Origins and future of the report “Healthcare Innovations in Georgia”

The Medicaid goal of the political right in Georgia has always been careful stewardship of tax-payer funds. Three years ago, the Georgia Public Policy Foundation began to flog a bargain basement Medicaid waiver plan priced at $2500 per capita.

The core rationale for this seemingly meager amount was that $60-$70 a month direct primary care makes almost all other care unnecessary except in rare “true catastrophic” cases.

Everything from the political right claiming vast advantages for direct primary care needs to be seen in connection with Medicaid cost control efforts.

At the same time, direct primary care advocacy from the right, at least in Georgia right now, also needs to be viewed as intended to support Section 1332 waiver authority for an ACA-market-segmenting limited benefit plan built around direct primary care.

Healthcare Innovations in Georgia: Two Recommendations, the report prepared for the Georgia Public Policy Foundation by the Anderson Economic Group and Wilson Partners, praised the cost-savings benefits of direct primary care. Ostensibly, it did so in support of requiring large insurers to offer direct primary care as a primary care option within comprehensive, full benefit, ACA compliant plans. But the Georgia Public Foundation has ordinarily advocated for direct primary care in a context limited to either (a) controlling public cost for Medicaid and state employee coverage, or (b) opposing the Affordable Care Act itself. The Foundation has, as well, been generally antagonistic toward ACA full benefit plans.

Accordingly, I am not persuaded that GPPF was ever seriously in favor of, or even interested in, expanding choice within the ACA by including direct primary care within full benefit plans. There even appear to be signs within the AEG/WP report itself that earlier drafts may have included specific recommendations for channeling Medicaid and state employees into direct primary care plans with limited benefits.

In any case, there is no sign that the State is moving toward direct primary care within ACA compliant full benefit plans. Instead, with enthusiastic support from GPPF, the State is seeking a waiver to allow and support limited benefit plans. And this enables the AEG/WP to be offered for what I believe more realistically reflects the reasons for which the Georgia Public Policy Foundation commissioned it.

Specifically, in the advocacy from the political right yet to come, I am quite certain the AEG/WP report will be represented as a massive, quantitative study that confirms the cost-effectiveness of direct primary care. Yet, despite its many tables of numbers, its imposing appearance, and its astonishing 75 pages, there is good reason to question whether the AEG/WP report demonstrates that direct primary care has billion dollar value or any value at. Blog posts just prior to this one and a number of subsequent posts address these questions.

Ironically, the best way to test the cost-effectiveness of direct primary care might very well be to create options within comprehensive, full benefit, ACA compliant plans where direct primary care can compete on an even basis in an actual market directly with traditional fee for service primary care. So, kudos to the Georgia Public Policy Foundation for commissioning and publishing the AEG/WP report that presented that idea. Actually getting behind that market-based idea would be even better, and might actually help Georgia blaze a trail for the nation.

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