Medicaid Matters: Coverage saves lives

Queenesther is a mother of five children living in Albany, GA. She and her children, all under the age of 10, receive health care coverage and care through Medicaid.

Queenesther recently underwent surgery to remove an ectopic pregnancy that was causing severe health issues and could have proved fatal. “Had it not been for Medicaid I wouldn’t have been able to get it removed and who knows what would have happened,” she said, reflecting on the importance of Medicaid for herself and her family. Because she was able to have the ectopic pregnancy removed quickly, Queenesther has been able to focus on caring for her young family and earning her degree.

Queenesther is fortunate compared to many low-income parents because Georgia makes it very difficult for parents to qualify for Medicaid coverage. Because Georgia’s Governor and the state legislature have so far refused to extend health coverage to most low-income parents (and other poor adults), parents must make less than 36% of the federal poverty line ($7656 annually for a family of three) to qualify for insurance through Medicaid. Parents who make between 36% and 100% of the federal poverty line ($9096-$25,100 annually for a family of four) are stuck in the coverage gap with no pathway to affordable coverage.

In Dougherty County, where Queenesther and her family live, 5,472 people, 22% of whom are parents, are stuck in the coverage gap but could be covered if Georgia’s policy makers extended insurance to this group. Like Queenesther, gaining coverage would enable them to better care for their children, pursue an education, and support their families.

For more on how parents and families would benefit from extending health insurance coverage, please revisit the Many Working Parents and Families in Georgia Would Benefit from Extending Medicaid Coverage report from GHF and the Georgetown Center on Children and Families.


Your story is powerful! Stories help to put a human face to health care issues in Georgia. When you share your story, you help others understand the issue, its impact on Georgia, and its importance.

Your health care story is valuable because the reader may be your neighbor, friend, someone in your congregation, or your legislator. It may inspire others to share their stories or to become advocates. It is an opportunity for individuals who receive Medicaid or fall into the coverage gap, their family members, their physicians and concerned Georgia citizens to show that there are real people with real needs who will be impacted by the health policy decisions made by Congress and Georgia’s state leaders.

Share your story here!


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GHF and Step Up Savannah partner to host health advocacy training

Georgians for a Healthy future partnered with Step Up Savannah to host a health advocacy training on Tuesday, April 3rd.  Advocates learned how they could participate and lead health advocacy efforts in their own community and received information about pressing health advocacy issues in Georgia. Representatives from Healthy Savannah and the Chatham County Safety Net Planning Council were also in attendance to share local resources.

The significance of Medicaid was highlighted throughout the event. Participants learned that Medicaid primarily covers low-income children, people with disabilities, seniors, and pregnant women, including 40,000 of Chatham County residents. Alyssa Green, GHF’s Outreach & Education Manager, discussed Georgia’s opportunity close the coverage gap so that 240,000 more Georgians would have access to health insurance coverage. Alyssa shared the story of a Georgia woman who works part-time at DisabilityLINK but is stuck in the coverage gap and, as a result, has trouble managing her high blood pressure.

GHF’s Executive Director Laura Colbert introduced ways that people can advocate for the health care issues that matter most to them, like increased access to healthcare, bringing down health care costs, and protecting the Medicaid program. She explained how to build a relationship with legislator, communicate support or opposition for significant bills, and other forms of advocacy.

The training concluded with presentations from the Chatham County Safety Net Planning Council and Healthy Savannah. The two Savannah-based organizations provided participants with information and resources to promote and build a healthy local community.

 

If you are interested in hosting a training like this in your community, please contact Alyssa Green at agreen@healthyfuturega.org or 404-567-5016 x 2 for more information.


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The 2017 Legislative Session is underway!

Georgians for a Healthy Future will be at the Capitol throughout the forty-day session to monitor health-related legislation, serve as a voice for health care consumers, and keep you informed about opportunities to engage and take action. For the past four years, our top legislative priority had been closing Georgia’s coverage gap by expanding Medicaid. In the wake of the 2016 election, the national policy landscape has shifted considerably, knocking that off the table this year and placing existing coverage, care, and consumer protections at risk. Despite this backdrop of uncertainty and a critical need for federal advocacy, there will be important decisions made over the next three months at the state level that impact the health of individuals, families, and communities.

