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.
* * *
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.
Wednesday, April 16, 2008
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
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.
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."
(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.
(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.
Friday, April 4, 2008
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
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."
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.
"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
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
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.
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;
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.
(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.
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.
New Medicaid Rules Would Limit Care for Children in Foster Care and People with Disabilities in Ways Congress did not Intend
From: The Budget on Budget and Policy Priorities / by Judith Solomon
On December 4, the Centers for Medicare and Medicaid Services (CMS) of the U.S. Department of Health and Human Services published interim final rules governing case management services provided by state Medicaid programs.[1] CMS claims the new rules are necessary to implement changes Congress made in the Deficit Reduction Act of 2005 (DRA). In fact, the rules go well beyond what Congress intended in the DRA and would have a detrimental impact on beneficiaries, particularly poor children in foster care and poor individuals with physical or mental disabilities or other chronic health conditions.
Background: Medicaid’s Case Management Benefit - Medicaid defines case management services as those that help beneficiaries “in gaining access to needed medical, social, educational, and other services.” States may offer case management to adult beneficiaries who need it; they must provide it to child beneficiaries who need it.[2] States can target case management for particular beneficiaries based on their health condition or where they live. When case management is designed for a specific group of beneficiaries, it is called targeted case management (TCM).
The DRA did not change the definition of case management but did make some changes to the benefit. It listed certain specific services that may be included in case management, such as assessing a beneficiary’s needs, developing a care plan, and referring beneficiaries to other services. It also clarified the scope of the benefit under the DRA:
l Case management includes contacts with family members and other individuals who are not themselves eligible for Medicaid when these contacts are necessary to manage the care of the beneficiary receiving case management, but it does not include management of the ineligible person’s own needs for medical care and other services;
l Case management also does not include the actual delivery of a medical, social, educational, or other service to which the individual is referred. The DRA lists foster care services such as home investigations, transportation, and arranging placements as examples of services that are excluded.
l Federal funds are not available for case management if a third party is liable to pay for the service.
New CMS Rules Go Well Beyond Congress’s Intention - According to CMS, the interim final rules would reduce federal Medicaid spending by $1.28 billion over five years, considerably more than the $760 million projected by CBO when it analyzed the DRA.[3] This difference is one indication that the rules go beyond what Congress intended.
The rules would force states either to spend additional state funds to compensate for the lost federal funds or to cut services for beneficiaries. The rules also would significantly limit state flexibility to provide case management in the most effective and efficient manner possible.
Limiting Case Management for Beneficiaries Leaving Institutional Care - States may currently provide case management to help beneficiaries make the transition from an institution to the community. Specifically, federal Medicaid reimbursement is available for case management provided for up to the last 180 days of a stay in an institution. This policy was issued in 2000 in response to the U.S. Supreme Court’s Olmstead decision, which found that the Americans with Disabilities Act requires states to provide services in the most integrated community settings that are appropriate to beneficiaries’ needs.
The interim final rules significantly restrict this policy. Under the rules, federal matching funds would be available for case management provided only during the last 60 days of a stay in an institution if the stay is 180 days or more, and for only the last 14 days of a stay that lasts fewer than 180 days. This usually is not enough time to arrange housing and other services needed for a successful transition.
Moreover, the rules would prohibit payment until an individual is actually living in the community. As a result, some providers would not be able to deliver transition services — because they lack the financial capacity to wait for payment and cannot take the risk that the individual will not be able to complete the transition to the community, in which case they would not be paid at all.
In addition, these changes would seriously undermine the “Money Follows the Person” demonstration, a centerpiece of the President’s New Freedom Initiative to help people with disabilities participate more fully in community life. Under the demonstration, which is intended to support efforts to move Medicaid beneficiaries from institutions to the community, some states are apparently allowing up to 180 days for case management services as allowed under current Medicaid policy.
Forcing States to Fragment Services for Children in Foster Care - The DRA includes a list of activities that can not be included in case management for children in foster care. In addition to the activities noted above, these activities include assessing adoption placements, serving legal papers, and administering foster care subsidies. All of the excluded activities relate to the administration of foster care programs and are separate from the delivery of health care.
The interim final rules, however, go substantially beyond the DRA — they prohibit federal Medicaid funds for all case management services provided by child welfare and child protective services agencies and their contractors, even if the contractors are qualified Medicaid providers.
In an April 5, 2006 letter to HHS Secretary Michael Leavitt, Senator Charles Grassley (R-Iowa), then chair of the Senate Finance Committee, explained Congress’s intention in the DRA in order to guide CMS in implementing the case management provision. He wrote: “[Case management] services, which the Congress intended would be appropriately considered a Medicaid expense, are particularly important to children in foster care. These are children who have multiple social, educational, nutritional, medical and other needs.” The letter cautioned that the “disallowance of reimbursement under Medicaid for services specified in the DRA for TCM for children in foster care . . . is in direct contradiction to Congressional intent” [emphasis added].
Disregarding Senator Grassley’s letter, the interim final rules prohibit any federal funding for case management services that child welfare agencies (or qualified Medicaid providers that have contracts with these agencies) provide to children in foster care. Under the new rules, only a Medicaid provider operating outside the child welfare system could provide case management services to children in foster care. This would force states to fragment the services provided to children in foster care — a result directly contrary to the purpose of the case management benefit, which is to coordinate needed medical, social, and educational services.
Almost half of all children in foster care have a disability or a chronic medical problem, and up to 80 percent have serious emotional problems. Almost all children in foster care are Medicaid beneficiaries. States have used the case management benefit to better coordinate the medical, social, and educational services these children need with the foster care services they receive.
Senator Grassley’s letter makes clear that the DRA was intended not to restrict this use of case management services, but instead to prevent states from using federal Medicaid funds to deliver the foster care services themselves.
Restricting Case Management for Some Children with Disabilities - All children in Medicaid are eligible for case management services when the services are medically necessary. Some states provide medically necessary case management services to children with disabilities in school settings in order to ensure that they receive an appropriate public education, as required by both the Individuals with Disabilities Education Act (IDEA) and Section 504 of the Rehabilitation Act. (Section 504 prohibits the denial of a “free and appropriate” education for children with disabilities regardless of whether a child receives special education services under the IDEA.)
The interim final rules would allow case management for children with disabilities in schools only when it is designated as a required service in the child’s Individualized Education Program (IEP) or an infant’s or toddler’s Individualized Family Service Plan (IFSP). The new rules specifically disallow the provision of case management when it is part of a child’s plan under Section 504 even if a child’s disability requires the coordination of multiple medical, social, and educational services in order for the child to participate in school programs.
Limiting States’ Flexibility to Manage Medicaid Efficiently - A central tenet of the federal-state partnership to operate Medicaid is that states must follow federal guidelines while retaining broad flexibility over payment rates and policies. The new rules disregard this tenet, arbitrarily restricting state flexibility in a way that could make Medicaid payments less efficient.
The rules would prohibit states from making fee-for-service payments for case management services in increments that exceed 15 minutes of a given service. This would be a significant change for states, which often use case rates, per diem rates, or other methodologies to pay for case management when these approaches are more efficient.
The highly prescriptive approach in the new rules would make it difficult or impossible for states to provide case management as part of assertive community treatment (ACT), a comprehensive, evidence-based treatment program for people with serious mental illness that provides services 24 hours a day, seven days a week. Paying for case management services on the basis of 15-minute increments would not work for programs like ACT, where case managers must be on-call and ready to respond at all times.
