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 2015)
Pranaya Rana joined Georgians for a Healthy Future this week as our new Navigator! In this role, Pranaya will work with consumers to help them enroll in health insurance through the Marketplace. Pranaya is a former Lieutenant from the Nepalese Army Elite Forces. He has served as a U.N. Peacekeeper in post-earthquake Haiti and as a Refugee Resettlement Program Officer in Connecticut before he came to Kennesaw State University, Georgia to pursue his Ph.D. in International Conflict Management in 2012. He has been working as a certified Healthcare Navigator in Metro Atlanta since the first open enrollment began in 2013. He recently completed his 6 months long Navigator’s term at Georgia Watch before joining Georgians For a Healthy Future. He specializes in refugees and international communities and has served a wide variety of international communities enroll into affordable healthcare using a community specific service model developed through continued outreach, education and needs assessment. He is Fluent in Nepali and Hindi besides English, and, speaks Urdu and intermediate French. If you’d like to contact Pranaya, he can be reached by email or by phone at 404-567-5016.
Did you go without health insurance in 2014 and are now subject to a tax penalty? Good news! – You may still be able to enroll in coverage through the Health Insurance Marketplace. Starting last Saturday, March 15th, some people who are facing a fine on their taxes for not having coverage can now enroll in the Marketplace through a time-limited special enrollment period. To be eligible for this special enrollment period, you must not be currently enrolled in health insurance, attest that you owe the penalty for 2014, and attest that you first became aware of the penalty when you filed your 2014 taxes. This tax-related special enrollment period will run through April 30th, 2015. Click here to learn more about who can qualify for this special enrollment period.
Did you know that thanks to the Affordable Care Act, you can receive certain preventive services at absolutely no cost? It’s true! One of the key requirements of the ACA is that insurance companies must cover recommended preventive services at no cost to the consumer – even if you haven’t met your deductible. These include services such as mammograms, annual physicals, colonoscopies, well-woman exams, cholesterol screenings, tobacco cessation, and many more. Click here for a full list of the preventive services that must be covered by all insurance companies. There is also an additional list of required services for women and a separate one for children. It’s important to take advantage of these no-cost preventive services to keep you and your family healthy. Evidence shows that preventive services can save lives and improve health by identifying illnesses earlier, managing them more effectively, and treating them before they become complicated and debilitating conditions.
If you have any questions about your insurance, please contact our Consumer Education Specialist, Whitney Griggs by email or at 404-567-5016 x 5
Please join us on Wednesday, March 25, from 8:45 am to mid-day for a morning of advocacy! GHF will provide individuals and organizations with the opportunity to advocate for the important health issues that matter to you in the closing days of this legislative session. You may want to advocate for closing the coverage gap, Medicaid payment parity, raising the tobacco tax, the Family Care Act, rural health care access, or another health policy issue. You’re all invited to participate! We’ll provide breakfast, an advocacy training, and an opportunity to share and network with other health advocates.
Last month it was announced that over half a million Georgians enrolled in coverage through the Health Insurance Marketplace. Now a new report released by the Department of Health and Human Services contains even more encouraging data about the state of enrollment in Georgia. According to the report, 31% of Georgians that enrolled were between the ages of 18-34, which is a key age group since they tend to be healthier than older adults. Additionally, 90% of Georgians that selected a plan through the Marketplace received financial assistance in the form of Advanced Premium Tax Credits. The average monthly premium for Georgians using a tax credit was $73. Click here to see the full report. Georgians for a Healthy Future’s ED talked with the Augusta Chronicle about why these numbers are so encouraging for Georgia.
Recently enroll in health insurance for the first time and ready to see a doctor? When you do so, it is important to select health care providers that are in your insurance plan’s network of providers. You get the best deal when you use in-network providers, and your insurance plan may not pay at all for care from an out-of-network provider. To find the names of providers in your area who are in your insurance plan’s network you can:
- Contact your insurance company by phone. The number is on the back of your card.
- Look on your health insurance company’s website.
