Enrollment Policy Corner


Breaking: Subsidies Upheld!

In a 6-3 ruling the Supreme Court upheld tax credits in the Affordable Care Act. This is a big victory for Georgia health care consumers!

As an organization committed to making sure all Georgians have access to the health care they need, Georgians for a Healthy Future is celebrating today’s Supreme Court decision! This ruling is a big win and a big relief for the more than 400,000 newly enrolled Georgians who can keep their coverage and the access to care and financial peace of mind that comes with it.

“Today we celebrate an important victory for health care consumers, and we are relieved that hundreds of thousands of Georgians can keep their coverage,” said Cindy Zeldin, Georgians for a Healthy Future’s Executive Director. “But there is still work to do. Georgia has the second highest rate of uninsured in the country, and three-hundred thousand Georgians fall into a coverage gap that was created by Georgia’s decision not to expand Medicaid.”

Now that the outcome of King v. Burwell is clear, we must not forget these workers, parents, and veterans in our state who still lack access to quality, affordable health insurance. It’s time to close the coverage gap.

Tell your legislator that it’s time to close the coverage gap!

Moving Forward: Policy Recommendations Following OE2

Georgians for a Healthy Future surveyed and interviewed enrollment assisters across the state to understand not only the “what” but also the “why” behind the second open enrollment period.  The results of that research have led us to several policy recommendations to maximize health insurance enrollment and retention and to ensure that coverage translates to meaningful access to timely and appropriate medical services for Georgia health care consumers.


Health Insurance Literacy

From choosing a plan to using your plan, health insurance can be complicated and many Georgians lack the information they need to make informed decisions.  In GHF’s recent report Getting Georgia Covered: Best Practices Lessons Learned and Policy Recommendations from the Second Enrollment Period, we interviewed enrollment assisters across the state and found that more than two-thirds of our survey respondents identified low health insurance literacy as a barrier to enrollment. Many of the consumers that assisters worked with had never been insured before, so they did not know how to choose a primary care physician or pay their monthly premium. One of the assisters interviewed acknowledged they needed to educate consumers on how to use their health insurance, but that it was a challenge when scheduled with a large number of enrollment appointments. Additionally, some assisters reported that consumers chose the lowest premium plan because they did not understand the concept of a high deductible. Sometimes consumers would return to the assister wanting to change plans once they had tried to use their coverage. As we move forward, Georgians for a Healthy Future will be focusing efforts on improving the health literacy of Georgians and ensuring they have the knowledge, information, and confidence they need to make informed decisions.

OE2 By the Numbers

New health insurance opportunities created through the Affordable Care Act (ACA) have let to historic reductions in the nation’s uninsured rate.  The strong enrollment numbers in Georgia mean that more Georgia consumers can access the health care services they need and enjoy enhanced financial security for themselves and their families.


New Resource: Getting Georgia Covered

New health insurance opportunities created through the Affordable Care Act (ACA ) have led to historic reductions in the nation’s uninsured rate. Here in Georgia, more than half a million consumers signed up for health insurance during the open enrollment period that ended this past February, known as OE 2.

These strong enrollment numbers mean that more Georgia consumers can access the health care services they need and enjoy enhanced financial security for themselves and their families. The reduction in our state’s uninsured rate, although smaller than that of the nation as a whole, also has positive implications for the vitality of local health care systems and communities throughout Georgia.

Too many Georgians, however, remain uninsured, either because

  • they are unaware that there are coverage options that can meet their needs and budget
  • face cultural, linguistic, financial, or other barriers to coverage; or
  • fall into the “coverage gap” that was created when Georgia declined to expand Medicaid as authorized under the ACA

The goals of this report are

  • to explain the role of in-person assistance on enrollment outcomes and consumers’ experiences
  • to explore best practices that helped achieve robust enrollment in Georgia
  • to identify any common challenges or barriers to enrollment that Georgia consumers faced during OE2
  • to highlight promising strategies and approaches to reach the remaining uninsured who qualify for affordable health insurance
  • to put forth policy recommendations that can help facilitate a positive experience for health care consumers, both for those who are newly enrolled and for those who remain uninsured.

You can download and read the report below.