The rules would also limit state flexibility by prohibiting a state from providing a beneficiary with more than one case manager, even when the complexity of the beneficiary’s condition demands the expertise of more than one such individual. In most cases, having one case manager is beneficial to avoid duplication. But if a beneficiary has multiple conditions — for example, HIV/AIDS, mental illness, and an intellectual disability — no single case manager may be able to coordinate housing, health care, and social needs across multiple systems.
Conclusion
Senator Grassley’s letter to Secretary Leavitt explains that the DRA's case management provisions were intended “to insert clarity as to what is an appropriate [case management] service under Medicaid, and therefore appropriately claimed under Medicaid, and what is not.” The interim final rules published by CMS go well beyond that, cutting funds for legitimate case management services for children in foster care and individuals with disabilities and serious chronic health conditions. CMS should withdraw these rules and provide appropriate guidance to states that is in line with Congressional intent regarding case management services.
On December 4, the Centers for Medicare and Medicaid Services (CMS) of the U.S. Department of Health and Human Services published interim final rules governing case management services provided by state Medicaid programs.[1] CMS claims the new rules are necessary to implement changes Congress made in the Deficit Reduction Act of 2005 (DRA). In fact, the rules go well beyond what Congress intended in the DRA and would have a detrimental impact on beneficiaries, particularly poor children in foster care and poor individuals with physical or mental disabilities or other chronic health conditions.
Background: Medicaid’s Case Management Benefit - Medicaid defines case management services as those that help beneficiaries “in gaining access to needed medical, social, educational, and other services.” States may offer case management to adult beneficiaries who need it; they must provide it to child beneficiaries who need it.[2] States can target case management for particular beneficiaries based on their health condition or where they live. When case management is designed for a specific group of beneficiaries, it is called targeted case management (TCM).
The DRA did not change the definition of case management but did make some changes to the benefit. It listed certain specific services that may be included in case management, such as assessing a beneficiary’s needs, developing a care plan, and referring beneficiaries to other services. It also clarified the scope of the benefit under the DRA:
l Case management includes contacts with family members and other individuals who are not themselves eligible for Medicaid when these contacts are necessary to manage the care of the beneficiary receiving case management, but it does not include management of the ineligible person’s own needs for medical care and other services;
l Case management also does not include the actual delivery of a medical, social, educational, or other service to which the individual is referred. The DRA lists foster care services such as home investigations, transportation, and arranging placements as examples of services that are excluded.
l Federal funds are not available for case management if a third party is liable to pay for the service.
New CMS Rules Go Well Beyond Congress’s Intention - According to CMS, the interim final rules would reduce federal Medicaid spending by $1.28 billion over five years, considerably more than the $760 million projected by CBO when it analyzed the DRA.[3] This difference is one indication that the rules go beyond what Congress intended.
The rules would force states either to spend additional state funds to compensate for the lost federal funds or to cut services for beneficiaries. The rules also would significantly limit state flexibility to provide case management in the most effective and efficient manner possible.
Limiting Case Management for Beneficiaries Leaving Institutional Care - States may currently provide case management to help beneficiaries make the transition from an institution to the community. Specifically, federal Medicaid reimbursement is available for case management provided for up to the last 180 days of a stay in an institution. This policy was issued in 2000 in response to the U.S. Supreme Court’s Olmstead decision, which found that the Americans with Disabilities Act requires states to provide services in the most integrated community settings that are appropriate to beneficiaries’ needs.
The interim final rules significantly restrict this policy. Under the rules, federal matching funds would be available for case management provided only during the last 60 days of a stay in an institution if the stay is 180 days or more, and for only the last 14 days of a stay that lasts fewer than 180 days. This usually is not enough time to arrange housing and other services needed for a successful transition.
Moreover, the rules would prohibit payment until an individual is actually living in the community. As a result, some providers would not be able to deliver transition services — because they lack the financial capacity to wait for payment and cannot take the risk that the individual will not be able to complete the transition to the community, in which case they would not be paid at all.
In addition, these changes would seriously undermine the “Money Follows the Person” demonstration, a centerpiece of the President’s New Freedom Initiative to help people with disabilities participate more fully in community life. Under the demonstration, which is intended to support efforts to move Medicaid beneficiaries from institutions to the community, some states are apparently allowing up to 180 days for case management services as allowed under current Medicaid policy.
Forcing States to Fragment Services for Children in Foster Care - The DRA includes a list of activities that can not be included in case management for children in foster care. In addition to the activities noted above, these activities include assessing adoption placements, serving legal papers, and administering foster care subsidies. All of the excluded activities relate to the administration of foster care programs and are separate from the delivery of health care.
The interim final rules, however, go substantially beyond the DRA — they prohibit federal Medicaid funds for all case management services provided by child welfare and child protective services agencies and their contractors, even if the contractors are qualified Medicaid providers.
In an April 5, 2006 letter to HHS Secretary Michael Leavitt, Senator Charles Grassley (R-Iowa), then chair of the Senate Finance Committee, explained Congress’s intention in the DRA in order to guide CMS in implementing the case management provision. He wrote: “[Case management] services, which the Congress intended would be appropriately considered a Medicaid expense, are particularly important to children in foster care. These are children who have multiple social, educational, nutritional, medical and other needs.” The letter cautioned that the “disallowance of reimbursement under Medicaid for services specified in the DRA for TCM for children in foster care . . . is in direct contradiction to Congressional intent” [emphasis added].
Disregarding Senator Grassley’s letter, the interim final rules prohibit any federal funding for case management services that child welfare agencies (or qualified Medicaid providers that have contracts with these agencies) provide to children in foster care. Under the new rules, only a Medicaid provider operating outside the child welfare system could provide case management services to children in foster care. This would force states to fragment the services provided to children in foster care — a result directly contrary to the purpose of the case management benefit, which is to coordinate needed medical, social, and educational services.
Almost half of all children in foster care have a disability or a chronic medical problem, and up to 80 percent have serious emotional problems. Almost all children in foster care are Medicaid beneficiaries. States have used the case management benefit to better coordinate the medical, social, and educational services these children need with the foster care services they receive.
Senator Grassley’s letter makes clear that the DRA was intended not to restrict this use of case management services, but instead to prevent states from using federal Medicaid funds to deliver the foster care services themselves.
Restricting Case Management for Some Children with Disabilities - All children in Medicaid are eligible for case management services when the services are medically necessary. Some states provide medically necessary case management services to children with disabilities in school settings in order to ensure that they receive an appropriate public education, as required by both the Individuals with Disabilities Education Act (IDEA) and Section 504 of the Rehabilitation Act. (Section 504 prohibits the denial of a “free and appropriate” education for children with disabilities regardless of whether a child receives special education services under the IDEA.)
The interim final rules would allow case management for children with disabilities in schools only when it is designated as a required service in the child’s Individualized Education Program (IEP) or an infant’s or toddler’s Individualized Family Service Plan (IFSP). The new rules specifically disallow the provision of case management when it is part of a child’s plan under Section 504 even if a child’s disability requires the coordination of multiple medical, social, and educational services in order for the child to participate in school programs.
Limiting States’ Flexibility to Manage Medicaid Efficiently - A central tenet of the federal-state partnership to operate Medicaid is that states must follow federal guidelines while retaining broad flexibility over payment rates and policies. The new rules disregard this tenet, arbitrarily restricting state flexibility in a way that could make Medicaid payments less efficient.