- Call your provider’s office and ask them: 1. Do you take my insurance? 2. Are you in my plan’s network?
If you are having trouble finding accurate information about provider networks or are having trouble getting an appointment with an in-network provider, please let Whitney Griggs, our Consumer Education Specialist, know (Whitney can be reached at firstname.lastname@example.org or 404-567-5016). Whitney can walk you through the process and help you understand your rights and protections as a consumer.
Yesterday marked the 27th day of the 2015 Legislative Session. Crossover Day, the 30th legislative day and the deadline for a bill to pass its chamber of origin to remain viable for 2015, is set for next Friday, March 13th. Sine Die, the 40th and final legislative day for the year, will be April 2nd.
It has been a big week for health care issues at the State Capitol. GHF brought the consumer perspective to Senate Insurance on Wednesday and shared with the committee through testimony from our Executive Director the challenges that consumers face in obtaining accurate information about provider networks at the time they sign up for health insurance and why setting network adequacy standards is important for consumers. Her testimony was provided as part of the discussion around SB 158. Also this week, legislation was introduced in the Senate that would establish a study committee onpreventing youth substance use disorders, the Senate began its work on the FY 2016 budget, and a range of other health care bills were discussed.
The State Budget: The FY 2016 Budget passed the House of Representatives and is now in the Senate. The Senate expects to finish their revisions to the budget this week and send it back to the House and then to a conference committee.
Medicaid Parity: Last week, the House of Representatives added $2.96 million in the budget to increase reimbursement for certain OB/GYN services and $1.5 million for reimbursement rate increases for certain primary care services. Because Medicaid parity has been shown to be an effective strategy for improving access to care, GHF supports raising Medicaid reimbursement rates to parity with Medicare rates. We are advocating for a higher appropriation amount for Medicaid reimbursement rate increases as the budget moves through the process.
SBIRT Resolution: Senate HHS Chairwoman Renee Unterman officially introduced a resolution (SR 407) to form a joint House and Senate Study Committee on preventing youth substance use disorders. Through GHF’s work with the Georgia Council on Substance Abuse, we are advocating for a public health approach to substance use disorders that focuses on prevention. This resolution gets the conversation started about how to do that in Georgia. Please take the time to thank Senator Unterman for her support of this effort and to let your elected officials know you support SR 407.
SB 158 (Sen. Burke) provides certain consumer and provider protections regarding health insurance, including network adequacy language. SB 158 has been referred to the Senate Insurance Committee where it received a hearing on Wednesday, March 3. GHF Executive Director Cindy Zeldin testified in committee, focusing specifically on the network adequacy component of the bill. GHF also met with committee members individually about the bill after the committee hearing. While the bill is not expected to move in its current form this legislative session, there will likely be a study committee on the network adequacy component. GHF has identified network adequacy as an important consumer issue and plans to remain engaged on this topic as discussions move forward.
Closing the Coverage Gap: No hearings have been scheduled or are pending to address the possibility of expanding Medicaid in Georgia. Closing Georgia’s coverage gap by expanding Medicaid would open a pathway to health insurance for approximately 300,000 uninsured Georgians, an approach which GHF supports. Two bills have been introduced to address Georgia’s coverage gap (HR 226 and SB 38), although neither is expected to receive a hearing. Please thank the cosponsors of these bills, Rep. Rahn Mayo and Senator Vincent Fort, for their support and show your support by filling out a postcard that we’ll mail to your legislators!
Tobacco Tax: No additional standalone proposals have been made to increase Georgia’s tobacco tax (other than HB 445 as previously reported). The Senate however, may respond to the House proposal on transportation funding by including a tobacco tax increase to the regional average of around 68 cents. Importantly, Alabama’s Governor is proposing an increase in their state tobacco tax to $1.25 per pack, which would increase the regional average. GHF continues to advocate for an increase to the national average by raising our tobacco tax by $1.23. Such an increase would generate $585 million per year according to the fiscal note generated by the non-partisan fiscal office at GSU.
