Thursday, February 12, 2004


While driving in to work today from the gym (more on that later) I was listening to the Georgia Public Radio news broadcast about how Georgia Medicaid is going to go broke this spring:

Georgia's Medicaid program will run out of money in May unless it can recoup an estimated $400 million in overpayments to hospitals and other medical providers. Our backs are against the wall," Tim Burgess, commissioner of the Department of Community Health, told an agency board meeting Wednesday. "The option is to run out of cash."

The dire cash situation exists despite the expected infusion of $172.8 million from the General Assembly, and anticipated federal funding.

Greedy doctors to blame, you say? It's their fault!! How dare they rip off the state to the tune of $400 million!! Well the situation is largely of Georgia Medicaid's own making:

The payment discrepancies came as a result of claims snags starting in April 2003, when a new computer system run by Texas-based Affiliated Computer Services took over Medicaid billing.

Because most medical bills weren't being paid then, the state began paying providers an amount based on their billings in the previous year. Now, DCH has estimated that the state paid providers about $700 million more than the same period the previous year.

As I posted in August this involved sending checks to providers without any indication of which patient the money was for. It was several months before we were able to reconcile accounts. The amount the state wants back from the Acme Surgical Corp: $15,000 a month. While that won't reduce us to eating ramen soup for three meals a day, it certainly isn't a good thing.

It's not like no one saw it coming, according to the November 10th Atlanta Journal-Constitution:

A last-minute deal that balanced this year's state budget and funded pet local projects could leave Georgia's health care program for the poor and disabled short of money to pay bills by the spring.

The state's Medicaid program may need a quick infusion of money during the upcoming 2004 session of the Georgia General Assembly because $148 million was cut from its budget as part of an agreement to help balance the state's $16 billion spending plan.

What frightens me about this is what if Medicaid (i.e. the government) was the only game in town? As it is now, we at least have the private insurance population to ensure that we can get some income. But what if such a budget crisis were to occur under a single-payer system? What would happen then? Would the legislature have the political will to raise taxes? At first glance not likely:

The money originally was proposed by Perdue in January to help pay for Medicaid health care services this fiscal year, which began July 1. Channell said it was cut out by Perdue's administration to help balance the budget. The administration pointed the finger at lawmakers.

"The governor's budget left that money in. The reality is, the legislators took it and used it to fund a variety of their pet projects," said Dan McLagan, the governor's spokesman.

Lawmakers added more than $20 million in local projects, including money for a museum in the hometown of the House Appropriations Chairman Tom Buck (D-Columbus); seed money for a housing project in the hometowns of other House leaders; and bond money for construction projects in the districts of Senate Appropriations Chairman Jack Hill (R-Reidsville) and Sen. Don Cheeks (R-Augusta), one of the budget negotiators.

While Graham and I do not agree on the single-payer question, I agree with the point made in this post that the question is not if we CAN do it, but do we WANT to do it. Which is about the same as realty doesn't matter, but the perception of reality does.
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