be controlled. But they disagree on the best ways to address rapidly escalating health spending and health insurance premiums. Some favor price controls and imposing strict budgets on health care spending. Others believe free market competition is the best way to solve the problems. Public health advocates believe that if all Americans adopted healthy lifestyles, health care costs would decrease as people required less medical care.

There appears to be no agreement on a single solution to health care’s high price tag. Many approaches may be used to control costs. What we do know is if the rate of escalation in health care spending and health insurance premiums continues at current trends, the cost of inaction will severely affect employer’s bottom lines and consumer’s pocketbooks.

Grady Coalition Looks to Future, Vows to Keep Fighting

By Jonathan Springston, Senior Staff Writer, APN (March 04, 2008)

(APN) ATLANTA – Even though the transfer of power between the Fulton-DeKalb Hospital Authority (FDHA) and the new Grady Memorial Hospital Corporation (GMHC) may appear to be a done deal, members of the Grady Coalition say they are going to keep fighting for Grady Hospital, its patients, and its workers.

"We are marathon runners and we’re not going to disappear," Rev. Timothy McDonald, pastor of the First Iconium Baptist Church and leading figure in the Grady Coalition, said Thursday night, February 28, 2008.

About 50 citizens attended a Town Hall Meeting held by the Coalition Thursday night at Grady Hospital’s Steiner Auditorium to discuss what’s next in the fight to keep Grady alive and accountable to the public."We have to monitor them once we nail them down," State Sen. Vincent Fort (D-Atlanta) said of whoever will be the new Board Members of GMHC, which the FDHA and others could name soon.

Now that Fulton and DeKalb Counties have consented to the lease agreement transferring power from the FDHA to the GMHC, the Grady Coalition is turning its attention to make sure business leaders follow through on delivery of millions of dollars in funds to Grady that have allegedly been verbally promised in secret, and that State leaders follow through on possible funding which have raised as a possibility.

Upon execution of the lease, business leaders have allegedly promised to deliver to Grady $50 million followed by $150 million over the next three years. In addition, they are said to have promised to undertake a "best efforts" campaign to raise another $100 million over three years.
Many in attendance Thursday doubt anyone will follow through on delivering these funds. "You won’t see $50 million in any lump sum at any time," Jack Jersawitz said.

Fort outlined three "pots" of money the Georgia General Assembly is either considering expanding, revising, or creating this session. First, Gov. Sonny Perdue has recommended budgeting $53 million for a Statewide Trauma Network with $7 million of that for Grady. Fort said the network really needs $180 million. Second, the State Legislature is considering revising the Medicaid reimbursement formula so that Grady could receive an additional $7 or $8 million per year. Third, the Indigent Care Trust Fund could receive an additional $5 or $6 million.

Overall, Fort said Grady could receive between $22 and $40 million from the State in addition to what has been budgeted for this year. But he noted the State cut $60 million from Grady last year and even if Grady receives new funds from the State, it could still leave Grady between $15 and $25 million short of what it needs from the State.

"This is like getting robbed and then going back and asking back for what’s yours," Fort said. Fort introduced legislation this week that would levy a statewide half-cent sales tax. Those funds would be used to funds all public hospitals in Georgia.

"I don’t like to beg," Fort said Thursday. "I don’t want to do this every year." As much as Grady needs the money, the Coalition emphasized the need to protect workers and patients by holding the new 501(c)(3) accountable.

"We cannot allow the patients…to suffer because of greed, corruption, and a takeover," McDonald said.

"People should not lose something in this transfer," Nancy Lenk of American Federation of State, County, and Municipal Employees, Local 1644, a union that represents Grady workers, said.

"Privatization means often that work is contracted out." "We have to continue as a community to put our arms around Grady workers," she added.

"It boils down to who is on that board," Dr. Neal Schulman said. "If it’s only filled with yes people, then that is a great, great tragedy."

Fulton County Approves Two Grady Hospital Resolutions

By Jonathan Springston, Senior Staff Writer, APN (March 15, 2008)

(APN) ATLANTA – The Fulton County Board of Commissioners approved a pair of resolutions Wednesday, March 05, 2008, concerning funding and ethics at Grady Memorial Hospital, which as Atlanta Progressive News has previously reported, has been targeted for privatization by the business community.