The rules would prohibit states from making fee-for-service payments for case management services in increments that exceed 15 minutes of a given service. This would be a significant change for states, which often use case rates, per diem rates, or other methodologies to pay for case management when these approaches are more efficient.
The highly prescriptive approach in the new rules would make it difficult or impossible for states to provide case management as part of assertive community treatment (ACT), a comprehensive, evidence-based treatment program for people with serious mental illness that provides services 24 hours a day, seven days a week. Paying for case management services on the basis of 15-minute increments would not work for programs like ACT, where case managers must be on-call and ready to respond at all times.
The rules would also limit state flexibility by prohibiting a state from providing a beneficiary with more than one case manager, even when the complexity of the beneficiary’s condition demands the expertise of more than one such individual. In most cases, having one case manager is beneficial to avoid duplication. But if a beneficiary has multiple conditions — for example, HIV/AIDS, mental illness, and an intellectual disability — no single case manager may be able to coordinate housing, health care, and social needs across multiple systems.
Conclusion
Senator Grassley’s letter to Secretary Leavitt explains that the DRA's case management provisions were intended “to insert clarity as to what is an appropriate [case management] service under Medicaid, and therefore appropriately claimed under Medicaid, and what is not.” The interim final rules published by CMS go well beyond that, cutting funds for legitimate case management services for children in foster care and individuals with disabilities and serious chronic health conditions. CMS should withdraw these rules and provide appropriate guidance to states that is in line with Congressional intent regarding case management services.
SCHIP Extended Until 2009
Despite broad public and Congressional support, the State Children’s Health Insurance Program (SCHIP) was not reauthorized this year. Instead, Congress passed a bill, the Medicare, Medicaid and SCHIP Extension Act of 2007 (S. 2499) that will, among other things, extend SCHIP until March 31, 2009.
S. 2499 provides sufficient funding so states can continue covering the current 6 million children enrolled in the program. The bill passed by unanimous consent in the Senate on December 18; the next day the House approved the measure 411-3. President Bush is expected to sign S. 2499. Twice this year he vetoed SCHIP reauthorization bills that had bipartisan support and would have expanded the program to cover more children.
A matter of great concern to the advocacy community and to Members in Congress that was not addressed in the extension bill relates to an August 17 directive issued by the Centers for Medicare and Medicaid Services (CMS). The directive effectively caps eligibility for SCHIP at 250% of the federal poverty line, which is $42,925 a year for a family of three in 2007.
This directive dramatically changes the nature of the SCHIP program, which in its 10 years of existence has never had an income restriction. It will also have a negative impact on children’s coverage. A new report issued by the Center for Children and Families finds that by August 2008, 23 states will be affected by the directive.
Four states have already had to scale back or halt their coverage plans. If not addressed, thousands of children are likely to lose coverage.
There is support in Congress to revoke the measure. On December 14, Senators Robert Menendez (D-NJ) and Arlen Specter (R-PA) sent a letter to the Finance Committee and Senate leaders, which was signed by more than a dozen other Senators, urging that Congress make it a priority to repeal the directive. This issue will surely be a priority for advocates in 2008.
Advocates are deeply disappointed by these results. They hoped a reauthorization bill would have been enacted that would have strengthened and expanded SCHIP to cover millions more children, given the popularity of the program and the broad bipartisan support in Congress. The bills Congress passed and sent to the President for his signature would have added $35 billion to the program over 5 years and provided health insurance to 10 million children.
However, the President and a small group of Republicans who aligned with him squandered these hopes and successfully blocked any efforts to improve the program this year. The Democratic leadership has pledged to continue pushing in 2008 until a bill is enacted.
The House has scheduled a vote on overriding the President’s second veto for January 23, the same week as the State of the Union address.
S. 2499 provides sufficient funding so states can continue covering the current 6 million children enrolled in the program. The bill passed by unanimous consent in the Senate on December 18; the next day the House approved the measure 411-3. President Bush is expected to sign S. 2499. Twice this year he vetoed SCHIP reauthorization bills that had bipartisan support and would have expanded the program to cover more children.
A matter of great concern to the advocacy community and to Members in Congress that was not addressed in the extension bill relates to an August 17 directive issued by the Centers for Medicare and Medicaid Services (CMS). The directive effectively caps eligibility for SCHIP at 250% of the federal poverty line, which is $42,925 a year for a family of three in 2007.
This directive dramatically changes the nature of the SCHIP program, which in its 10 years of existence has never had an income restriction. It will also have a negative impact on children’s coverage. A new report issued by the Center for Children and Families finds that by August 2008, 23 states will be affected by the directive.
Four states have already had to scale back or halt their coverage plans. If not addressed, thousands of children are likely to lose coverage.
There is support in Congress to revoke the measure. On December 14, Senators Robert Menendez (D-NJ) and Arlen Specter (R-PA) sent a letter to the Finance Committee and Senate leaders, which was signed by more than a dozen other Senators, urging that Congress make it a priority to repeal the directive. This issue will surely be a priority for advocates in 2008.
Advocates are deeply disappointed by these results. They hoped a reauthorization bill would have been enacted that would have strengthened and expanded SCHIP to cover millions more children, given the popularity of the program and the broad bipartisan support in Congress. The bills Congress passed and sent to the President for his signature would have added $35 billion to the program over 5 years and provided health insurance to 10 million children.
However, the President and a small group of Republicans who aligned with him squandered these hopes and successfully blocked any efforts to improve the program this year. The Democratic leadership has pledged to continue pushing in 2008 until a bill is enacted.
The House has scheduled a vote on overriding the President’s second veto for January 23, the same week as the State of the Union address.
Grady Hospital Activists Deliver Petitions to State Leaders
By Jonathan Springston - The Atlanta Progressive News - 1/19/2008
photo: Our Voices 2008
(APN) ATLANTA – About 50 members of the Grady Coalition delivered 10,000 signed petitions to the Georgia State Capitol Tuesday, January 15, 2008, urging State leaders to provide more funding for the Grady Health System.
"The central issue is making sure Grady gets the resources it needs as a regional hospital," State Sen. Vincent Fort (D-Atlanta) said during a press conference held before delivery of the petitions.
The Georgia General Assembly reconvened this week and so far, several lawmakers have proposed imposing a variety of fees to fund a statewide trauma care network. Sen. Fort said in addition to funding a statewide trauma care network, the General Assembly could consider many bills concerning Grady.
One bill, SR 722, introduced on January 17, 2008, by Sen. David Shafer (R-Duluth) would create a state-level Grady committee to oversee issues like funding, contract, and structure. It has 30 bipartisan cosponsors.
Another bill by Shafer, SB 353, would ban vendors and others with financial ties to Grady from leading it.The Grady Coalition is hoping the large volume of petitions will signal to lawmakers the desire of Georgians to see state funding for Grady.
"We have heard rumors they [State leaders] want to do the right thing," Rev. Timothy McDonald, of the First Iconium Baptist Church, said. "We hope and pray all these elected officials will support [Dr. Martin Luther King's] name…by passing legislation that supports Grady."
After the press conference, the Grady Coalition marched into the Capitol to deliver the petitions. Members visited Gov. Sonny Perdue’s office first.
"Grady is not just a place for people to get healed, it’s a place to transform," Hul-yah Yis-rael, a Grady patient, told Bert Brantley, Gov. Perdue’s press secretary. Gov. Perdue has proposed imposing additional fines on "super speeders," or drivers who are caught driving well above the speed limit, to help fund a trauma network.
