The health care industry in Chattanooga, like the rest of the nation, is being squeezed from all sides.
From rising health care costs to fluctuating reimbursements for doctors and hospitals, providers say they're hard pressed to care for the needs of an unhealthy population on tighter budgets and smaller profit margins.
The health care needs in Tennessee and Georgia are enormous, with both states ranking high in terms of incidences of obesity and related illnesses such as heart disease and diabetes.
An expansion of Medicaid eligibility under health reform could add thousands to the public program in Tennessee and Georgia.* 250,000 -- Anticipated increase in Medicaid patients in Tennessee* 673,968 -- Anticipated increase in Medicaid patients in GeorgiaMAJOR REFORM PROVISIONS* Six months after enactment, insurance companies can't deny coverage on a family's health plan to children with pre-existing conditions. Starting in 2014, adults can't be denied insurance or have their rates raised because of pre-existing conditions.* Starting in 2014, individuals and small businesses can pool to buy insurance through state-run insurance exchanges, with the help of government subsidies based on income for those between 133-400 percent of the federal poverty level.* Starting in 2014, businesses with more than 50 employees will have to provide insurance to their workers or pay a $2,000-per-employee penalty. Individuals will have to buy coverage or face penalties.* In 2014, insurers can't impose annual limits on coverage.Source: Kaiser Family Foundation
And many of those with chronic medical conditions such as diabetes and hypertension are uninsured and suffer from the consequences of not managing their diseases, leading to more medical complications and more costly care, local providers said.
In Tennessee, more than 904,000 non-elderly people are uninsured, according to 2008 estimates from the Kaiser Family Foundation, a nonprofit organization that focuses on health care policy. The figure is 1.6 million in Georgia.
The economic recession only is adding to the ranks of the uninsured, particularly in the North Georgia area, where the carpet industry has suffered, said Nancy Kennedy, executive director of the Northwest Georgia Healthcare Partnership in Whitfield County.
"The challenges are great right now with so many people being unemployed, and so many are unemployed for perhaps the first time," she said. "They've never had to try to locate services to help them."
Health care reform provisions that expand coverage will provide critical access to those who fall through the cracks today, said Bambi Evans, Tennessee Health Care Campaign. For instance, eligibility for Medicaid -- TennCare in Tennessee -- will be expanded to allow people in the program who earn up to 133 percent of the federal poverty level. In addition, adults up to age 26 can stay on their parents' health insurance plans.
"There is a very vulnerable population in the kids coming out of college, and the ability to stay on their parents' health care plans will solve a lot of problems," Ms. Evans said.
DISMAL HEALTH STATUS
Rising rates of childhood obesity don't bode well for the future of today's youth, local health advocates said.
Nearly one-fifth of sixth graders in Georgia are obese, according to the most recent student health survey completed in 2007. In Hamilton County, a survey during the 2008-09 school year showed 15 percent of children were overweight and 17 percent were obese, according to the Office of Coordinated School Health, part of the state education department.
Efforts to reverse those trends and avoid a tsunami of obesity-related illnesses in the coming decades must address both individuals' behavior and the social environment, said John Bilderback, program coordinator for Step One, the anti-obesity initiative of the Chattanooga-Hamilton County Health Department.
"When you look at the environment, when you look at the neighborhood where a child is growing up, how easy is it for them to get to a park? Can they play outside? Is it safe?" he said.
The health department and its community partners are focusing on low-income communities in Chattanooga with the help of a grant from the Robert Wood Johnson Foundation. Health advocates will gather insights about the barriers to healthy living -- from unsafe playgrounds to hard-to-reach grocery stores -- from residents of various neighborhoods in an effort to reverse trends in childhood obesity.
On the other end of the age spectrum, the nation's elderly population is about to rise dramatically, bringing new pressures to an already-strained Medicare program and new demands on health care professionals.
In 2008, those 65 and older made up 12.8 percent of the U.S. population, and the demographic is expected to grow to 19 percent of the population by 2030, according to the federal Administration on Aging.
"We don't have enough physicians and nurses and other health care providers to really take care of our aging population as it is," said Dr. Ken Hayman, director of the emergency department at Parkridge Medical Center and immediate past president of the Chattanooga and Hamilton County Medical Society.
BUSINESS CONCERNS
For physician practices and hospitals, a major challenge is working to keep their business afloat while addressing greater demand for care, all within an atmosphere of great uncertainty and unreliable reimbursements from payers, private and public. Many doctors, for instance, are deeply concerned about Congress' failure to revamp a formula that determines how much they are paid under Medicare.
"The real problem for doctors today is the unknown," said Deborah Hudson, past president of the Tennessee Medical Group Management Association and practice administrator for Tri-Cities Gastroenterology in Kingsport, Tenn. "You're not really sure ever what Medicare is going to pay you. The ripple effect of that is that most commercial payers are paying you a percentage of Medicare. ... Every year, it's like you're held hostage."
On the horizon, the national health care reform package signed into law last month soon will begin addressing issues such as covering the 46 million uninsured in the United States. The problem will be approached through an expansion of public programs such as Medicaid and a mandate that everyone buy insurance, with the assistance of government subsidies in many cases.
But some worry that the expansion of public programs will overwhelm the provider system. Particularly in primary care, caregivers such as nurse practitioners and physicians assistants increasingly will be relied upon to get care to a growing patient population, Dr. Hayman said.
"If we aren't adding physicians to the health care delivery system, the other providers will, in fact, step in to close the gap," he said.
Insurance companies will face new prohibitions on denying insurance or increasing premiums for people with expensive pre-existing medical conditions. It remains to be seen if an individual mandate that every American buy health insurance or pay a penalty will offset insurers' losses from insuring those sicker patients, said Don Mooradian, an analyst with HealthLeaders InterStudy in Nashville.
Greater requirements for insurers to report medical-loss ratios -- that is, what portion of premium revenues go toward paying for actual medical care -- and other financial data could bring about greater competition and improved products offered to consumers, he said.
"There's going to be a lot more transparency and, with that, I think you'll see increased efficiencies and hopefully that will work to everybody's advantage," he said.