The first resolution called on the Fulton-DeKalb Hospital Authority (FDHA) to not reduce or eliminate any provisions of the funding agreement between the FDHA and the Grady Memorial Hospital Corporation (GMHC), the nonprofit corporation created by FDHA to possibly take over management of the hospital system.

Section 3 of the funding agreement states before the execution of the lease agreement, the GMHC must obtain a written commitment from the business community that they will provide $200 million in capital improvements over four years to Grady Hospital.

The first payment should be $50 million, according to the funding agreement, to be paid immediately into escrow or in cash on or before execution.

It also calls on the business community to provide a written commitment it will undertake a "good faith, best efforts" campaign to raise an additional $100 million, beyond the $200 million, for capital improvements over three years.

But Section 5 of the funding agreement gives the FDHA the discretion to permit the GMHC to obtain less than the amounts of funds promised in Section 3 of the agreement.

Fulton’s resolution, authored by Commissioner Emma Darnell and Vice Chairman William "Bill" Edwards, asks the FDHA not exercise that discretion.

"Though you have the power... please don’t exercise it," Darnell asked Wednesday.

The funding agreement is part of the lease agreement, which transfers power from the FDHA to the GMHC. In exchange, the business community is said to have promised verbally to give Grady millions in badly needed funds.

The FDHA approved the lease on January 28, 2008, and sent it to Fulton and DeKalb County Commissioners for their consent. Both consented February 20, 2008 and February 26, 2008, respectively.

The FDHA then approved the revised lease based on changes made by the Counties on March 1, 2008.

The second resolution, also authored by Darnell and Edwards, asks the FDHA to develop and adopt a code of ethics.

"You and I know that every three weeks, there is some…concern over ethics," Darnell said of the FDHA.

"I don’t think it would do any harm," she added of adopting a code of ethics. "It would erase concerns of some members of the public…if the [FDHA] would just consider a code of ethics that has a little higher standards" than what is outlined in the Georgia Hospital Authorities Act.

Conservatives must cultivate self-reliance

By Jim Wooten - Atlanta Journal-Constitution - 4/10/07

Maybe there's no going back. But conservatives —- for the nation's good —- need to make one enormous try.

To be honest, the media won't be much help. By its nature, it highlights the case for more government. It documents suffering and what it sees as inequity and injustice that require a governmental solution.

Personal responsibility is rarely, if ever, a mentioned virtue. Poor choices —- like, for example the decision to bring babies into the world without a mother and a father in the home —- are rarely, if ever, questioned, and never in a way that would suggest blame.

The current debate in Georgia over PeachCare is the proper balance between providing a temporary safety net for those who are genuinely down on their luck and with creating a government program that invites adults to make bad choices, and to dump their children onto the backs of taxpayers.

It is terribly unfortunate that debates like this are always reduced to absurdity, with social and fiscal conservatives caricatured in penny-pinching stereotype while the advocates of more spending are seen as compassionate and, therefore, virtuous.

Georgia House Speaker Glenn Richardson (R-Hiram) spoke, in a story published this weekend, to that balance. "It is the obligation of all of us to take care of those that cannot take care of themselves," he told reporter Bill Hendrick. The benefits, however, have been made too generous to strike the proper balance and furthermore, he argued, PeachCare is coming to be regarded as an entitlement and a constitutional right, which it isn't. "The responsibility to take care of children is first with moms and dads. Mamas and daddies are responsible."

When PeachCare is discussed it is in terms of a struggle between good and evil —- bad people intentionally inflicting suffering on the deserving poor over the objections of the virtuous. But in the story Hendrick presents, a minister making $42,000 a year, with a wife and three children, opts instead to preach as a freelancer, substantially reducing his family's income, thus qualifying the children for PeachCare.

I cannot possibly know, nor can any journalist present in a single story, the reasons people make the choices they do. So I'm not here to judge the choices the family made.

The public policy question, however, is whether parents should be invited to make choices that transfer a parental obligation to government.

We keep crossing that divide. For all its public support, the truth is that HOPE stipends do the same thing. The program says to parents that it's no longer an essential family obligation to save for your child's college expenses. Even for children who are not college material, HOPE is available.

So in at least these two instances, we start from the premise that deserving people are falling through the cracks —- and use that to construct social programs that alter adult behavior, often in ways that are contrary to the public good.

Public welfare, for all its good, became a program that made men immaterial. Women married government. The result, now, is that in some populations men are disappearing from the lives of their children. Read the newspaper or watch television news and note how seldom men show up, especially in stories involving underclass families. Men are incidental.