From there, it was on to Lt. Gov. Casey Cagle’s office. "Grady is the people’s hospital," Chioke Perry, another Grady patient, said. "We need State support for the people’s hospital."
Lt. Gov. Cagle has also expressed support for funding a statewide trauma network with State dollars but has not offered specifics on how to do so.
The final stop was the office of Speaker of the House Glenn Richardson, who spoke Tuesday morning in the House of his determination to secure funding for a trauma care network.
Richardson proposed several weeks ago imposing a $10 annual fee on all vehicle registrations to support the network.
The speaker now appears more flexible on the funding issue when he said Tuesday he does not care how the funding occurs, just as long as it occurs, according to an Atlanta Journal-Constitution blog.
State Rep. Harry Geisinger (R-Roswell) has proposed a different kind of fee: a one dollar per month fee on all cell phones and land lines. Geisinger’s proposal, which has not been introduced and does not have a bill number, also includes a 10 percent tax to all disposable cell phones and a 10 percent tax on all minutes purchased on those phones.
Sen. Fort said there could be a bill that would impose a half cent sales tax to fund Grady but he is unsure who would introduce such a bill or when.
photo: Our Voices 2008
(APN) ATLANTA – About 50 members of the Grady Coalition delivered 10,000 signed petitions to the Georgia State Capitol Tuesday, January 15, 2008, urging State leaders to provide more funding for the Grady Health System.
"The central issue is making sure Grady gets the resources it needs as a regional hospital," State Sen. Vincent Fort (D-Atlanta) said during a press conference held before delivery of the petitions.
The Georgia General Assembly reconvened this week and so far, several lawmakers have proposed imposing a variety of fees to fund a statewide trauma care network. Sen. Fort said in addition to funding a statewide trauma care network, the General Assembly could consider many bills concerning Grady.
One bill, SR 722, introduced on January 17, 2008, by Sen. David Shafer (R-Duluth) would create a state-level Grady committee to oversee issues like funding, contract, and structure. It has 30 bipartisan cosponsors.
Another bill by Shafer, SB 353, would ban vendors and others with financial ties to Grady from leading it.The Grady Coalition is hoping the large volume of petitions will signal to lawmakers the desire of Georgians to see state funding for Grady.
"We have heard rumors they [State leaders] want to do the right thing," Rev. Timothy McDonald, of the First Iconium Baptist Church, said. "We hope and pray all these elected officials will support [Dr. Martin Luther King's] name…by passing legislation that supports Grady."
After the press conference, the Grady Coalition marched into the Capitol to deliver the petitions. Members visited Gov. Sonny Perdue’s office first.
"Grady is not just a place for people to get healed, it’s a place to transform," Hul-yah Yis-rael, a Grady patient, told Bert Brantley, Gov. Perdue’s press secretary. Gov. Perdue has proposed imposing additional fines on "super speeders," or drivers who are caught driving well above the speed limit, to help fund a trauma network.
From there, it was on to Lt. Gov. Casey Cagle’s office. "Grady is the people’s hospital," Chioke Perry, another Grady patient, said. "We need State support for the people’s hospital."
Lt. Gov. Cagle has also expressed support for funding a statewide trauma network with State dollars but has not offered specifics on how to do so.
The final stop was the office of Speaker of the House Glenn Richardson, who spoke Tuesday morning in the House of his determination to secure funding for a trauma care network.
Richardson proposed several weeks ago imposing a $10 annual fee on all vehicle registrations to support the network.
The speaker now appears more flexible on the funding issue when he said Tuesday he does not care how the funding occurs, just as long as it occurs, according to an Atlanta Journal-Constitution blog.
State Rep. Harry Geisinger (R-Roswell) has proposed a different kind of fee: a one dollar per month fee on all cell phones and land lines. Geisinger’s proposal, which has not been introduced and does not have a bill number, also includes a 10 percent tax to all disposable cell phones and a 10 percent tax on all minutes purchased on those phones.
Sen. Fort said there could be a bill that would impose a half cent sales tax to fund Grady but he is unsure who would introduce such a bill or when.
Grady Board Approves Lease, Despite Unmet Conditions
By Jonathan Springston - The Atlanta Progressive News - 1/30/2008
(APN) ATLANTA – The Fulton-DeKalb Hospital Authority (FDHA) approved in principle a lease agreement 8-1 Monday, January 28, 2008, that will transfer much of its current authority to the Grady Memorial Hospital Corporation (GMHC), a private, nonprofit governing board.
According to the Georgia Secretary of State’s website, Atlanta Progressive News can confirm that the GMHC has officially incorporated, although no officers have been yet appointed. Troutman-Sanders law firm is designated as the registered agent.
FDHA Member Geoffrey A. Heard voted no because he opposed the plan to shift management of Grady Hospital to a private entity in the first place. Chairwoman Pam Stephenson did not vote.
The process is far from over, as several conditions remain unfulfilled.
The Board, which will initially appoint the 16 members to the nonprofit corporation, did not do so Monday but could within a week.
Once those Board Members are chosen, they will have to approve the lease.
Attorney Lewis Horne, who worked on the lease, said Fulton and DeKalb County Commissioners must consent to the lease because each has bond agreements with the hospital.
But he noted both would only have a general consent, not a word-by-word consent, and it would be up to both to decide how to approve.
Fulton County Attorney Gerry Clark said he is recommending Commissioners hold a vote on the agreement.
PUBLIC REMAINS UNCONVINCED
The lease states the GMHC will continue Grady’s Mission as a charity hospital and its "major service lines," although it does not define what constitutes major service lines.
"If you leave it up to this new Board to define what major service lines are, you leave the door open to cuts," State Sen. Vincent Fort (D-Atlanta), a leader of the Grady Coalition, said.
Some citizens have been especially concerned the new Board could decide to close its dialysis centers and discontinue other services at Grady that are crucial for Atlanta’s indigent population.
"I have some unreadiness," Fort said. "How are we going to be sure as a community…that services won’t be cut?"
The lease specifies the GMHC must consult with the FDHA prior to cutting any major medical service lines, but an earlier draft of the lease was stronger. It had previously said the FDHA would essentially have veto power over any such cuts.
NO PUBLIC FEEDBACK
Stephenson promised on December 27, 2007, during two public hearings on the first draft of the lease to provide an advanced copy of a final draft before the FDHA voted on it.
Instead, the public received the final draft only minutes before the vote and there was no time allotted for public comment.
Fort called out the Board and requested the public be granted a new public hearing to discuss the final draft.
Trustees balked at the suggestion, but did allow some questions concerning the language of the lease after everyone had received a copy.
Horne said the agreement had gone through several drafts, with changes continuing all the way up until Monday’s meeting.
Those negotiations took place behind closed doors without input from the general public.
STIPULATIONS UNMET
There are several stipulations, not only in the lease agreement, but also in an earlier resolution by the FDHA, which remain unfulfilled.
The Board passed a resolution on November 26, 2007, that authorized the creation of a 501(c)(3) and the preparation of a funding and lease agreement.
However, it outlined several special conditions that must be met before the execution of the lease.
PRIVATE SUPPORT UNVERIFIED
The resolution calls for a written confirmation from the business community for a donation of $200 million for capital improvements to be paid out over four years.
