Virginia Anderson, The Atlanta Journal-Constitution, Author at �鶹Ů�� Health News

For Millions In Georgia, A Toothache Not Treated By Obamacare

Virginia Anderson, The Atlanta Journal-Constitution — Fri, 29 May 2015 09:00:10 +0000

It’s barely past opening time, and the waiting room at the Mercy Care clinic in downtown Atlanta is standing-room-only.

Bruce Williams, 53, grimaces. He has a gum infection and needs surgery. But he doesn’t have dental insurance, or a job, or money. So he gets by as best he can, eating soft foods in tiny bites.

“I have headaches all in the front of my head,” said Williams, trying to talk without moving his lips and mouth too much. “I’m just here to see what they can do.”

Williams, who lives in Atlanta, is one of the estimated more than 4 million Georgians without dental coverage. Many haven’t seen a dentist in decades. Places like Mercy Care offer free dental clinics, but resources are limited and the clinic staffs are only able to help a small fraction of the people who need care.

The Affordable Care Act aimed to provide access to those without medical or dental insurance, but dental wasn’t considered one of the law’s “essential health benefits.” Roughly 85,000 Georgians enrolled in one of more than a dozen stand-alone dental plans sold through the law’s online insurance marketplace in 2014, compared with upwards of 300,000 people who got medical coverage, according to the nonprofit Kaiser Family Foundation.

Of the about 90 medical policies that included dental benefits for the second year of open enrollment, there’s an array of deductibles, out-of-pocket expenses and premiums that confuse dentists and their office staffs, not to mention consumers. There are no reliable figures for how many Georgians gained coverage through one of those plans.

“Unfortunately, if you’ve seen one, you’ve seen one,” said Dr. Maxine Feinberg, president of the American Dental Association, whose group has viewed policies from all over the country, including Georgia. “They’re all different. It’s been a very steep learning curve for our members.”

Also, the federal tax credits to help make insurance more affordable generally did not apply to dental policies. Typically, the credits were exhausted in paying for medical coverage, with essentially none left over to help consumers pay for dental care, said Colin Reusch, senior policy analyst with the Children’s Dental Health Project, which also analyzed adult enrollment in various states across the country.

The result: the Affordable Care Act has done little to lower the number of Americans who lack dental coverage.

‘If I Had My Teeth’

While dental disease seldom kills, it does lead to tooth loss and infections. It also can affect how a person eats, drinks and interacts with society.

It may be linked to cardiac disease, premature births and other maladies. Problems with the tongue and gums can also be indications of cancer, and dentists can often detect problems early, before these cancers become advanced.

Americans age 23-34 are the largest single group buying standalone dental coverage through the Affordable Care Act’s insurance marketplaces, according to the Department of Health and Human Services, suggesting young adults might be purchasing the plans as they transition off their parents’ policies, experts say.

In that group is Liese Redd of Decatur, 27, who works at a veterinary clinic. She receives medical insurance from her employer but bought dental insurance in November through Obamacare.

Redd said she’s thrilled with her coverage. She pays $29 a month for dental/vision combined. The plan covers preventive services, such as two cleanings a year, and it covered the filling she recently had.

“It’s been on par with what I had before, or better,” said Redd, who was insured previously under her parents’ dental policy.

Meanwhile, Michael Wilkins can only imagine such access to a dentist. The 51-year-old Atlantan, who sought help recently at Mercy Care, was disabled when a Ford 150 struck him a few years ago while he was riding a bicycle. He said he’d like to train to find a job rather than remain on disability. But he avoids people because he is missing his upper teeth.

“If I had my teeth, I could smile at people,” Wilkins said. “I would not be ashamed.”

‘State Lags Behind’

The poor, both adults and children, also find it difficult to get preventive dental care in Georgia because few dentists regularly accept Medicaid, according to a study from The Pew Charitable Trusts. Obamacare couldn’t fix that.

Only about 17 percent of Georgia dentists actively participate in Medicaid, the government health program for the poor, said Jane Koppelman, research director for Pew’s children’s dental campaign.

“It’s nice to have a card, but if you can’t get treatment, what good is it?” Koppelman said.

Georgia has improved access to dental care and dental health over the years for children and adults, according to a May 2014 report by the Georgia Department of Public Health titled “The Burden of Oral Health.” For example, more than 90 percent of Georgians have access to fluoridated water, and the number of third-graders with untreated tooth decay has fallen.

But “the state lags behind … objectives in several oral health indicators,” the report adds. Gaps exist in access. For example, in 2009, twice as many non-Hispanic black and Hispanic high school students visited an emergency room or urgent care center for oral or dental problems than non-Hispanic white high school students.