This is, then, the consuming goal of conservatives in government: Strike a balance in the creation of social programs, or any other, so that help is extended to deserving poor without cultivating dependency and without tempting adults to make choices that could be harmful to family and to children. If, as with PeachCare, people are allowed onto the rolls without having to verify citizenship or eligibility, the result is obvious. Ineligible people will enroll, inviting dishonesty and forcing taxpayers to support freeloaders.

PeachCare reform, then, is not about abandoning public responsibility to the poor, but is about striking a balance that doesn't entice the middle class into dependency.

Policy-makers can re-fashion social programs intelligently. Welfare reform's emphasis on work is one example. The HOPE VI housing program, under which public housing projects are razed and replaced with upscale mixed-use housing, invites back those who demonstrate personal responsibility by work, by conduct and by property upkeep. The government that cultivated dependency is reconfigured to cultivate self-reliance and other virtues.

It's a tough challenge for conservatives. The pressure, always, is to throw money and to equate intent with results. That's what conservatives have to change.

Jim Wooten is associate editor of the editorial page.
His column runs Tuesdays, Fridays and Sundays.
jwooten@ajc.com

Shutting Grady Would Swamp Other Hospitals, Many Say

By GAYLE WHITE / gwhite@ajc.com Published on: 11/25/07

Consider these possibilities:

A well-insured woman's long-awaited hip replacement is postponed. Her bed has been taken by a homeless woman in need of emergency surgery for a broken hip.

A house in Buckhead bursts into flames, and several people are burned. Helicopters airlift them to Augusta to the state's only burn center.

A late-night pileup occurs on the Downtown Connector. Ambulances race the most severely injured passengers to Macon, where the specialists they need are available around the clock.
Those and other images of metro Atlanta without Grady Health System have brought business leaders, elected officials, doctors and clergy together in a historic effort to save the state's largest public hospital.

Having Grady healthy is in the best interest of all metro Atlanta residents and all other hospitals, said Dr. Robert Albin, chairman of the board of the Medical Association of Atlanta.

"There's no doubt in our minds that the medical delivery system in Fulton and DeKalb counties is entirely incapable of absorbing the inpatient, outpatient, emergency and referral load if Grady is not there," Albin said.

"People would be naive to believe there wouldn't be a logjam in the emergency rooms in all our hospitals. They would be naive to believe there wouldn't be a shortage of beds. The access to health care people have taken for granted may be severely compromised."

Hope for survival

Months of studying, meeting and negotiating could come to a head Monday when the Fulton-DeKalb Hospital Authority is scheduled to vote on restructuring management of the Grady Health System.

A task force of the Metro Atlanta Chamber of Commerce proposed turning over day-to-day management to a private nonprofit corporation run by a board independent from county politicians.

Leaders of the task force, which was created at the request of the hospital authority, said the shift is mandatory to attract the money needed to keep the hospital afloat.
Grady has lost money every year since 2000 and faces a projected record deficit of about $55 million this year.

Chamber leaders say they have a $200 million commitment for capital improvements at Grady if the proposal is approved.

Critics argue that county, state and federal governments should fund the hospital adequately under its current management system and warn that creating a private corporation could endanger Grady's commitment to the poor.

Both sides say Grady must be rescued. At stake is a range of medical services, from a neonatal intensive care unit that cares for babies from throughout Georgia, to Crestview, the state's largest nursing home.

Right now, Grady is the front-line hospital in the event of a plane crash at Hartsfield-Jackson International Airport, a major influenza outbreak in metro Atlanta or an assassination attempt on a visiting presidential candidate. And, as a teaching hospital for Emory University and Morehouse schools of medicine, Grady Memorial Hospital trains a quarter of Georgia's physicians.

"Grady doctors go all over the state," said Ben Robinson, executive director of the Georgia Board for Physician Workforce. "Grady is servicing rural Georgia as well as Atlanta."
Selling point for business

Any threat to Grady threatens not only medical care across metro Atlanta but possibly the region's economy, business and medical leaders say.

"Atlanta hosts over 3 million people a year in conventions and trade shows alone," said Bill Howard of the Atlanta Convention and Visitors Bureau. "Trauma centers are probably not at the top of the mind for meeting planners, but they become top of the mind if an emergency comes up."

