Healthcare

Georgia Health Marketplace and the Healthcare Safety Net

The goal of the Georgia Health Marketplace (GHM) is to put healthcare decisions back into the hands of consumers through the creation a healthcare clearinghouse. Multiple insurers will be represented and will provide a strong, competitive market to individuals and small business owners. This streamlined system coupled with newly offered products along with the portability of the products will produce real savings for the consumer.

The Problem: Individuals who work for businesses that do not provide insurance are unable to purchase coverage with pre-tax dollars. Additionally, not only is it difficult obtaining private health insurance, but many don’t have the time to learn the ins and outs of the complex maze of the insurance market.

The Solution: The best healthcare solutions rely on educated consumers making informed choices in a free-market system. The GHM will help consumers choose between policies and purchase them with pre-tax dollars. Additionally, consumers want a health care product they can take with them from job to job and this program would allow for that flexibility and will be easily accessible on a one-stop-shop website.

Five categories of healthcare products will be offered:

Traditional Health Insurance – Any plan that meets the current standards for sale in our state
Physician Direct – An innovative category which would allow physician groups or hospitals to directly market to consumers with a set array of medical services at a fixed annual cost. By going directly to consumers, services would be offered at more competitive rates. These bundled non-catastrophic needs would ideally be combined with catastrophic coverage.
GeorgiaHIP – The recently announced plan by the Department of Community Health would be available as a purchase option for small business owners with 50 or less employees.
PeachCare for Kids – Georgia’s PeachCare for kids program would also be eligible for enrollment through GHM to those who qualify.
Catastrophic Health Insurance – A new plan for true catastrophic insurance with minimal mandates and high deductibles at a low monthly cost. Ideally paired with coverage plans or Health Savings Accounts.

The GHM will be operated by a Marketplace Authority that will manage the day-to-day operation, issue rules and regulations and approve marketing contracts.

Enhancing the Healthcare Safety Net

The goal of the Safety Net Program is to provide accessible and affordable clinics to serve the healthcare needs of indigent patients. Oftentimes, basic healthcare needs go unmet or if they are met, are coupled with a very costly visit to the emergency room.

The Problem:1.7 million Georgians are uninsured and that number continues to rise. Often, uninsured patients resort to expensive emergency room care in cases where the condition could easily be treated in a clinic environment. The number one treated condition in Georgia’s emergency rooms last year was an upper respiratory infection – in many cases a common cold - at a cost of $33 million.

The Solution: Instead of using emergency rooms as primary care providers, we should be investing in primary care clinics that can offer treatment for commonly diagnosed conditions. Safety Net Partnership Grants will be made available for five pilot Safety Net clinics to serve indigent patients. Grants will be offered on a competitive basis to applicants that demonstrate a robust public-private partnership between a physician group, urgent care clinic, county medical association or hospital and a county health department or federally qualified health center.

Clinical services will be selected from among the top 25 conditions most often seen in emergency rooms as well as chronic disease treatment and prevention services. Physicians in our state will be incentivized to volunteer their time through income tax deductions. Funding will come largely from existing indigent care dollars.

Common Emergency Room Conditions Treated:

Upper Respiratory Infection
Sore Throat
Digestive Problem
Headache
Earache

Over 20,000 Georgians visited the emergency room last year for dental problems

Patients utilizing the program would be required to sign a waiver certifying that they earn less than 300% of the poverty level and falsifying information would carry legal penalties. Additionally, patients will participate in their care by paying an affordable co-pay based on income in order to access the SafetyNet clinic.

Associated Document(s):

	Press Association Speech 8-23-07.doc

	The Future of HealthCare in Georgia.ppt
	Power Point presentation given by the Lt. Governor on September 25.