BERNARD COLUMN: Kemp’s healthcare budget priorities

Published 10:30 am Saturday, December 10, 2022

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By Jack Bernard
Bernard is a retired corporate executive

Georgia ranks as the fourth worst in healthcare versus other states. And that should influence our state’s budgetary decisions, directly affecting county residents. 

When I was a County Commissioner, I was also the Chair of the Association of County Commissioner’s Tax Committee. I am an unapologetic progressive on social issues like guns, racial equality and women’s rights. However, I have always been a conservative regarding fiscal matters. As a state executive, local elected official and senior level corporate executive, I have always applied cost-benefit analysis as my yardstick regarding expenditures. 

Earlier this year, Leah Chan and the respected Georgia Budget and Planning Institute issued a report on Kemp’s 2023 healthcare budget priorities. Its findings are illuminating, especially in regard to healthcare (Departments of Community Health, Public Health and Behavioral Health and Disabilities), which are about 20% of state spending. Most of that amount is spent on Medicaid/Peachcare with the majority going to the elderly (i.e., nursing homes) and the disabled. 

Consistent with what I have written in earlier columns, that report indicated that Georgia’s response to the pandemic was inadequate, with Georgia ranking 47th of 50 states. Why? Here’s just one example. 

Our death rate, 386 per 100,000, was the 13th highest of the 50 states. Governor Kemp likes to compare us to blue states like California which implemented lock downs. Their rate was only 247 per 100,000- less than two-thirds of ours. We have had 41,070 reported deaths due to Covid, probably an underestimate. If our rate was that of California, we would have had 26,280 deaths. Stated another way, if Kemp would have implemented stronger lockdown measures, we could have potentially avoided 15,000 deaths. 

The GBPI report goes on to detail other failures. One glaring example is the state’s “unequal access to affordable, high-quality health care.” 

With an uninsured rate nearing 14%, Georgia is one of the worst states in regard to the number of uninsured. Only Florida and Texas are worse. If we just expanded Medicaid (using 90% federal funding), we could cover another 560,000 Georgians.

The GBPI report is excellent, but due to my personal knowledge base I would go further in one area- mental health. Back in the 1970s, I was the first Georgia Director of Health Planning. My units developed the state’s first physical and mental health comprehensive plans. It was difficult to get the executive and legislative branches to actually implement the plan, the key reason I left state government for private enterprise. 

One prime example is mental hospital deinstitutionalization. In the 70s, there was a push to close mental hospitals which took care of those with mental disabilities and substance abuse. In 1976, I did a comprehensive tour of these facilities and detailed my findings in a report to the Commissioner of DHR, the state agency over physical and mental health.  

Conditions were atrocious. My recommendation was to continue the deinstitutionalization process that was underway, transferring those financial resources to community mental health. The commissioner was in agreement. And the mental health portion of the State Health Plan reflected that fact. 

However, the legislature was never on board. State mental hospitals were closed, a good thing. But the funding for local mental health was never nearly enough. Instead of mental health outpatient boarding homes, many of these patients ended up on the streets. They still are to this day. This same scenario played out across the nation as well. 

Former Georgia House Speaker David Ralston, who recently passed away, recognized the extent of this issue. To his credit, he pushed increased funding for mental health services through the legislature as part of the 2023 budget. 

Governor Kemp did not create this problem. But he should recommend to the General Assembly that more funding be appropriated in future years as necessary to get the mentally ill and disabled the housing and local care that they need.