Georgia Tech economist Thomas Boston, who conducted studies in 2001 and 2006 on the economic impact of Grady, said Grady is an essential part of the social infrastructure that draws businesses to Atlanta.

"Major corporations will not move to an area they perceive has overcrowded and inefficient health care services," Boston said.

Business aside, some Atlanta area clergy are saying Grady is essential to the moral vision of the city because of its role in indigent care.

Grady is there, said the Rev. Gerald Durley, co-chairman of the Regional Council of Churches of Atlanta, "for the least, the lost and the left out."

President Bush Vetoes Children's Health Insurance Bill, Again!

THE FOLLOWING IS A STATEMENT BY ROBERT GREENSTEIN, EXECUTIVE DIRECTOR OF THE CENTER ON BUDGET AND POLICY PRIORITIES, IN RESPONSE TO THE VETO:

"With today’s veto, the President again struck down legislation that would do precisely what he promised in his 2004 re-election campaign — 'lead an aggressive effort to enroll millions of poor children who are eligible but not signed up for government health insurance programs.'

The bill would provide coverage to nearly 4 million otherwise-uninsured children, the vast majority of them poor enough that they already qualify for coverage under states’ current rules. Yet the President ignored this fact, as well as the substantial changes Congress made to the original bill after he vetoed it in order to respond to critics’ concerns.

Most notably, the new bill prohibits states from raising their SCHIP income limits above 300 percent of the poverty line. Also, unlike the original bill, the new bill focuses all of its financial incentives for enrolling uninsured children on states that enroll more children who are eligible for Medicaid, most of whom are below the poverty line. Unlike the original bill, none of the incentive payments would go for enrolling more eligible children in SCHIP.

In addition, the bill tightens citizenship documentation procedures to respond to the spurious charge that the original bill would open Medicaid to illegal immigrants. As under the original bill, states could substitute a Social Security Administration match of the validity of each applicant’s Social Security number for more onerous verification procedures that have kept thousands of eligible poor citizen children out of the program. But under the new bill, these states would also have to verify an applicant’s citizenship through the SSA database — and would have to require applicants to produce a birth certificate, passport, or similar documentation if the SSA database could not confirm that the individual is a citizen.

The new bill also makes it more financially rewarding for states to use some of their SCHIP funds to help families buy private coverage through their employers, if it is available. This change responds to overblown claims that the earlier bill would mainly shift children from private to public coverage.

Finally, the new bill terminates SCHIP coverage for childless adults at the end of next year, nine months earlier than under the original bill. That undercuts another false charge: that the original bill favored adults over children.

Despite these significant changes, the President has chosen to veto the bill, and to justify his veto by misrepresenting what the bill does. As a result, health coverage for millions of low-income children is at risk, and the nation has once more lost an opportunity to make significant progress in reducing the number of uninsured children."

This statement is posted to http://www.cbpp.org/12-12-07health-stmt.htm.

Medicaid Tab Hurts Grady; State Must Help

By Mike King - The Atlanta Journal-Constitution - 12/13/07

The state of Georgia shouldn't have a hard time finding more money to help pay for trauma care at Grady Memorial Hospital and other trauma care centers around the state. Certainly, that will be easy compared to Grady's most threatening financial ailment —- compensation for the thousands of Medicaid patients who rely on the Atlanta hospital for basic health care.
Put aside, for the moment, how Grady has been managed over the years. The hospital has always served as the canary in the coal mine for public health care financing in Georgia. And that bird is chirping at the top of its little lungs.

Grady can't survive without a major overhaul in the way the state pays for acute care to the poorest of the poor and those who have no health insurance. The problem it faces is duplicated at dozens of public hospitals statewide, even if they do not face Grady's immediate financial crisis.
To Grady's benefit, a political consensus seems finally to be forming to create a special fund for trauma care. Gov. Sonny Perdue, House Speaker Glenn Richardson and Lt. Gov. Casey Cagle have all indicated they will encourage the General Assembly to find a way to directly support the statewide network of trauma hospitals. Grady, which operates the busiest and most sophisticated trauma unit in the network —- and the only one in North Georgia —- could wind up getting as much as $30 million if they prevail.