The Metro Atlanta Chamber of Commerce has said for several weeks that an anonymous donor is willing to make a $200 million donation only after Grady makes the transition to a nonprofit.
The identity of that donor remains a mystery and it is unclear if a written confirmation has been provided or if said donor will follow through on his promise.
The resolution also called on the business community to provide written confirmation that they will undertake a campaign to raise another $100 million in private donations over three years.
It is unclear if that confirmation has been provided in writing or if the business community will indeed engage in such a campaign.
The lease agreement states that, as part of a separate funding agreement, the GHMC will be responsible for securing both the $200 million and a commitment to a $100 million fundraising campaign from the business community.
The Chamber has been leading the way in transforming Grady’s management structure and made it clear that money would only arrive to the troubled health system if the FDHA agreed to relinquish control to a 501(c)(3).
STATE SUPPORT UNRESOLVED
The resolution states that the Governor, Lieutenant Governor, and Speaker of the House must each provide written confirmations of their intent to support legislation that would not only secure an additional $30 million in annual funding but also funding for a statewide trauma network.
Each official has stated, like the Chamber, that Georgia would only agree to give Grady additional money after the FDHA turned over control to a 501(c)(3).
The Georgia General Assembly is considering several pieces of legislation concerning Grady this session, including HB 973, which would provide funding for a statewide trauma network through the imposition of a small tax on all telephone and wireless service subscribers.
While this legislation could generate funds for Grady’s Level I trauma center, there is no legislation currently before lawmakers that would give the hospital $30 million in direct, state financial assistance.
EMORY, MOREHOUSE NEGOTIATIONS NOT AGREED TO
As part of the funding agreement, the GMHC must secure from the Medical Schools at Emory University and Morehouse College a commitment to renegotiate outstanding obligations owed by Grady to the schools and the existing medical school contracts.
The resolution said Emory and Morehouse should provide written confirmations to the FDHA concerning these points.
While both schools have publicly expressed willingness to enter into some kind of negotiations, it is unclear how far either school is willing to negotiate or if either has provided written confirmations of their intent.
IRS DETERMINATION OF TAX EXEMPTION UNGRANTED
The GHMC has yet to file Form 1023 requesting the Internal Revenue Service of the US recognize the GMHC as a tax- exempt organization. Atlanta Progressive News called and sent emails to the FDHA and Troutman Sanders law firm regarding this matter, and were told by Mr. Horne on January 7, 2008, the forms have not yet been submitted.
The form requires the organization to provide detailed information on its funding, governance structure, operations, and must show no private partners or other entities are making private gain off of the organization, in order for it to meet tax-exempt criteria adopted by US Congress. It is unclear whether the GMHC decided on enough of those issues to be ready to submit such an application.
The IRS must provide this written determination before the lease can take effect. Horne said that form has yet to be filed on behalf of the GMHC and does not know how long it would take the IRS to provide the determination.
About the author:
Jonathan Springston is a Senior Staff Writer for Atlanta Progressive News and may be reached at jonathan@atlantaprogressivenews.com.
(APN) ATLANTA – The Fulton-DeKalb Hospital Authority (FDHA) approved in principle a lease agreement 8-1 Monday, January 28, 2008, that will transfer much of its current authority to the Grady Memorial Hospital Corporation (GMHC), a private, nonprofit governing board.
According to the Georgia Secretary of State’s website, Atlanta Progressive News can confirm that the GMHC has officially incorporated, although no officers have been yet appointed. Troutman-Sanders law firm is designated as the registered agent.
FDHA Member Geoffrey A. Heard voted no because he opposed the plan to shift management of Grady Hospital to a private entity in the first place. Chairwoman Pam Stephenson did not vote.
The process is far from over, as several conditions remain unfulfilled.
The Board, which will initially appoint the 16 members to the nonprofit corporation, did not do so Monday but could within a week.
Once those Board Members are chosen, they will have to approve the lease.
Attorney Lewis Horne, who worked on the lease, said Fulton and DeKalb County Commissioners must consent to the lease because each has bond agreements with the hospital.
But he noted both would only have a general consent, not a word-by-word consent, and it would be up to both to decide how to approve.
Fulton County Attorney Gerry Clark said he is recommending Commissioners hold a vote on the agreement.
PUBLIC REMAINS UNCONVINCED
The lease states the GMHC will continue Grady’s Mission as a charity hospital and its "major service lines," although it does not define what constitutes major service lines.
"If you leave it up to this new Board to define what major service lines are, you leave the door open to cuts," State Sen. Vincent Fort (D-Atlanta), a leader of the Grady Coalition, said.
Some citizens have been especially concerned the new Board could decide to close its dialysis centers and discontinue other services at Grady that are crucial for Atlanta’s indigent population.
"I have some unreadiness," Fort said. "How are we going to be sure as a community…that services won’t be cut?"
The lease specifies the GMHC must consult with the FDHA prior to cutting any major medical service lines, but an earlier draft of the lease was stronger. It had previously said the FDHA would essentially have veto power over any such cuts.
NO PUBLIC FEEDBACK
Stephenson promised on December 27, 2007, during two public hearings on the first draft of the lease to provide an advanced copy of a final draft before the FDHA voted on it.
Instead, the public received the final draft only minutes before the vote and there was no time allotted for public comment.
Fort called out the Board and requested the public be granted a new public hearing to discuss the final draft.
Trustees balked at the suggestion, but did allow some questions concerning the language of the lease after everyone had received a copy.
Horne said the agreement had gone through several drafts, with changes continuing all the way up until Monday’s meeting.
Those negotiations took place behind closed doors without input from the general public.
STIPULATIONS UNMET
There are several stipulations, not only in the lease agreement, but also in an earlier resolution by the FDHA, which remain unfulfilled.
The Board passed a resolution on November 26, 2007, that authorized the creation of a 501(c)(3) and the preparation of a funding and lease agreement.
However, it outlined several special conditions that must be met before the execution of the lease.
PRIVATE SUPPORT UNVERIFIED
The resolution calls for a written confirmation from the business community for a donation of $200 million for capital improvements to be paid out over four years.
The Metro Atlanta Chamber of Commerce has said for several weeks that an anonymous donor is willing to make a $200 million donation only after Grady makes the transition to a nonprofit.
The identity of that donor remains a mystery and it is unclear if a written confirmation has been provided or if said donor will follow through on his promise.
The resolution also called on the business community to provide written confirmation that they will undertake a campaign to raise another $100 million in private donations over three years.
It is unclear if that confirmation has been provided in writing or if the business community will indeed engage in such a campaign.
The lease agreement states that, as part of a separate funding agreement, the GHMC will be responsible for securing both the $200 million and a commitment to a $100 million fundraising campaign from the business community.
The Chamber has been leading the way in transforming Grady’s management structure and made it clear that money would only arrive to the troubled health system if the FDHA agreed to relinquish control to a 501(c)(3).
STATE SUPPORT UNRESOLVED
The resolution states that the Governor, Lieutenant Governor, and Speaker of the House must each provide written confirmations of their intent to support legislation that would not only secure an additional $30 million in annual funding but also funding for a statewide trauma network.
Each official has stated, like the Chamber, that Georgia would only agree to give Grady additional money after the FDHA turned over control to a 501(c)(3).
The Georgia General Assembly is considering several pieces of legislation concerning Grady this session, including HB 973, which would provide funding for a statewide trauma network through the imposition of a small tax on all telephone and wireless service subscribers.