[embeddoc url=”http://healthyfuturega.org/wp-content/uploads/2015/12/Getting-Georgia-Covered.pdf”]

King v Burwell: What’s at Stake for Georgia?

On March 4th, the United States Supreme Court will hear oral arguments in King v. Burwell, a lawsuit challenging the tax credits that consumers utilizing the federal Health Insurance Marketplace receive to help make health insurance affordable. Consumers in thirty-four states, including Georgia, use the federal Marketplace to find and enroll in coverage. Nearly nine out of 10 people who enrolled in coverage through healthcare.gov received financial help and paid 75 percent less than the full monthly premium. This has helped bring the nation’s uninsured rate to an historic low.

A study by the Robert Wood Johnson Foundation and the Urban Institute found that the majority of health care consumers who would be impacted and who would likely become uninsured if the tax credits were struck down live in the South. Here in Georgia, hundreds of thousands of people are at risk for becoming uninsured.

We believe there is no legal basis for this challenge and that in June, when a decision comes down, we’ll all breathe a sigh of relief. If the court does, however, strike down the tax credits, such a decision would disproportionately impact the South and would put states like Georgia at a competitive disadvantage by exacerbating existing regional health disparities. If this comes to pass, Georgians for a Healthy Future will advocate for a contingency plan to ensure that Georgians have the same access to tax credits that their counterparts in states like New York, California, Colorado, and Kentucky (states that set up their own health insurance exchanges) have.

Our friends at Families USA have put together a resource page for advocates interested in learning more about King v. Burwell.

Hot Topic Update: Network Adequacy


With open enrollment in full swing, Georgia consumers are once again exploring their health insurance options and signing up for coverage. When consumers enroll in a health insurance plan, they gain access to a network of medical providers with whom their insurer has contracted. For health insurance to facilitate meaningful access to care, this network of providers must be adequate to ensure that consumers enrolled in the plan have reasonable access to all covered benefits and services. In a recent issue of the Peach Pulse, we provided a primer on network adequacy, a hot topic in health policy (click here to get caught up on what network adequacy means and why it matters for consumers, advocates, and policymakers). In that overview, we promised to keep you updated on policy developments around network adequacy, in particular the ongoing process at the National Association of Insurance Commissioners (NAIC) to update its model law. This model law can provide a framework for states to establish and enforce standards to ensure that provider networks are adequate. At its fall meeting in November, the subgroup at the NAIC working on network adequacy announced it would take comments on an initial draft of proposed revisions for the model act until January 12, 2015. To learn more about this process and to see the draft, click here.

To ensure the needs of consumers are considered in this process, the NAIC consumer representatives released a report featuring the results of a survey of state Departments of Insurance and recommendations for state policymakers, regulators, and the NAIC to consider as they work on updating network adequacy standards. These recommendations include:

  • Establish quantitative standards for meaningful, reasonable access to care, such as minimum provider-to-enrollee ratios, reasonable wait times for appointments based on urgency of the condition, and distance standards that require access to network providers within a reasonable distance from the enrollee’s residence.
  • Ensure consumers are provided sufficient information to identify and select between broad, narrow or ultra-narrow networks. In areas without sufficient choice, require health plans to offer at least one plan with a broad network or an out-of-network benefit, with limited exceptions to be determined by the Commissioner.
  • Require health plan provider directories to be updated regularly, publicly available for both enrolled members and individuals shopping for coverage, and include standards for information that must be included to provide consumers with information on network differences and the potential financial impact on consumers depending on which plan they choose.

There are 17 recommendations in all. For advocates interested in learning more about this issue and in speaking up for consumers in this process, see the full report here.

If you would like to weigh in at the state level, please contact Georgia’s Department of Insurance and ask the Commissioner to support the NAIC’s process to revise the model act and specifically to support the consumer recommendations described above.

If you are an individual consumer enrolled in a commercial health plan and the provider directory you were given was incorrect or if you have concerns about your ability to access covered services under your plan, please contact the Georgia Office of Insurance & Fire Safety, Consumer Services Division by calling (800) 656-2298 or use the Consumer Complaint Portal at www.oci.ga.gov/ConsumerService. Please also consider sharing your story with Georgians for a Healthy Future so we can get a better picture of what is happening in our state.