That will help, but it won't come close to solving the hospital's financial problems. Grady bleeds most of its red ink in providing routine, acute-care services for the 56 percent of its patients whose bills are supposed to be paid by Georgia's Medicaid program. And when a hospital loses money treating more than half of its patients, its long-term survival prospects are bleak.
The decades-old Medicaid program was originally designed for those among the poorest of the poor who needed to be hospitalized for acute illnesses. But the health insurance program has changed dramatically over the years, now covering, among other things, nursing home care for the indigent elderly and disabled.

How the program is financed has changed as well. In Georgia, the state is responsible for about 40 percent of the costs for covering roughly 600,000 residents. As Congress moved to restrict how much is paid at the federal level, Georgia and other states have taken on more of the financial burden —- so much so that for several years Medicaid was the fastest growing part of the state's annual budget.

To keep Medicaid costs from accelerating even more, the state has done two things: It cut the reimbursement rate for most Medicaid patients to about 85 percent of what the hospitals usually get for a Medicare patient getting the same care, which means high-cost hospitals lose money on many Medicaid patients. The state also contracted with managed-care organizations to run the program; physicians are required to get permission before admitting a Medicaid patient for hospital care.

The first measure was strictly for belt tightening. The second is supposed to improve the quality of care —- forcing Medicaid patients to use a physician for routine care instead of just showing up in emergency rooms. But the change also reduced costs $78 million in its first year.

While that may have helped the state's bottom line, it has hurt public hospitals, especially Grady. For instance, if a Medicaid patient is treated in an emergency room for a condition the managed-care plan doesn't consider an emergency, the hospital gets a flat fee of $50 to $75. Yet, hospitals are required to screen all ER patients who routinely run up hundreds of dollars in diagnostic charges.

With no relief from the federal government in sight, the state now faces some hard decisions —- start paying a much higher percentage of Medicaid's tab by raising more revenue (meaning taxes) or continue to let hospitals bleed more red ink.

Reaching a consensus on what to do about that will not come easily or quickly. Grady officials will have to take a leap of faith that the state is up to the task. And state officials need to get started in finding a solution, otherwise more Georgia hospitals will soon be in the same shape Grady finds itself in now.

Mike King is a member of the editorial board. His column appears Thursdays.
mking@ajc.com

What's Behind the Budget Battles Between the President and Congress?

A Policy point presentation from The Center on Budget and Policy Priorities

In his conflicts with Congress over issues from taxes to children’s health insurance to appropriations bills, the President is casting himself as the defender of fiscal responsibility. His actions, however, tell a different story.

In fighting congressional efforts to pay for tax-cut legislation, rather than to let the deficit rise, the President is insisting that tax loopholes for extremely affluent equity-fund and hedge-fund managers remain untouched. Similarly, in threatening to veto Medicare legislation being developed in Congress, he is insisting that billions of dollars in government overpayments to private health insurance companies remain untouched. He is also demanding that Congress cut billions of dollars from domestic programs ranging from education to medical research to help for poor families and elderly people with soaring winter heating bills.

The obvious conclusion is this: the President’s stance is not about fiscal responsibility, but rather that Congress must bow to his priorities.

AMT Relief: Rejecting the House’s plan to pay for it.

The Administration has said it would veto a House-approved bill to offset the cost of extending relief from the Alternative Minimum Tax (AMT) for upper-middle-income taxpayers by closing lucrative tax loopholes used by managers of private equity firms and hedge funds, many of whom make millions of dollars a year. The Senate has now fallen in line with the President’s wishes.

Extending AMT relief without paying for it, as the Administration favors and as the Senate has approved, would add $51 billion in deficits this year alone — and up to $1.3 trillion over the coming decade if Congress keeps doing that.

There are no free lunches. If the nation doesn’t pay for extending AMT relief now, it will have to later, through tax increases, spending cuts, or both, that are likely to affect millions of ordinary working families.

Medicare: Protecting billions in overpayments to private insurance companies.

Congress is crafting Medicare legislation to avert a large cut (taking effect in January) in Medicare payments to physicians. To help offset the cost, Senate Finance Committee Democrats and Republicans were negotiating a very modest scaling back of the large overpayments to private “Medicare Advantage” plans, which serve some Medicare patients. (The House has passed legislation to largely eliminate these overpayments, avert the cut in doctors’ fees, and make other improvements in Medicare, especially for low-income beneficiaries.) But in a letter to Congress this week, HHS Secretary Leavitt signaled the Administration will veto the bill if it contains any Medicare Advantage savings.