According to the Pew Charitable Trusts, there were 60,000 visits to Georgia emergency rooms for dental pain in 2007, the most recent year for which figures were available. The cost of those visits totaled more than $23 million.

Going to the ER is “an expense that makes no sense,” said Feinberg of the ADA, because while patients might be given painkillers or an antibiotic to fight an infection, their underlying issue generally will not be treated.

The solution, dental advocates say, is improved access. That includes not only offering dental insurance under Obamacare, but also increasing how much Medicaid pays dentists and expanding Medicaid coverage.

The Georgia Medicaid program currently provides coverage to roughly 1.8 million poor children, pregnant mothers, the elderly and disabled. Expansion would extend coverage to an estimated 600,000 low-income Georgians, mostly adults under age 65 who don’t have children. But Gov. Nathan Deal and other conservative lawmakers have said Georgia cannot afford to expand Medicaid coverage for health care, much less dental care.

So for Georgians without a job, money or dental insurance, services such as the Mercy Care Clinic will remain their option. David Swift of Atlanta, 53, who hadn’t been to a dentist in more than 20 years until a recent visit to Mercy Care, when he feared a filling from childhood had fallen out.

“I’m just hoping they’ll be able to do something,” he said. “Dental care has become a luxury.”

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Georgia Insurers, Doctors Partner To Improve Patient Care, Cut Costs

Virginia Anderson, The Atlanta Journal-Constitution — Wed, 08 Apr 2015 09:00:28 +0000

Ann Finley has faced a host of challenges since her daughter, Mikayla, came into the world 13 weeks early, weighing barely a pound and a half.

Her daughter, now 12, suffers from asthma, attention-deficit hyperactivity disorder and Asperger’s, an autism spectrum disorder. The multitude of appointments with various specialists Mikayla must see makes scheduling complex and overwhelming.

But one thing Finley doesn’t have to worry about now is keeping up with appointments at Mikayla’s pediatrician’s office in Gainesville. A nurse there tracks Mikayla’s records from specialists and calls Finley when it’s time to come in for a checkup.

“A lot of times, I don’t even know it’s time,” Finley said. “And they’ll call to check up on her, just to see how she’s doing.”

The practice, The Longstreet Clinic, is one of a growing number of in Georgia teaming up with insurers, specialists, hospitals and others to by better overseeing their overall care and, the theory goes, rein in out-of-control health care costs in the process.

Both Longstreet in Gainesville and Emory Healthcare in metro Atlanta have partnered with Blue Cross and Blue Shield of Georgia to do just that. Launched in 2013, a program through Blue Cross is experimenting with paying doctors based on how patients fare rather than the traditional model of reimbursing for every service, test, and office visit. The program, called Enhanced Personal Health Care, has nearly 1,000 providers participating so far.

Similar programs are popping up across the country.

Insurers like paying doctors based on quality of care versus quantity of services because healthier patients are less expensive to cover. Providers like it because they get paid more for improved patient health. Patients, especially those suffering from chronic diseases like diabetes, benefit from more personalized attention from their doctors.

Critics of the traditional “fee-for-service” model say the outdated system has helped drive up U.S. health care costs far higher than those of other industrialized nations. It’s also led, they argue, to unnecessary tests and lab work that may not really be needed.

The five-year-old is helping to accelerate this push toward rewarding providers based on the quality, not quantity, of their care. Under the law, for example, (the government health program for Americans age 65 and older) is beginning to pay — — hospitals based on quality of care.

Sharing data

It’s too early to tell conclusively if the partnerships between Blue Cross and providers are succeeding, but early feedback is promising.

Costs have fallen roughly 6 percent among primary care doctors at . The health care system has also seen an about 6 percent improvement in quality measures being tracked.

Insurers and providers sharing information with each other is critical for the Blue Cross program and others like it to work, experts say.

One element that particularly helps is a website with real-time data, said Dr. Christopher Apostol, who practices near Augusta and is participating in the Blue Cross program. It allows a care coordinator in his office to check on what has happened medically with a patient since his or her last visit.

Many practices are also adding care coordinators to further improve the flow of information and to follow up with patients.

When a prescription is ordered, for instance, the coordinator can see whether a patient follows through with filling it. The coordinator can also see when a patient visits another doctor or is admitted to the hospital.

That information gives primary care doctors a more complete picture of , particularly those who suffer from chronic illnesses, such as diabetes or hypertension.

“Ninety percent of health care is spent on chronic illnesses, and eighty percent of those are preventable,” said Morgan Kendrick, president of Blue Cross and Blue Shield of Georgia.