The Role of Navigators on Consumer Experiences

Georgians for a Healthy IMG_9087-300x181Future partnered with Seedco at a briefing in Atlanta on October 16 to present and discuss findings from a comprehensive evaluation of the impact of health insurance navigators on consumer experiences during the first open enrollment period. The evaluation was conducted by a team of researchers at the University of Georgia, and its key findings include:

-Navigators succeeded in assisting consumers from diverse communities and in reaching those in need of affordable health services

-Rates of achieving enrollment or application success with navigators differed by region, by demographics, and by consumer financial status

-Navigator interpersonal communications, and especially follow-up, was the biggest factor in consumer satisfaction

As we gear up for the next open enrollment period, which begins on November 15, 2014, the findings from this report can inform the work of enrollment assistance personnel and community-based organizations in Georgia and across the country. Selected recommendations from the report include:

-Continue partnering with community agencies that serve diverse populations

-Publicize the navigator role and concrete ways to access free in-person assistance

-Follow up with consumers after they receive in-person assistance

For a summary document highlighting and describing these and other key findings and recommendations, click here. To read the full study, click here.


Network Adequacy Explained

When consumers enroll in a health insurance plan, they gain access to a network of medical providers. Insurance companies contract with a range of providers, including both primary care and specialty physicians, to deliver health care services included within the plan’s benefit package. This network of providers must be adequate to ensure that consumers enrolled in the plan have reasonable access to all covered benefits. This is what is meant by network adequacy. More specifically, to be considered adequate, a network must provide adequate numbers, types, and geographic distribution of providers; must ensure that access to care is timely; and must include essential community providers that serve predominantly low-income, medically underserved individuals. Additionally, accurate information about providers must be made available to consumers.

Network adequacy has become a hot topic over the past several months because many consumers who enrolled in new health plans through the Health Insurance Marketplace found that their plan came with a narrow network of providers. Provider directories weren’t always accurate or up-to-date, and consumers expressed a fair amount of confusion over which providers were in their plan’s network.

At the same time, the National Association of Insurance Commissioners (NAIC), which develops model laws and rules that states often adopt, has been working to update its network adequacy model law. Stakeholders ranging from insurers to medical providers to patient and consumer advocates are weighing in on this process, making network adequacy a hot topic in the policy arena too. Georgians for a Healthy Future has been monitoring this process through the participation of our executive director as one of the consumer representatives to the NAIC. Earlier this summer, the consumer representatives submitted comments to the NAIC focusing on developing a stronger standard and better oversight of network adequacy, an end to “balance billing” by out-of-network providers in in-network facilities, and greater transparency of provider networks.

Georgians for a Healthy Future will continue to monitor this process and will advocate at all levels, in conjunction with state and national partners, to ensure consumers have meaningful access to care.

If you are an individual consumer enrolled in a commercial health plan and the provider directory you were given was incorrect or if you have concerns about your ability to access covered services under your plan, please contact the Georgia Office of Insurance & Fire Safety, Consumer Services Division by calling (800) 656-2298 or use the Consumer Complaint Portal at www.oci.ga.gov/ConsumerService. Please also consider sharing your story with Georgians for a Healthy Future so we can get a better picture of what is happening in our state.

For more information on network adequacy, please see the following reports and resources:

From Georgetown Center on Health Insurance Reforms: Reforming State Regulation of Provider Networks: Efforts at the NAIC to Re-Draft a Model State Law

From Robert Wood Johnson Foundation and Georgetown University Health Policy Institute: ACA Implications for State Network Adequacy Standards

From Families USA: Network Adequacy and Health Equity: Improving Private Health Insurance Networks for Communities of Color

New Resources on Outreach & Enrollment

Open enrollment for the new health insurance marketplace begins on October 1st–a mere 53 days from today.  Over the past several months, Georgians for a Healthy Future has been working with community-based organizations, health care focused nonprofits, and other stakeholders to discuss plans for coordinating outreach and enrollment efforts in preparation for the new marketplace. Thanks to your robust participation, we have already had several productive conversations to get this effort underway. Last week, we held a webinar to share the latest information available on national and state plans around outreach and enrollment.