 

While it is early, here are the major health care issues we preliminarily expect legislators to tackle in 2017:

  • Renewal of the provider fee commonly known as the “hospital tax” or “bed tax” to help fund Medicaid and keep hospital doors open
  • Development of a set of reforms to improve mental health services based on the recommendations of a legislative study committee that has been meeting over the past several months
  • Creation of a “repeal” task force to assess the impact of changes to or repeal of the Affordable Care Act on Georgia
  • Addressing the practice of surprise medical billing, which can leave insured consumers with unexpected bills when a health care provider is out-of-network
  • Increasing reimbursement rates for certain primary care services for health care providers participating in Medicaid
  • Improving access to dental care for children, seniors, and people with disabilities

 

Georgians for a Healthy Future has several ways for you to stay up-to-date on what’s happening under the Gold Dome this year:

 

Stay tuned for updates throughout the session.

 


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Action Alert: #ProtectOurCare

The President-Elect and Congressional leadership are already working to repeal the Affordable Care Act, but have not yet communicated what a replacement might be. Repealing the law without an adequate replacement would do great harm to consumers, destabilize Georgia’s health insurance market, and stress our health care delivery system. It´s important to take care of your health in every way possible, if you happen to have issues such as stress or depression, especially Teen Counseling, buy kratom a natural drug that fights these issues immediately as cannabis products which are found in a cannabis store, you can also check Afinil which will help you out as well, read also is CBD good for you. If you want to know our special health care you can visit healthyhempoil.com.
Approximately one million Georgians would lose their health insurance by 2019, bringing the number of uninsured in our state to a staggering 2.4 million people – more than before the ACA was passed. Millions more would lose their basic rights and protections as consumers, and access to care would be at risk. We could lose:

 

  • Protections for people with pre-existing conditions from being charged more or from being barred from coverage. Pre-existing conditions include chronic diseases like diabetes, mental health conditions, asthma, cancer, and more
  • Protections that keep women from being charged more than men
  • Free preventive care
  • The ability to keep young adults on their parent’s plan until age 26
  • Financial protections that limit the amount of money consumers must pay out-of-pocket each year for care and that keep insurers from limiting lifetime benefits
  • Anti-discrimination provisions that protect consumers based on sex, gender identity, language spoken, or country of origin
  • Health insurance navigators who offer free, local, unbiased assistance to help people find the health care coverage that works best for them. It is nice to help people and care for them, encourage them physically, spiritually, and emotionally made by CDPAP services.

 

We need your help!

 

Members of Congress value what their constituents think, and the battleground over repeal will be focused on the United States Senate. Senators Isakson and Perdue need to hear from you today. Please call them at 202-224-3121 and tell them “Repealing the health care law without a replacement will affect everyone, particularly the one million Georgians who will lose coverage. Don’t take away our health care.”
Want to do more?

 

Please also consider sharing your health care story with us or with your Member of Congress or United States Senator. Federal policymakers need to hear the stories of their constituents whose basic access to coverage and care hangs in the balance before they make any decisions that impact your health care.

 

Follow #ProtectOurCare and GHF on Twitter and Facebook for updates and action alerts.

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Policy and advocacy opportunities to get Georgia covered

policy-prioritiesTremendous progress has been made over the past three years in increasing enrollment into health insurance that facilitates access to care and provides financial protection for individuals and families across the state of Georgia. However, too many Georgians are still uninsured, the trends toward narrow networks and consolidation within the health industry threaten to negatively impact access to care, and consumers express concerns about affordability. Addressing these issues will require collaboration between enrollment and health care stakeholders, advocates, and policymakers. Here are three things Georgia lawmakers can do to ensure that all Georgians have access to the quality of care they need.

