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MENTAL HEALTH AMERICA OF GEORGIA SUPPORTS MEDICAID EXPANSION
MHA of Georgia supports the expansion of Medicaid coverage because it will lead to improved access to care, a stronger health care delivery system, and a general boost to Georgia's economy.
The purpose of Medicaid is to bridge gaps in the availability of health insurance for specific groups of low income individuals. To qualify for Medicaid, one must have low income as well as fall into an eligible, covered group. Such groups include children, their parents, pregnant women, individuals with disabilities, and the elderly.
Most of Georgia's uninsured population has been without healthcare coverage for at least a year. These individuals go without coverage simply because it is too expensive. For example, in 2012 the Federal poverty level for a family of 3 was only $38,180 annually, while the cost of private health insurance was nearly $16,000 a year- an impossible expense. Consequently, people go uninsured and tend to forego care when they are sick, resulting in diagnosis and treatment at a much later stage of illness. The result of such delay in services is more costly treatment , often occurring in emergency rooms.
These facts and figures come from the Kaiser Family Foundation.
THE PROBLEM WITH SPECIALTY TIER MEDICATIONS
Traditional prescription drug benefits work on a three-tier formula. Typically, patients pay $10 for generics, $30 for preferred brand names, and $50 for a non-preferred brand name.
Specialty Tier prescription drugs (a fourth tier), often "biologics" that treat conditions like multiple scelrosis and cancer, require patients to pay co-insurance or a percentage of the drug's cost, which can be hundreds, if not thousands, of dollars.
When an insured patient's out of pocket prescription cost exceeds $500, approximately 28.8% choose not to buy it -- resulting in non-adherence to the care plan, poorer outcomes, and more frequent trips to the ER.
For more information about Specialty Tier Medications, contact Ellyn Jeager at MHA of Georgia: Ellyn@mhageorgia.org.
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