The webinar included presentations by:

  • Tony Garr of Enroll America
  • Duane Kavka of the Georgia Association for Primary Health Care
  • Lynn Quincy of Consumers Union
  • Cindy Zeldin and Amanda Ptashkin of Georgians for a Healthy Future

The slides from the webinar are available here.  You can also access a recording of the webinar here. Back in April, we also held a webinar and in-person meeting to discuss the federal navigator program.  For those of you who missed those meetings, materials can be found here.

In addition, many of the resources and materials discussed or requested during last week’s webinar are available below.

Health Insurance Navigator Grants: The U.S. Department of Health and Human Services (HHS) plans to announce grant awards to health insurance navigators on August 15th.  Health insurance navigators awarded grants through this program will conduct outreach and facilitate enrollment into qualified health plans when open enrollment begins in October. More information about the federal navigator program and the role of navigators is available here. When the grant awards are announced, we will share that information with you.

Certified Application Counselor Program: HHS also recently released the application for interested organizations to sign up as designated Certified Application Counselors (CACs). Certified application counselors will also assist consumers with enrollment into qualified health plans in the Health Insurance Marketplace. While there are no federal grants associated with this program, as there are with the navigator program, becoming a designated CAC organization is a terrific opportunity for entities that have a stake in covering as many Georgians as possible to engage directly in outreach and enrollment work. The application can be found here and guidance from CMS further describing the role of CACs can be found here.

Champions for Coverage:  Do you want to help get the word out about the new health insurance opportunities that will be available this fall to members of your community thanks to the Affordable Care Act?  Become a Champion for Coverage! Get widgets and badges for your website; fact sheets, posters, and brochures to distribute; and help get out the word about www.healthcare.gov and the new Health Insurance Marketplace call center line available to assist consumers at 1-800-318-2596  by officially becoming a Champion for Coverage. You can learn more about this HHS program here.

Help consumers learn about the new premium tax credits: Lynn Quincy of Consumers Union, the policy and advocacy division of Consumer Reports, participated in last week’s Georgians for a Healthy Future webinar to brief us on a new resource available to navigators and others in Georgia assisting health care consumers. A new consumer-oriented brochure explains how the tax credit would work and whether you and your family might be eligible for it. For those of you conducting outreach around the new Health Insurance Marketplace, this is a great tool for you. The brochure is available here, and ancillary information and materials are available here.

Public Policy & Advocacy Update: Georgians for a Healthy Future is closely monitoring public policy developments around health insurance outreach and enrollment and actively advocates for health care consumers on these issues. Below are some important updates for you:

  • The U.S. Department of Health and Human Services issued its final rule on health insurance navigators, which clarifies how the navigator program will work. Our friends at Families USA put together a summary of this rule, available here.
  • During the 2013 Georgia Legislative Session, our state’s policymakers enacted HB 198 into law, which requires state training, licensure, background checks, and continuing education for navigators. Georgians for a Healthy Future has some concerns about this legislation and the potential hurdles it sets up for community-focused nonprofits already facing an uphill battle to reach, educate, and facilitate enrollment for consumers who haven’t historically had insurance. As such, we reached out to the Georgia Department of Insurance with suggestions to make the implementation of the law less burdensome for navigators, and some of our input was incorporated. We will continue to monitor this process with an eye towards ensuring navigators and assisters aren’t impeded from carrying out their important work. The regulation implementing HB 198 is available here. We will provide additional information when we have it about the state requirements for navigators and certified application counselors. Georgians for a Healthy Future was also featured in two recent news articles in the Atlanta Journal-Constitution about the navigator program, available here andhere.  Additionally, the Center for Public Integrity just released an article focusing on various state licensure laws as they affect navigators.  That article can be found here.
  • Last week, health insurance premiums for the Marketplace were a hot topic, as Georgia’s Insurance Commissioner released some information about the rates that insurance companies proposed for the Marketplace. Georgians for a Healthy Future was frequently cited in media coverage of this issue, drawing attention to the fact that many consumers who were shut out of the market in the past would now be able to purchase insurance for the first time, with hefty tax credits that will make these plans affordable. This issue was covered by theAtlanta Journal- ConstitutionGeorgia Health NewsThe Augusta Chronicle, andWSAV-Savannah. These articles are available herehereherehere, and here.