  1. Close the coverage gap – Despite robust Marketplace enrollment in Georgia, we still have one of the highest uninsured rates in the nation, largely because our state policymakers have not yet closed the coverage gap. Georgia’s enrollment assisters have repeatedly expressed to advocates that this is the biggest barrier to enrollment that their consumers face.
  2. Addressing Affordability – Rate review is an annual process during which insurance companies submit their proposed plan rates for the coming year to be reviewed by state and federal regulators. We encourage state regulators to scrutinize these rates closely to ensure they are justified and to request adjustments if they are not. We also encourage policymakers to explore emerging approaches in health care payment and delivery reform that hold the potential to enhance value for consumers.
  3. Ensuring Access to Care – We encourage policymakers to build on the progress made by SB 302 by enacting comprehensive network adequacy standards in 2017.

For more details on policy and advocacy opportunities and our findings from research around the third open enrollment period, download our new report, Getting Georgia Covered: What We Can Learn from Consumer and Assister Experiences During the Third Open Enrollment Period.


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Q&A with A Spirit of Charity author Mike King

Final book cover-1
Georgians for a Healthy Future’s Executive Director Cindy Zeldin sat down with A Spirit of Charity author Mike King to discuss his new book on the role of public hospitals in America. Below is a Q&A that delves into some of the book’s major themes. On July 19th, Georgians for a Healthy Future will hold a book event in Atlanta with Mike King, providing a unique opportunity for the advocacy community to discuss the history and role of public hospitals in America and the direction of health policy in Georgia with the author.

 

 

MK_CZ_Q&A

Why did you decide to write this book?

I have been writing and editing stories about medicine and natural medicine like thai kratom powder and health care policy for about 30 years where they use different kind of medicines, you could for example this reach out to one!. When the newspaper business collapsed and I chose to leave it in 2009, I thought I’d just retire and take it easy. But when the Affordable Care Act passed in 2010 I realized I had the time, without daily deadline pressures, to tell a story about the most important effort at reform over the last 50 years and how it might play out right here in Atlanta and at Grady in particular,.

 

 

How do public hospitals serve as a window into America’s health system?

As the book hopefully makes clear, the people who show up in the emergency rooms and clinics of America’s public hospitals are the result of all gaping holes, political compromises and unintended consequences of decades of attempts to reform our health care system. Even in our noblest of efforts, we always seem to leave whole segments of our society behind. Donald Trump, in a candid moment earlier in the campaign when the media pushed him for more details about what his alternative to Obamacare would look like, frustratingly blurted, “Look, we won’t let people die in the streets, OK?” In some ways that’s been our baseline as a health care system from the start, which is why public hospitals were created. We don’t let our citizens die in the streets. They get sick in the street but, if they are lucky, we get them to a public hospital that hopefully will rescue them from dying before they return to the streets. That’s a harsh assessment, I know, and we do much better than that in many places thanks to the commitment of engaged local and state leaders, but there are too many places where the local public hospital seems expected to shoulder this burden on its own.

 

Four of the five hospitals profiled in your book are located in the South, and the role of Southern politicians in crafting U.S. health policy is explored throughout the book. Why a focus on the South?

Because the South is where the most problems are. Texas, Florida and Georgia lead the nation in the dubious distinction of having the most uninsured residents among all 50 states – mostly because all three have refused to expand Medicaid the way the ACA called for. Louisiana is high on the list too, but the new governor there is moving to try to expand Medicaid. Parkland Memorial Hospital in Dallas, Jackson Memorial in Miami, the University Medical Center in New Orleans (the replacement hospital for Charity) and, of course, Grady, all have to contend with a huge percentage of patients who are poor and uninsured and could be, should be, covered by Medicaid. That’s why I chose them.

 

Some public hospitals like Grady were established during segregation. The 1946 Hill-Burton Act, which catalyzed hospital construction, contained a provision permitting segregation in hospitals receiving federal funds. How does this legacy of segregation impact public hospitals today?

