Less expensive coverage comes with more risks “The administration’s rule change is dangerous for Georgia consumers,’’ said Laura Colbert of Georgians for a Healthy Future
Blog (March 2012)
By Sarah Candler, MD/MPH Candidate 2013, Emory University and Rollins School of Public Health
Today I joined my HealthSTAT colleagues and community partners at the Georgia State Capitol to voice my support for the Affordable Care Act (ACA) and to let Georgia’s lawmakers and citizens know how much the ACA can help our state.
As a future health professional from Georgia, I recognize that caring for my patients extends beyond the clinic, and I’ve seen first-hand the tragedy of un- and under-insurance in our state. Too frequently, my professional training and that of my colleagues in healthcare does not adequately address this kind of trauma. I joined HealthSTAT to educate myself and to help my patients. My learning about and advocating for laws like the ACA will help my patients as much as my learning the mechanisms and treatments of a disease like diabetes. As Dr. Harry Heiman reminded me today on the steps of the capitol, “As doctors, we take an oath to do no harm–we can’t with good conscience deny this beneficial healthcare legislation to our patients.” (more…)
JOIN US AT THE RALLY TO PROTECT THE AFFORDABLE CARE ACT
MONDAY, MARCH 26, 2PM
OUTSIDE THE GOLD DOME
FOR THE PAST TWO WEEKS WE HAVE BEEN COLLECTING SIGNATURES OF DOCTORS, ADVOCATES, AND HEALTH CARE CONSUMERS WHO SUPPORT AND WANT TO PROTECT THE AFFORDABLE CARE ACT.
ON MONDAY WE WILL BE RALLYING AT THE CAPITOL AND SPEAKING WITH SUPPORTERS AND THE MEDIA AND THEN DELIVERING OUR PETITION TO GOVERNOR NATHAN DEAL AND ATTORNEY GENERAL SAMUEL OLENS. THE PETITION ILLUSTRATES THAT WE SUPPORT PROGRESS IN HEALTH CARE REFORM FOR THE THOUSANDS OF GEORGIANS WHO HAVE ALREADY BENEFITED FROM THE LAW AND FOR THOSE WHO HAVE YET TO SEE THE BENEFITS OF FUTURE PROVISIONS.
WE HOPE TO SEE YOU AT THE CAPITOL!
This is a coalition effort with Georgians for a Healthy Future, Doctors for America, HealthSTAT, Votehealthcare.org, and Know Your Care – Georgia
Sign the Petition in Support of the Affordable Care Act!
Now that Crossover Day (the 30th day of the 40 day Session and the day by which a bill must pass at least one chamber to remain viable for the Session) has passed, the 2012 Legislative Session enters its final stretch. The legislative calendar is now set through Day 37. Here is what health advocates are watching:
- HB 1166 would restore child-only health insurance policies to Georgia’s individual market. Georgians for a Healthy Future, along with a range of child health advocacy groups, is in strong support of this measure to provide this option for families who need coverage for their kids. The bill passed the House last week and passed through the Senate Insurance and Labor Committee this afternoon. It now heads to the Rules Committee.
- HB 879 would allow non-medical staff to be trained to assist students with diabetes in a school setting when a school nurse is not present. The legislation also allows children, who are able, to manage their own diabetes. This legislation passed the Georgia House of Representatives and will be before the Senate Health and Human Services committee tomorrow.
- SB 471 authorizes an alternative approval process for health insurance policies sold in Georgia and could place hard-fought consumer protections at risk. This bill passed the Senate last week and we will monitor it on the House side.
Several bills that consumer health advocates were supporting did not make the Crossover Day cut:
- HB 1159, sponsored by Representative Pruett, would have created a Joint Study Commission on Education for Parents with Newborn Children to determine how best to gather information, raise funds and create a comprehensive informational video. The video would include but not be limited to information on the prevention of childhood obesity; how to prevent SIDS, shaken baby syndrome, and other forms of child abuse; how to prevent death and injury and additional information which would assist parents to raise safe and healthy children. HB 1159 passed through the House Health and Human Services Committee but did not make it out of the Rules Committee.
- SB 484 would help fight childhood obesity by encouraging – but not requiring – schools to open up and share their safe places for kids to play with responsible groups in their communities like churches, scouting troops, YMCAs and others. SB 484 passed the Senate Health and Human Services Committee but did not make it out of the Rules Committee.
- HB 801 and SB 418 were introduced by Representative Gardner and Senator Orrock, respectively, as companion bills to establish a health insurance exchange in Georgia. Neither bill received a hearing.
A shorter version of this commentary originally appeared on the op-ed page of the Atlanta-Journal Constitution on March 2nd, coauthored by Pat Willis of Voices for Georgia’s Children and Cindy Zeldin of Georgians for a Healthy Future (available here).