While this legislation could generate funds for Grady’s Level I trauma center, there is no legislation currently before lawmakers that would give the hospital $30 million in direct, state financial assistance.
EMORY, MOREHOUSE NEGOTIATIONS NOT AGREED TO
As part of the funding agreement, the GMHC must secure from the Medical Schools at Emory University and Morehouse College a commitment to renegotiate outstanding obligations owed by Grady to the schools and the existing medical school contracts.
The resolution said Emory and Morehouse should provide written confirmations to the FDHA concerning these points.
While both schools have publicly expressed willingness to enter into some kind of negotiations, it is unclear how far either school is willing to negotiate or if either has provided written confirmations of their intent.
IRS DETERMINATION OF TAX EXEMPTION UNGRANTED
The GHMC has yet to file Form 1023 requesting the Internal Revenue Service of the US recognize the GMHC as a tax- exempt organization. Atlanta Progressive News called and sent emails to the FDHA and Troutman Sanders law firm regarding this matter, and were told by Mr. Horne on January 7, 2008, the forms have not yet been submitted.
The form requires the organization to provide detailed information on its funding, governance structure, operations, and must show no private partners or other entities are making private gain off of the organization, in order for it to meet tax-exempt criteria adopted by US Congress. It is unclear whether the GMHC decided on enough of those issues to be ready to submit such an application.
The IRS must provide this written determination before the lease can take effect. Horne said that form has yet to be filed on behalf of the GMHC and does not know how long it would take the IRS to provide the determination.
About the author:
Jonathan Springston is a Senior Staff Writer for Atlanta Progressive News and may be reached at jonathan@atlantaprogressivenews.com.
Emma Darnell Will Vote "No" for Grady Lease Agreement
PRESS RELEASE REGARDING THE GRADY LEASE AGREEMENT
FROM:Commissioner Emma Darnell Fulton County Board of Commissioners
If the subject draft Lease Agreement is presented to the Board of Commissioners on Wednesday, February 20, I will vote no.
My accountability to the residents of Fulton County is not limited to medical schools and their sponsors. Fulton County has invested millions in the support of quality health care services for indigent and charity residents of Fulton County. In 2007, expenditures for Grady Hospital including debt service and malpractice insurance exceeded $103 million dollars.
We are legally and morally required to provide oversight to the standard of care and the cost of health services at Grady. We cannot delegate to a private group no matter how well—intentioned the authority and responsibility to decide who lives and who dies at Grady.
We need state and federal support for Grady. We need a change in the ITCF (DSH) formula. We need state funding for trauma care. We need state legislation to establish a regional system of funding for Grady Hospital to include all counties whose residents receive primary care services at Grady.
We need a better understanding of the story of the “Good Samaritan.” The point is to “rescue” the man by the side of the road —not rob him again.
FROM:Commissioner Emma Darnell Fulton County Board of Commissioners
If the subject draft Lease Agreement is presented to the Board of Commissioners on Wednesday, February 20, I will vote no.
My accountability to the residents of Fulton County is not limited to medical schools and their sponsors. Fulton County has invested millions in the support of quality health care services for indigent and charity residents of Fulton County. In 2007, expenditures for Grady Hospital including debt service and malpractice insurance exceeded $103 million dollars.
We are legally and morally required to provide oversight to the standard of care and the cost of health services at Grady. We cannot delegate to a private group no matter how well—intentioned the authority and responsibility to decide who lives and who dies at Grady.
We need state and federal support for Grady. We need a change in the ITCF (DSH) formula. We need state funding for trauma care. We need state legislation to establish a regional system of funding for Grady Hospital to include all counties whose residents receive primary care services at Grady.
We need a better understanding of the story of the “Good Samaritan.” The point is to “rescue” the man by the side of the road —not rob him again.
Fulton County Consents to Grady Hospital Lease Agreement
By Jonathan Springston - The Atlanta Progressive News - 2/20/2008
(APN) ATLANTA – The Fulton County Board of Commissioners approved a resolution Wednesday, February 20, 2008, consenting to the lease and transfer agreement by and between the Fulton-DeKalb Hospital Authority (FDHA) and the Grady Memorial Hospital Corporation.
The lease, approved by the FDHA in January 2008, would hand daily operations of Grady over to a 501(c)(3) led by community and business leaders. As Atlanta Progressive News previously reported, the lease was approved even though a number of conditions set by the FDHA in their original privatization resolution have not been met.
Fulton County’s approval brings the process one step closer to completion. The DeKalb County Board of Commissioners will vote next week. Both counties would have to approve the lease in order for it to go forward because each has bond agreements with Grady, providing about $100 million annually.
Fulton Commissioners spent one hour Wednesday debating the lease, which they had only received in the last 24 hours.
"There is not one CEO who would move forward with a 40 year lease with as little information as we have in front of us today," Commissioner Robb Pitts said.
Despite this statement, Pitts voted to approve the agreement anyway, along with fellow commissioners John Eaves, Tom Lowe, Nancy Boxill, and Lynne Riley.
Commissioners Emma Darnell and Bill Edwards voted no. Darnell made up her mind before Wednesday’s meeting, releasing a statement Tuesday explaining her decision.
"We are legally and morally required to provide oversight to the standard of care and the cost of health services at Grady,” she said. “We cannot delegate to a private group no matter how well-intentioned the authority and responsibility to decide who lives and who dies at Grady."
Darnell added Wednesday the need for the State to provide regional Grady funding that includes all Georgia counties whose residents receive primary care at the hospital.
State leaders and anonymous members of Atlanta’s business community have promised to deliver millions of dollars in relief to Grady on the condition the hospital transfer its power to a private, nonprofit corporation.
According to proponents of privatization, business leaders have said that they will also undertake a “best efforts” campaign to raise even more money for Grady upon the change.
Despite these promises, it is unclear if anyone will truly follow through, a point made by Pitts Wednesday.
"You can call a press conference saying you’re going to raise $100 million and not raise a dime," he said.
The Georgia General Assembly is considering a number of bills on Grady this session, including HB 973, the "Georgia Trauma Hospital Support Act of 2008."
That bill would levy a small telephone tax on all Georgians and that money would be used to fund a statewide trauma network.
But State leaders are growing impatient as the process drags on and political pressure is growing.
Fulton’s vote comes one day after State Rep. Mike Jacobs (R-Atlanta) introduced a bill that would force Grady to make the change to a nonprofit management structure.
Jacobs’s bill would authorize a citizen or the State Attorney General to take legal action to force the change. In addition, it also threatens to remove the FDHA and take away trauma care funding.
DeKalb County Commissioners Larry Johnson and Connie Stokes will attend a public information meeting Thursday to discuss the proposed lease. All members of the public are invited to attend the meeting at the Manuel Maloof Auditorium in Decatur at 6:30 p.m.
DeKalb will most likely vote on the agreement at its next meeting on February 26, 2008.
(APN) ATLANTA – The Fulton County Board of Commissioners approved a resolution Wednesday, February 20, 2008, consenting to the lease and transfer agreement by and between the Fulton-DeKalb Hospital Authority (FDHA) and the Grady Memorial Hospital Corporation.
The lease, approved by the FDHA in January 2008, would hand daily operations of Grady over to a 501(c)(3) led by community and business leaders. As Atlanta Progressive News previously reported, the lease was approved even though a number of conditions set by the FDHA in their original privatization resolution have not been met.