Although private insurance companies were brought into Medicare to lower costs, both CBO and the Medicare Payment Advisory Commission (MedPAC) — Congress’ own expert advisory body on Medicare payment policy — have found that they receive 12 percent more, on average, than it would cost traditional Medicare to cover the same people. MedPAC has unanimously recommended that Congress curb these overpayments, and has warned that failure to do so threatens the financial stability of Medicare.

CBO has reported that these overpayments will total $54 billion over the next five years and $149 billion over ten years. That will accelerate Medicare’s insolvency and ultimately necessitate much larger benefit cuts, tax increases, or both than would otherwise be needed to restore financial stability to the program.

Children’s Health: Rejecting a tobacco tax increase to pay for expanded coverage.

The President says he vetoed bipartisan legislation to provide nearly 4 million uninsured children with health coverage under the State Children’s Health Insurance (SCHIP) program because, among other things, it was financed through an increase in tobacco taxes. The Administration says it would veto any children’s health compromise that is financed by increased tobacco taxes.

Domestic Appropriations: Demanding domestic cuts.

The President insists that Congress cut overall funding for domestic appropriated programs to the level in his 2008 budget — which is $16 billion below the 2007 level, after adjusting for inflation.

The President has vetoed the Labor-HHS-Education appropriations bill as excessive. Cutting that bill down to the President’s level would require significant cuts in medical research ($1.4 billion), K-12 education ($1.3 billion), home heating assistance for the poor ($630 million), Head Start ($254 million, enough to serve nearly 34,000 children), and other programs.

Similarly, if funding for the nutrition program for low-income pregnant women, infants, and young children, known as WIC, is cut to the President’s level, the number of women, infants, and children receiving this assistance next year will be cut by more than 500,000.

These policy points have been brought to us from:
The Center on Budget and Policy Priorities820 First Street, NE, Suite 510Washington, DC 20002Shannon Spillane / Senior Communications Associate http://www.cbpp.org / spillane@cbpp.org

Congressional Budget Office's New Long-Term Budget Forecast

A Commentary by Robert Greenstein, Executive Director of CBPP

The new Congressional Budget Office report shows that rising health care costs are the largest driver of the nation’s long-term budget problems. But CBO’s projections also indicate that the costs of making expiring tax cuts — such as those enacted in 2001 and 2003 — permanent without paying for them would be the second largest factor, if policymakers follow that course.
In fact, assuming relief from the Alternative Minimum Tax is extended, making the tax cuts permanent without paying for them would account for one-third of the “fiscal gap” (the imbalance between spending and revenues) over the next 50 years.

Moreover, enforcing Pay-As-You-Go rules — and paying for any tax cuts Congress elects to extend (and any entitlement increases) — is within policymakers’ power. In contrast, as CBO explains, we probably won’t be able to secure the needed reductions in projected Medicare and Medicaid costs without causing serious harm to low-income and elderly patients unless we can slow cost growth throughout the entire U.S. health care system. And while this is the nation’s most important fiscal challenge, there is currently no consensus among health care experts about how to accomplish it; achieving such a consensus and fully implementing the appropriate policies could take years or decades.

The bottom line is this: because we currently lack an appropriate solution to rising health care costs, that makes it all the more important to avoid actions that would make the long-term budget outlook worse, such as extending the tax cuts without paying for them.



# # #
The Center on Budget and Policy Priorities is a nonprofit, nonpartisan research organization and policy institute that conducts research and analysis on a range of government policies and programs. It is supported primarily by foundation grants.

Resolution for Creation of 501(c)3 Corporation, Lease and Funding Agreement

RESOLUTION AUTHORIZING THE CREATION OF A 501(C)(3) CORPORATION, AND THE PREPARATION OF A LEASE AGREEMENT AND A FUNDING AGREEMENT

WHEREAS, The Fulton-DeKalb Hospital Authority (the “Authority”) was created on August 6, 1941, and owns and operates the Grady Health System (the “System”) a comprehensive healthcare system which includes Grady Memorial Hospital (“Grady Hospital”), Hughes Spalding Hospital (“Hughes Spalding”), Crestview Nursing and Rehabilitation Facility (“Crestview”), neighborhood health centers, and certain other real and personal property;

WHEREAS, as the primary provider of healthcare for the indigent and uninsured populations of Fulton County, DeKalb County, and surrounding areas, the Authority has sought over the past decades to fulfill its historic mission and preserve its unique role and character in the face of increasing indigent and charity populations and decreasing public funds;

