Saving PeachCare and Thoughts on ER Visits
I believe that few things are more deserving of our state’s resources than providing healthcare to children in need. The PeachCare program has been a remarkable success. At any given time, it provides affordable healthcare coverage to over 250,000 children in Georgia whose family income falls at or below 235% of the federal poverty level. Using 2007 statistics, that means a family of two parents and two children at 200% of the federal poverty level make approximately $41,300 per year as a household. Under the PeachCare program, this same family only had to pay $56 a month in insurance premiums for those two children. Additionally, families are not asked to pay premiums for children under six years of age.
These are hard working Georgia families that have trouble making ends meet and providing their children of quality healthcare at the same time. I have been a tireless advocate for this program and wholeheartedly believe in its mission.
As you can imagine, large healthcare programs like these are awfully expensive and take up a significant proportion of our state healthcare budget. But is it really in our state’s best interest to sacrifice the health of our children – especially those of lower income families – by removing thousands of children from PeachCare’s rolls? With too many Georgians already receiving much of their healthcare from the emergency room, at an alarmingly high cost to taxpayers, is it a responsible use of tax dollars to take away a child’s health privileges that may ultimately cause them to loose both access to preventive care and the attention of a primary care physician?
As state leaders, it is up to us to properly identify waste in government and eliminate it. Likewise, we must also identify those programs that are essential, like PeachCare, and find reasonable ways to salvage them.
Last year, I was proud to create a Senate PeachCare task force. This five member team came up with several scenarios that could keep this program alive amidst the fear of a reduction in federal matching funds.
After days of consultation with healthcare professionals, CMO’s, state officials, and others, the Senate Task Force proposed a solution that both saved the state $76 million dollars with minimal sacrifice to working families.
The task force proposed adopting a uniform premium set at 1.5% of income, and instituting a $25 co-payment for emergency room visits to encourage patients to seek more affordable treatment options for non-emergency problems. Keeping with our family of four example above, this family would now be asked to pay a monthly premium of only $61 (compared to $56 they pay currently).
One of the most common sense, yet affective portions of this proposal deals with emergency room co-pays. The number one ailment treated in Georgia’s emergency rooms is an “upper respiratory concern”, which is also known as “a cold”. An individual can receive treatment for a cold at their primary care physician for approximately $100. Yet in an emergency room setting, this “upper respiratory concern” costs approximately $14oo per visit. As hospitals absorb costs like this on a daily basis, they are forced to shift these costs onto you and me as consumers. In fact, it has been estimated that non-emergent ER visit cost as much as $33 million annually in Georgia. That is a staggering figure.
To address this concern, the senate proposed a $25 co-pay for PeachCare enrollees for each emergency room visit. This move would not only generate revenue for the PeachCare program but could potentially act as a deterrent for those who continue using the emergency room as their primary care home.
Presuming we take these steps, and work to renegotiate some of the state’s contracts with CMO’s, the projected savings to the state could potentially reach $76 million based on 2007 PeachCare statistics.
Asking families to make very minimal sacrifices in their premiums and pay a small amount when they use the emergency room are both reasonable – and affordable - approaches to salvaging this invaluable program that does so much for Georgia’s young people.
2 Comments:
This is a good example of where public and private stakeholders can come together to make sure this necessary service is available where needed. Children need these services; however, the burden of uninsured patients is costing our healthcare system billions. This is a really good solution to both improving the quality of care under PeachCare, while limiting the burden (specifically through the use of the ER). When uninsured patients go to the ER for non-emergency needs, this not only costs the system (and taxpayers) hundreds of millions of dollars every year, but it also decreases the quality of care for patients with emergent needs, thus limiting access to care. There are ways to improve this system without depending solely on the gov't to provide 100% (as the Lt Gov has proposed). This should be a public-private effort, because after all, it affects all of us.
By 
MR, at
October 21, 2008 9:02 AM
This is a great idea. It is going to take true leadership to make this happen. If anyone can do it its Casey. I will be watching the session with a lot of anticipation. How do you cut out all those pet projects and get the support of other legislators?
By 
Fred, at
January 12, 2009 6:17 PM