Fulton County’s approval brings the process one step closer to completion. The DeKalb County Board of Commissioners will vote next week. Both counties would have to approve the lease in order for it to go forward because each has bond agreements with Grady, providing about $100 million annually.
Fulton Commissioners spent one hour Wednesday debating the lease, which they had only received in the last 24 hours.
"There is not one CEO who would move forward with a 40 year lease with as little information as we have in front of us today," Commissioner Robb Pitts said.
Despite this statement, Pitts voted to approve the agreement anyway, along with fellow commissioners John Eaves, Tom Lowe, Nancy Boxill, and Lynne Riley.
Commissioners Emma Darnell and Bill Edwards voted no. Darnell made up her mind before Wednesday’s meeting, releasing a statement Tuesday explaining her decision.
"We are legally and morally required to provide oversight to the standard of care and the cost of health services at Grady,” she said. “We cannot delegate to a private group no matter how well-intentioned the authority and responsibility to decide who lives and who dies at Grady."
Darnell added Wednesday the need for the State to provide regional Grady funding that includes all Georgia counties whose residents receive primary care at the hospital.
State leaders and anonymous members of Atlanta’s business community have promised to deliver millions of dollars in relief to Grady on the condition the hospital transfer its power to a private, nonprofit corporation.
According to proponents of privatization, business leaders have said that they will also undertake a “best efforts” campaign to raise even more money for Grady upon the change.
Despite these promises, it is unclear if anyone will truly follow through, a point made by Pitts Wednesday.
"You can call a press conference saying you’re going to raise $100 million and not raise a dime," he said.
The Georgia General Assembly is considering a number of bills on Grady this session, including HB 973, the "Georgia Trauma Hospital Support Act of 2008."
That bill would levy a small telephone tax on all Georgians and that money would be used to fund a statewide trauma network.
But State leaders are growing impatient as the process drags on and political pressure is growing.
Fulton’s vote comes one day after State Rep. Mike Jacobs (R-Atlanta) introduced a bill that would force Grady to make the change to a nonprofit management structure.
Jacobs’s bill would authorize a citizen or the State Attorney General to take legal action to force the change. In addition, it also threatens to remove the FDHA and take away trauma care funding.
DeKalb County Commissioners Larry Johnson and Connie Stokes will attend a public information meeting Thursday to discuss the proposed lease. All members of the public are invited to attend the meeting at the Manuel Maloof Auditorium in Decatur at 6:30 p.m.
DeKalb will most likely vote on the agreement at its next meeting on February 26, 2008.
New Grady Coalition Wants Tom Bell Off the Grady Board
4/3/2008 - Footage shot outisde of Crawford Long Hospital, Atlanta, Georgia.
Police Tackle State Senator Fort, Others before Grady Privatization Vote
By Jonathan Springston, Senior Staff Writer - The Atlanta Progressive News - 11-26-07
This article contains additional reporting by Matthew Cardinale, News Editor
(APN) ATLANTA – Atlanta Police officers physically wrangled with State Sen. Vincent Fort (D-Atlanta), former Atlanta City Councilman Derrick Boazman, and two other activists, during a confrontation with protesters shortly before the 10-member Fulton-Dekalb Hospital Authority unanimously approved a resolution to privatize Grady Hospital.
Officers pushed Fort up against a wall and handcuffed him. They tackled Boazman to the ground and dragged him down a hallway. Boazman’s arm and wrist were hurt in the incident.
"We literally were in hand and hand combat. You had a female officer just grabbing my arm and snatching me and I told her that was not even necessary. People literally went berserk when they saw me in handcuffs and them taking me down some back hallway," Boazman told Atlanta Progressive News.
Boazman said he watched as a third activist, Fort’s niece-in-law, was attacked by one officer. As he was being tackled to the ground, he saw "them trying to put this... baton around this girl's neck, and I said take that baton from off her neck. I told her take her damn hands off the girl. And none of the officers were trying to restrain her. When I said that everyone just froze up," Boazman said.
A fourth person was escorted out by police, Fort said.
"They beat me down, cussed me down. It's a police state. What they were doing is using brute force to keep people from the meeting. It was a public meeting, and they were willing to use brute force. The question is, what did they have to hide?” Fort told Atlanta Progressive News.
"It's kind of a fascist move. I'm not surprised at what people will do to keep power. I'm not surprised of the evil men will do," Fort said.
The Hospital Authority’s resolution will, among other actions, create a nonprofit corporation to take over the Hospital, much to the dismay of hundreds of citizens present for the vote.
But even angry public denunciations and demonstrations could not stem the Chamber of Commerce’s push, which–with the support of the Atlanta Journal-Constitution editorial board, Emory University, and Morehouse Colleges–created the appearance of an inevitable tide towards privatization.
Yet Authority Members sought to deflect responsibility for their votes.
"In three weeks, our cash position would have been zero," Vice Chairman Christopher Edwards said. "You have to make the best decisions you can."
"It may not be the best resolution but this is the only thing that can keep the doors open," Member Thomas Dortch said. "Don’t blame us. If folks don’t put money on the table, it’s not going to happen. Don’t convict us."
The Grady Memorial Hospital Corporation would be a tax-exempt 501(c)(3) corporation with a 17-member Board to govern Grady Memorial Hospital.
The Corporation will consist of at least four members from the current Authority. The Authority Chairperson will appoint the other members. It is unclear whom those other members will be or from what professions or circumstances they will come.
The Authority will still exist to retain ownership of the real estate and the Authority must give its consent "for any significant curtailment of the current major service lines or historic mission of Grady Hospital."
Creation of a nonprofit corporation comes with other special conditions. Members of the business, charitable, and philanthropic community must provide a written commitment to deliver at least $200 million in capital funds.
Unnamed members of the business community are said to have already promised to deliver $200 million to Grady upon the change to a 501(c)(3), as well as to engage in a fundraising campaign to raise an additional $100 million, which must also be confirmed in writing.
The Authority and Corporation must also prepare, execute, and deliver a lease agreement "in order to lease certain assets of the [Grady Health] System to the Corporation, which will assume certain liabilities of the System."
The resolution goes on to say, "The lease agreement would only be executed after completion of the statutorily required public hearings scheduled for Dec. 27, 2007, and no later than Dec. 31, 2007."
The business community would make a payment of no less than $50 million in cash or in escrow on or before the execution of the lease agreement. This would mark the first installment of a four-year payment plan for the $200 million.
The resolution urges the State of Georgia to enact legislation that would appropriate $30 million annually to Grady and to take measures to fund the Statewide Trauma Network.
Emory and Morehouse medical schools must provide written confirmation to the Authority of their commitment to continue training doctors at Grady, willingness to negotiate with the Authority to restructure all outstanding obligations owed by Grady, and willingness to renegotiate current contracts between the parties.
The Authority wants this confirmation no later than the execution and delivery of the lease agreement.
A DRAMATIC AFTERNOON
Several dozen protestors with the Grady Coalition, American Federation of State, County, and Municipal Employees (AFSCME), and other groups rallied in front of Grady earlier in the day to denounce any move to create a nonprofit corporation.
When these protestors moved into the hospital with the intent of letting their voice be heard at the Authority meeting, security did not allow them in.
Grady security officers informed those gathered that the Authority was holding its Executive Session and that the public was not allowed in.
Protestors were forced to wait over an hour and a half in two separate corridors until 3:30 p.m., the scheduled start time.
When that time passed and protestors had still not gained access, tempers began to boil over.