The Georgia Department of Community Health is in the midst of a process to redesign the state’s Medicaid and PeachCare for Kids programs. Together, these two programs cover more than 1.7 million low-income children, families, and disabled Georgians. As advocates for Georgia’s children and for Georgia’s health care consumers, we view this redesign process as an opportunity to strengthen these programs to ensure they provide access to the services that children and families need to live healthy and productive lives.
The first phase of the Department’s redesign effort, an assessment of the Medicaid landscape in Georgia and in selected states around the country conducted by an outside consulting firm, was recently made public. In addition to a lay of the land, the report featured three major redesign options, each of which would move Georgians with disabilities from fee-for-service into managed care arrangements. There are questions about how well managed care may work for populations with complex health needs such as Disabled Access Lifts, and the Department should work with advocates for these vulnerable Georgia citizens to ensure any redesign system does not disrupt or impede care for this fragile population.
At the same time, we must not lose sight of the children who are already enrolled in managed care through Medicaid and PeachCare for Kids. Nearly a third of Georgia’s children are covered through these programs, and there are concrete steps that the Department can take now to bolster these programs for the future. We encourage the Department to adopt a best practices approach by focusing on three evidence-based themes as it redesigns these programs for children: first, coverage matters; second, ensuring access to care requires adequate network capacity and accountability; and third, ensuring quality of care requires system coordination.
Coverage matters. Numerous studies link continuous health insurance coverage to improved health outcomes. Georgia has made an intentional effort to cover more children in recent years: our uninsured rate for kids has steadily improved from 11 percent in 2008 to 9.8 percent in 2010. Still, about three-quarters of uninsured children in Georgia are eligible for Medicaid or PeachCare for Kids, and by leveraging new enhanced funding opportunities and program flexibilities at the federal level and by borrowing a page from successful initiatives in neighboring states like Alabama, which has reduced its uninsured rate for children to just six percent, we can get closer to the goal of providing health coverage to all of Georgia’s children. For example, Georgia could simplify the eligibility process for children by adopting a policy of 12 months continuous eligibility for kids (currently, some children fall through the cracks with a 6-month renewal policy). There are other administrative and technology system enhancements the Department can take to make it easier for kids to enroll and remain enrolled in coverage, and we encourage the Department to do so.
Ensuring Access to care requires adequate network capacity and accountability. Getting and keeping kids enrolled in Medicaid and PeachCare for Kids is critical, but it is only a first step to ensure that children have appropriate access to a well-coordinated and patient-centered medical home. Significant documented weaknesses in pediatric specialty networks exist in certain regions of the state. Georgia has two policy levers at its disposal to bring these networks up to standard: first, increase provider reimbursement rates for specialty care and second, monitor the contracts with the care management organizations to ensure compliance with policies to establish out-of-network arrangements. Where overall shortages in physician supply hinder access, the Department should work with the care management organizations to explore emerging solutions such as telemedicine, an approach that states like Texas have embraced with some success.
Ensuring quality of care requires system coordination. The Department of Community Health maintains strong quality standards, but performance measures show opportunities for improvement. For example, well-care visits and key screenings are below national averages, and less than half of Georgia’s children with behavioral health needs obtain the care they need. Promising care coordination practices in states like Texas, which uses an electronic health records system to share medical histories and ensure coordinated care for children in the state’s foster care system, and Rhode Island, which utilizes specially trained parent consultants, can inform Georgia’s efforts to develop a more coordinated system of care for children. The Department should also develop and enforce rigorous contracting standards to enhance quality.
We commend the Department of Community Health for its proactive efforts to modernize Medicaid and PeachCare for Kids and encourage best-practices based systems changes that incorporate these three themes. The health of Georgia’s children hangs in the balance.
In the on-going efforts to redesign Georgia’s Medicaid and PeachCare programs, the Department of Community Health (DCH)
is continuing to analyze and evaluate its options and has convened three taskforces to gather feedback from consumer advocates, providers and other stakeholders. The latest taskforce, focused on children and families will hold its first meeting on March 9th. GHF’s Outreach and Advocacy Director Amanda Ptashkin will be there to represent health care consumers who currently access these programs or who will gain access through the Medicaid expansion in 2014. Part of the charge of this taskforce includes identifying:
- Program features identified in the Navigant report that are most/least appealing to meeting the needs of families and children;
- Current features of the program that should be maintained;
- Largest unmet need of the current program;
- Better medical management and coordination for children in foster care;
- Additional insights not identified in the report; and
- Identification of critical design features needed to protect the needs of children and families
If you or your organization have thoughts on the above charge, please email Amanda Ptashkin. To learn more about the redesign process, visit www.healthyfuturega.org/issues/careforgeorgiaskids