WHEREAS, as a result of decreasing public funds, adverse reimbursement policies and other factors beyond the control of the Authority, the Authority has suffered severe financial hardships and deficits in recent years that have threatened the System’s ability to continue to provide high-quality medical services to the indigent and other residents of Fulton and DeKalb Counties;

WHEREAS, in seeking to address its current financial situation in the face of rising healthcare costs and diminished resources, the Authority (i) engaged a national consulting firm to evaluate its financial and operating conditions, (ii) sought additional input from business and other organizations and received the report of the Greater Grady Task Force of the Metro Atlanta Chamber of Commerce, and (iii) engaged the law firm of Troutman Sanders LLP to conduct due diligence activities relating to a proposed restructuring of the System;

WHEREAS, in response to said due diligence activities, as well as input and recommendations from Authority stakeholders and other parties, the Authority on September 24, 2007, authorized the Chairperson to appoint a special committee of Trustees (the “Exploratory Committee”) to work jointly with an Ad Hoc Advisory Group of representatives from civic, religious, governmental, business, philanthropic, and other community interests to explore strategic alternatives for the future operations of the System;

WHEREAS, the Exploratory Committee convened several meetings and considered various options to address the financial challenges facing the Authority, including but not limited to state government funding of Grady Hospital operations; the creation of a regional hospital authority to jointly fund Grady Hospital operations; the initiation or increase of sales and/or ad valorem taxes to directly fund Grady Hospital operations; and the formation of a 501(c)(3) nonprofit corporation which would lease Grady Hospital and other operating units of the System from the Authority, would assume many debts and liabilities of the Authority, and would assume responsibility for the day-to-day operations of the System, including Grady Hospital;

Questions Remain as Grady Hospital Holds Lease Hearings

By Jonathan Springston - The Atlanta Progressive News - 12/28/2007

(APN) ATLANTA – The Fulton-DeKalb Hospital Authority (FDHA) held two legally required public hearings on December 27, 2007, to let the public speak out on the proposed leasing of the Grady Health System to a nonprofit corporation.

Attendance at the hearings was relatively low due to the current holiday season, and not only among the public. Only three FDHA Board Members were in attendance.

The agreement, which is still tentative and under negotiation, provides for the leasing of Grady’s assets to the proposed Grady Memorial Hospital Corporation (GMHC), a 501(c)(3) that would oversee the daily operation of the hospital.

GMHC has not been formed as a Georgia corporation as of this date according to the Secretary of State’s website, Atlanta Progressive News can confirm. However, a name reservation was filed for GMHC on November 27, 2007, one day after FDHA passed a resolution to create the corporation.

"This is a work in progress," Pam Stephenson, FDHA Chairwoman, told Atlanta Progressive News. "We will go back and come up with something acceptable to all parties."

The draft lease states the GMHC must "irrevocably, absolutely, and unconditionally provide indigent care and charity care and operate the hospital as a safety net hospital."

While the GMHC would control Grady’s major medical services it must consult with the FDHA before eliminating any service, according to the draft lease.

If the GMHC does make a cut and the FDHA determines the move could put Grady’s Mission of serving the poor and uninsured in jeopardy, the FDHA could declare the whole lease null and void.

"The historic mission of the hospital – changing that is a deal breaker," Dr. Christopher Edwards, FDHA Vice Chair, said. "That is not an option. We envision those services will continue to be provided."

According to the November 26 resolution, the FDHA still needs to obtain recognition of tax-exempt status from the Internal Revenue Service (IRS) of the United States of the proposed corporation. It is unclear how tax-exempt status can be sought for an organization that has not yet been created.

The FDHA has to also approve a final draft of the lease agreement.
However, there are also several conditions outlined in the November 26 resolution that have not been met.

As previously reported by Atlanta Progressive News, that resolution, which provides for the creation of the GMHC, calls on the State of Georgia to provide written confirmation that it will support $30 million in annual financial support for Grady. Many state leaders, including Governor Sonny Perdue, oppose that idea.

Also, the resolution calls on the business, philanthropic, and charitable communities to provide written confirmation of their intent to provide $200 million for capital improvements to be paid over four years.

Anonymous business leaders have allegedly pledged to give Grady $200 million but only after the FDHA turns over control to the GMHC. The identity of the donor or donors remains a mystery.