Fort and Boazman apparently tried to barge into the Authority’s session and that’s when they were subsequently physically handled by security. Protestors howled their disapproval.
After prolonged shouting matches and more waiting, word came around 4 p.m. the meeting would be moved to the Steiner Auditorium across the street so that everyone could attend.
Forty-five minutes after the meeting should have started, Chairwoman Pam Stephenson brought the session to order.
Members dealt with other business before Lewis Horne, an attorney with the Troutman Sanders law firm, read the resolution.
When no member had anything to say, the Authority was ready to vote. The audience shouted in disgust and demanded the public be allowed to speak before the vote.
Just when it seemed a riot might break out, Stephenson finally allowed a comment period and for the next hour and a half, citizens peppered the Authority with harsh criticisms.
"We didn’t come this far to have Uncle Toms sell out the least of these," Boazman, who in addition to Fort was allowed back in for the hearing, said.
"The State of Georgia created this problem," Rev. Tim McDonald, of the First Iconium Baptist Church, said. "This is extortion. The Chamber of Commerce is guilty of extortion. You didn’t create this problem."
"Who are they?" Nancy Lenk, deputy director of AFSCME Local 1644, asked. "We don’t even know the names of the people we’re signing the hospital away to."
About the author:
Jonathan Springston is a Senior Staff Writer for Atlanta Progressive News and may be reached at jonathan@atlantaprogressivenews.com
This article contains additional reporting by Matthew Cardinale, News Editor
(APN) ATLANTA – Atlanta Police officers physically wrangled with State Sen. Vincent Fort (D-Atlanta), former Atlanta City Councilman Derrick Boazman, and two other activists, during a confrontation with protesters shortly before the 10-member Fulton-Dekalb Hospital Authority unanimously approved a resolution to privatize Grady Hospital.
Officers pushed Fort up against a wall and handcuffed him. They tackled Boazman to the ground and dragged him down a hallway. Boazman’s arm and wrist were hurt in the incident.
"We literally were in hand and hand combat. You had a female officer just grabbing my arm and snatching me and I told her that was not even necessary. People literally went berserk when they saw me in handcuffs and them taking me down some back hallway," Boazman told Atlanta Progressive News.
Boazman said he watched as a third activist, Fort’s niece-in-law, was attacked by one officer. As he was being tackled to the ground, he saw "them trying to put this... baton around this girl's neck, and I said take that baton from off her neck. I told her take her damn hands off the girl. And none of the officers were trying to restrain her. When I said that everyone just froze up," Boazman said.
A fourth person was escorted out by police, Fort said.
"They beat me down, cussed me down. It's a police state. What they were doing is using brute force to keep people from the meeting. It was a public meeting, and they were willing to use brute force. The question is, what did they have to hide?” Fort told Atlanta Progressive News.
"It's kind of a fascist move. I'm not surprised at what people will do to keep power. I'm not surprised of the evil men will do," Fort said.
The Hospital Authority’s resolution will, among other actions, create a nonprofit corporation to take over the Hospital, much to the dismay of hundreds of citizens present for the vote.
But even angry public denunciations and demonstrations could not stem the Chamber of Commerce’s push, which–with the support of the Atlanta Journal-Constitution editorial board, Emory University, and Morehouse Colleges–created the appearance of an inevitable tide towards privatization.
Yet Authority Members sought to deflect responsibility for their votes.
"In three weeks, our cash position would have been zero," Vice Chairman Christopher Edwards said. "You have to make the best decisions you can."
"It may not be the best resolution but this is the only thing that can keep the doors open," Member Thomas Dortch said. "Don’t blame us. If folks don’t put money on the table, it’s not going to happen. Don’t convict us."
The Grady Memorial Hospital Corporation would be a tax-exempt 501(c)(3) corporation with a 17-member Board to govern Grady Memorial Hospital.
The Corporation will consist of at least four members from the current Authority. The Authority Chairperson will appoint the other members. It is unclear whom those other members will be or from what professions or circumstances they will come.
The Authority will still exist to retain ownership of the real estate and the Authority must give its consent "for any significant curtailment of the current major service lines or historic mission of Grady Hospital."
Creation of a nonprofit corporation comes with other special conditions. Members of the business, charitable, and philanthropic community must provide a written commitment to deliver at least $200 million in capital funds.
Unnamed members of the business community are said to have already promised to deliver $200 million to Grady upon the change to a 501(c)(3), as well as to engage in a fundraising campaign to raise an additional $100 million, which must also be confirmed in writing.
The Authority and Corporation must also prepare, execute, and deliver a lease agreement "in order to lease certain assets of the [Grady Health] System to the Corporation, which will assume certain liabilities of the System."
The resolution goes on to say, "The lease agreement would only be executed after completion of the statutorily required public hearings scheduled for Dec. 27, 2007, and no later than Dec. 31, 2007."
The business community would make a payment of no less than $50 million in cash or in escrow on or before the execution of the lease agreement. This would mark the first installment of a four-year payment plan for the $200 million.
The resolution urges the State of Georgia to enact legislation that would appropriate $30 million annually to Grady and to take measures to fund the Statewide Trauma Network.
Emory and Morehouse medical schools must provide written confirmation to the Authority of their commitment to continue training doctors at Grady, willingness to negotiate with the Authority to restructure all outstanding obligations owed by Grady, and willingness to renegotiate current contracts between the parties.
The Authority wants this confirmation no later than the execution and delivery of the lease agreement.
A DRAMATIC AFTERNOON
Several dozen protestors with the Grady Coalition, American Federation of State, County, and Municipal Employees (AFSCME), and other groups rallied in front of Grady earlier in the day to denounce any move to create a nonprofit corporation.
When these protestors moved into the hospital with the intent of letting their voice be heard at the Authority meeting, security did not allow them in.
Grady security officers informed those gathered that the Authority was holding its Executive Session and that the public was not allowed in.
Protestors were forced to wait over an hour and a half in two separate corridors until 3:30 p.m., the scheduled start time.
When that time passed and protestors had still not gained access, tempers began to boil over.
Fort and Boazman apparently tried to barge into the Authority’s session and that’s when they were subsequently physically handled by security. Protestors howled their disapproval.
After prolonged shouting matches and more waiting, word came around 4 p.m. the meeting would be moved to the Steiner Auditorium across the street so that everyone could attend.
Forty-five minutes after the meeting should have started, Chairwoman Pam Stephenson brought the session to order.
Members dealt with other business before Lewis Horne, an attorney with the Troutman Sanders law firm, read the resolution.
When no member had anything to say, the Authority was ready to vote. The audience shouted in disgust and demanded the public be allowed to speak before the vote.
Just when it seemed a riot might break out, Stephenson finally allowed a comment period and for the next hour and a half, citizens peppered the Authority with harsh criticisms.
"We didn’t come this far to have Uncle Toms sell out the least of these," Boazman, who in addition to Fort was allowed back in for the hearing, said.
"The State of Georgia created this problem," Rev. Tim McDonald, of the First Iconium Baptist Church, said. "This is extortion. The Chamber of Commerce is guilty of extortion. You didn’t create this problem."
"Who are they?" Nancy Lenk, deputy director of AFSCME Local 1644, asked. "We don’t even know the names of the people we’re signing the hospital away to."
About the author:
Jonathan Springston is a Senior Staff Writer for Atlanta Progressive News and may be reached at jonathan@atlantaprogressivenews.com
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