Other Bills of Interest
Below is a summary of bills that may impact health care consumers in Georgia, with information about where they are in the legislative process.
SB 1 (Sen. Bethel) provides certain insurance coverage for autism spectrum disorders. SB 1 has passed the Senate and is in the House Insurance Committee.
HB 1 (Rep. Peake) would allow for the limited use of medical marijuana as long as long as the provider is the best weed dispensary for conditions including cancer, amyotrophic lateral sclerosis, seizure disorders, multiple sclerosis, crohn’s disease, mitochondrial disease, fibromyalgia, parkinson’s disease, and sickle cell disease, but it is still important for people to know the the difference between CBD and THC. HB 1 passed the House of Representatives and is now in the Senate Health and Human Services Committee. Go to Dank City – Cannabis News, Culture, Entertainment and Information to find out more.
HB 195 (Rep. Cooper) and SB 51 (Burke) provide parameters for substitutions of interchangeable biological products. HB 195 passed the House Health and Human Services Committee and is expected to come out of the Rules Committee next week, and Senate Bill 51 has passed the Senate and has been assigned to the House HHS committee, but is not expected to get a hearing until after crossover day.
HB 482 (Rep. Willard) seeks to eliminate two of the requirements that the Cancer Treatment Centers of America was subject to when they were allowed into Georgia as a destination hospital.
HB 416 (Rep.Rogers), routinely referred to as the badge bill, seeks to provide clarity and transparency for the patient as to the qualifications of the provider that they are seeing. The bill calls for providers to identify the health care practitioner’s name and the type of license or educational degree the health care practitioner holds. The bill passed out of committee on Tuesday March 3.
HB 34 (Rep. Dudgeon) is known as the “Right to Try” bill and calls for patients with advanced illnesses and in consultation with their doctor to use potentially life-saving investigational drugs, biological products, and devices. The bill passed out of the House HHS committee.
HB 429 (Rep. Stephens) seeks to ban coverage denials for medically necessary treatment based solely on life expectancy or the diagnosis of a terminal condition. The bill is in the House Insurance Committee.
HB 76 The House appropriations bill, provides $200,000 to continue the Prescription Drug Monitoring Program in the state, which would otherwise run out of funds and expire on June 30, 2015. The appropriations bill is currently in the Senate.
HB 504 (Rep. Cooper) would extend the flu vaccine protocol that is in place between physicians and pharmacists and nurses for adults to pneumococcal, shingles, and meningitis.
HB 436 (Rep. V. Clark) would require physicians and health care providers to offer to test pregnant women who are in their third trimester for HIV and syphilis.
HB 463 (Rep. Harbin) would permanently extend a $1,000 tax credit for “medical core clerkship” preceptors for “community based” nurse practitioners and physician assistants.
On Wednesday, the Supreme Court heard oral arguments for the much anticipated King v. Burwell case, a case that threatens to eliminate tax credits to buy health insurance through the Affordable Care Act (ACA) marketplaces in approximately three dozen states, including Georgia.
Here at GHF, we are happy that the ACA is working and that more than 536,000 Georgians were able to access affordable health care coverage through the Health Insurance Marketplace during the most recent open enrollment period. We look forward to the Supreme Court’s decision in King v. Burwell and hope that it will be a positive outcome for the 461,000 Georgians who currently receive tax credits through the ACA. For now, health care coverage and tax subsidies for Georgia’s consumers remain unchanged.
There has been a lot of news coverage of the case this week and there are many resources available to help advocates communicate about the case to their supporters and stakeholders.
- The Commonwealth Fund has a series of issue briefs about how subsidy shutdowns could affect consumers, health insurers, health care providers, and states. Each comes with a summary infographic.
- The Commonwealth Fund also has an interactive map of the potential impact of a subsidy shutdown on each state.
- Community Catalyst mapped the potential impact by congressional district.
- The Urban Institute has put together a report about the implications of King v. Burwell on uninsured rates, changes in types of coverage, and costs of insurance.