While negotiations continue, it is unclear if the State, Fulton, and/or DeKalb Counties will agree to provide additional annual Grady funding or if anonymous donors would be willing to deliver $200 million before the power transfer occurs.

If these stipulations are not met, it is unknown whether or not the FDHA will decide to move forward with transferring its power and Grady’s assets to the GHMC.
In response to questions from APN, attorneys from the FDHA merely said that they were still working on trying to get additional funding.

It appears, however, that the FDHA would not be able to approve the lease, based on the language in the November 26 resolution. In that case, a new resolution may have to be passed for the lease to go forward.

Those who spoke at both hearings Thursday remain skeptical of the whole process and angry over how it is being carried out.

For example, many were outraged they did not receive copies of the draft of the lease agreement in advance of the hearings. State Sen. Vincent Fort (D-Atlanta) called it "an absolute insult."

"How can we have a public hearing on the lease agreement when it is not here?" Derrick Boazman, former Atlanta City Councilman and activist, asked.

"Without the actual document in the room, we don’t know what we’re discussing. We’re just talking to each other."

Indeed, copies of the draft were not available to the public or press until near the end of the first hearing, when copies finally circulated.

Many citizens maintained the FDHA’s plan to relinquish control of Grady to a nonprofit corporation is a sham which will endanger the hospital’s mission of serving the poor and uninsured.

"People in the streets are totally baffled by what’s happening behind closed doors," Dianne Mathiowetz, member of the Atlanta International Action Center, said. "If this new Board thinks it’s going to close services, it’s not going to happen without a struggle."

"It’s up to the [FDHA] to set the record straight and snatch victory from the jaws of defeat," Leonard Tate, community activist, said. "The public is getting hoodwinked and the poor are being exploited."

The FDHA has yet to announce a specific date to discuss and vote on a final lease agreement. The FDHA will hold another public meeting sometime in early 2008 for these purposes, Chairwoman Stephenson told Atlanta Progressive News.

About the author:
Jonathan Springston is a Senior Staff Writer for Atlanta Progressive News and may be reached at jonathan@atlantaprogressivenews.com.

Fulton Commission Refuses Grady $99M in Funding

By D.L. BENNETT - Atlanta Journal-Constitution - 1/9/08

Commissioners vote to give $80M, plus $5M —Hospital says it's still not enough

Fulton County Commissioners today refused Grady Memorial Hospital's request for $99.2 million in 2008 —cash hospital officials said was desperately needed to keep the ailing hospital afloat.

Instead, the board agreed to $80 million, plus $5 million in reserve funding if Grady meets certain management goals.

The amount matches what the county paid Grady in 2006 before approving $20 million in emergency funding last year.

Grady officials warned that any cut could have dire consequences to a public hospital already facing huge debt, problems with cash flow and challenges with patient care. Officials said patient care could suffer, nurses not be hired and vendor payments delayed.

"There is no plan B," said Dr. Christopher Edwards, a Grady board member. "There is no more cutting we can do. We are at bare bones here. At the end of the day, if Fulton County decides to withhold, we are done."

The decision came after more than two hours of dramatic debate as commissioners debated Grady's financial condition and its patient care.

"I'm not going to leave here feeling guilty we haven't done all we could do," said Commissioner Bill Edwards. "Fulton County cannot be the stopgap for Grady. I want to do what I can. I want to do more than I can. But I don't see an end to this."

The issue split the board 4-3 with Chairman John Eaves and Commissioners Nancy Boxill and Tom Lowe refusing to cut Grady's request.

"Fulton County has a responsibility to do everything we can to make sure health care is provided to all citizens, those who pay and those who cannot pay," Boxill said.

Commissioners Bill Edwards, Emma Darnell, Robb Pitts and Lynne Riley all said Fulton had already done enough. They said they were concerned about the hospital's questionable finances and wondered why Fulton should continue to pay more when no other entity has done so.
The Grady decision began what is likely to be a daylong debate over the county's 2008 budget.
Commissioners need to slash more than $30 million in proposed spending to balance the 2008 budget because the original $690 million spending plan called for a $33 million property tax hike. Commissioners rejected the tax hike last week.

The Grady decision saves the county $15 million in proposed spending, leaving just $18 million more to make up for the loss in revenue from rejecting the tax increase.