The strategy is not only about insurance companies making money but also about containing costs so that people can afford medical care they need, Kendrick added.

Challenges remain

Despite some successes, experts say it’s still unclear if the enhanced primary care model can achieve significant savings.

Cost-saving is difficult because while some patients will benefit and end up in the hospital less, others may not need the additional oversight, said David Howard, a health policy expert at Emory University.

“The challenge is to identify which patients do we have to target,” Howard said.

Still, insurers and doctors remain hopeful the approach will help patients stay healthier.

Dr. Jeffrey Reinhardt is seeing some success at The Longstreet Clinic.

The practice has reduced the number of patients readmitted to hospitals and knows if a patient ends up in the emergency department, said Reinhardt, an OB/GYN at the Gainesville practice.

“It gives me the info that I didn’t know about a patient and the ability to take a lot better care of my patients,” he said.

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One-Third Of Georgia’s Medicaid Applicants Still In Limbo

Virginia Anderson, The Atlanta Journal-Constitution — Wed, 27 Aug 2014 12:53:00 +0000

Roughly 27,000 poor Georgians, most of them children, still don’t know whether they’ll get health coverage months after applying for Medicaid through the Affordable Care Act’s health insurance marketplace.

Earlier this year, HealthCare.gov determined roughly 89,000 low-income Georgia residents qualified for Medicaid. But the federal computers could not communicate properly with the state’s computers, leaving the majority of those applicants in the dark for months about whether they would actually be enrolled in the program.

Federal regulators warned Georgia’s Medicaid agency in July that they planned to investigate the “substantial backlog” of applications. The state has since managed to process 70 percent of the applications, with about 31,000 people now receiving benefits. About the same number who were initially determined eligible for the government health program by the marketplace ended up being denied coverage after further review of their records, said Pam Keene, a spokeswoman for the Georgia Department of Community Health, which administers Medicaid.

“Georgia Medicaid has now completed database checks of all of the account transfers and determined eligibility status for them or that additional information from the applicant is needed to complete evaluation,” she said.

It’s unclear when the state will make final determinations on the tens of thousands of applications still stuck in limbo, according to Keene.

The delay has been frustrating for families trying to enroll and those trying to help them navigate the process.

“It’s unfortunate,” said Monique Winters, a community resource specialist at Mercy Care Atlanta who has helped enroll dozens of people in the federal marketplace. “The children are the ones who are affected the most, and it just takes extra time to keep going back and back.”

Nationwide, Georgia has one of the largest numbers of children who are Medicaid-eligible but still uninsured.

“We know that they have limited resources, but at the same time, there are people who enrolled and still don’t know their status,” said Cindy Zeldin, executive director of the nonprofit Georgians for a Healthy Future, an advocacy group. “This is a really big opportunity to reach a lot of unreached kids, so it seems like it’s been a missed opportunity.”

It also is a missed opportunity to keep healthcare costs lower for all Georgians, said Tim Sweeney, director of health policy at the Georgia Budget & Policy Institute.

“The healthcare system is funded by everybody, and costs are passed around,” Sweeney said. “High uninsured rates mean more hospital visits, more costs for hospitals, and they will make that up. We all end up paying in a less efficient way.”

The failure to quickly enroll Medicaid-eligible Georgians was an example of problems that millions have encountered with the federal marketplace, a key element of the Affordable Care Act. Transfer of information from one computer system to another was supposed to have been seamless, but it wasn’t.

“There were obvious glitches for states relying on the federal marketplace,” said Robin Rudowitz, a health policy analyst with the Kaiser Family Foundation, a non-profit organization that conducts health policy research. “It’s been a widespread problem.”

Rudowitz said she was encouraged that the state is making progress on processing the Medicaid applications.

She also said that the inability to transfer important information about qualifying for Medicaid was due to lapses on the state and federal level.

Hazel Mapp of Stone Mountain knows the hassle and anxiety only too well. Much to her surprise, the single parent learned in March that her teenaged son was eligible for Medicaid. Mapp sells real estate, but business isn’t as good as she needs it to be. Her only child, who takes AP classes and hopes to become a lawyer, wears glasses and wore braces. The costs were high.

“It was costing me a penny,” Mapp said, but she was able to work out a payment plan. “It was a struggle.”

She was thrilled and grateful to learn the family was eligible for help. Then came the frustrating delays. She managed with the help of Winters at Mercy Care, who managed a “work around” by enrolling the child in the state Medicaid enrollment system and bypassing the federal marketplace.

Now that her son is enrolled, the frustration is behind.

“The truth of the matter is that I’m relieved now,” Mapp said. “I thank God it has all worked out. I hope the same for the others.”

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