Hill-Burton was the first time federal law actually codified a separate-but-equal funding mechanism and it was inserted into the law specifically to get members of Congress from the South to go along. Rural hospitals around the South and more than a few in the suburbs were built in the 1950s and 60s with Hill-Burton money. Grady was rebuilt as a segregated hospital in 1958. After the enactment the Civil Rights Act in 1964 and Medicare in 1965 that changed. Segregated hospitals – public and private – stood to lose too much money that they would be getting for the care of previously uninsured elderly patients if they stayed segregated. But there is still a legacy to overcome. There’s a reason elderly Atlantans still refer to Grady as the Gradies, going back not that long ago to when there was a Black Grady and a White Grady, with black nurses taking care of black patients and white nurses taking care of white patients. It still complicates the public discussion about how best to finance and administer this particular public hospital. I suspect that goes on in a lot of communities around the South that share a similar legacy.

 

You write that public hospitals serve as a “pressure release valve” for our nation’s health system. What do you mean by this?

We often refer to these places as safety net hospitals. But I contend they are more than that. The existence of a single hospital in a community that is chartered or required to take in all patients regardless of ability to pay fundamentally alters the medical marketplace in that community. It allows those hospitals that compete with it to measure their anticipated level of charity care against their expected revenue from insured patients and come up with a formula that helps them stay healthy and able to grow. It is not that most of these competing hospitals don’t provide a responsible level of charity care. Most of them do. But it is always at a level they can afford to provide. Public hospitals operate on a totally different business model. They have to take all comers and the only way they can stay open is to get some level of funding from state and local taxes to offset their losses. Here’s another way of looking at it: If Grady had gone belly up in 2007 and 2008, all the uninsured and indigent patients it served would have swamped the emergency rooms of Piedmont, the Atlanta Medical Center, Northside, St. Joseph’s, Emory and DeKalb Medical as well as other hospitals, jeopardizing their ability to provide the level of services their business model calls for. The safety valve would have blown.

 

Information about Medicaid, the health care program intended to help finance care for low-income Americans, is interwoven throughout your book. How are the histories and fates of Medicaid and public hospitals intertwined?

MK_CZ_Q&A2They are the key to understanding each other because Medicaid patients make up a large portion of the patients who go to these hospitals. When Medicaid was enacted in 1965 the theory was that with a health insurance program now in place for the poor and with Medicare available to the elderly, our nation’s public hospitals would finally start getting paid for many of the services they had been providing on a charity basis. But unlike Medicare, Medicaid was hampered – I would argue fundamentally flawed – by a series of compromises to get it through Congress. States were given a much bigger role in determining how poor you had to be to qualify for Medicaid, how much they wanted to pay doctors and hospitals to provide services for Medicaid patients and indeed whether they wanted to participate in the program at all. (Arizona didn’t join Medicaid until the 1980s.) The result was a checkerboard of health care programs for the poor around the country, based largely on what the states decide. And in the South, Medicaid has been chronically underfunded at the state level and treated more like a welfare program. This is how Southern politicians get away with calling it a failure. They starve it for funds, make it difficult for low-income people to get covered by it, grossly underpay doctors and hospitals that take patients covered by it and then decry the program for not working and being inefficient.

 

America’s health system is characterized by fragmentation. Why do you think this is and what is the role of public hospitals in a fragmented system?

We’ve all heard it before. America has a sick care system, not a health care system. And that system is based on who pays for sick care, not necessarily how we can more effectively pay for care to help keep people healthy. The good news is that the ACA is moving in the direction of breaking down some of the silos that have developed over the decades in how we deliver and pay for health care, with an emphasis on moving away from paying a fee for specific services and toward paying for overall wellness. That’s good. But it will take years to see results. Public hospitals will need to move in this direction as well – and some of them are. Cook County’s Medicaid Program (County Care) is coordinating care with its community hospital and clinic network and the federally funded community health centers in Chicago. The initial results look encouraging. If it works it will not only save lives but help control the rise in costs. But public hospitals must adapt to these new models and remain, in most large cities, the sole providers of costly essential services like trauma, HIV/AIDS and behavioral health for those who are still uninsured.

 

You write that, if public hospitals didn’t exist, “We would have to invent them.” What would an America without public hospitals look like?

It would be fascinating to see, wouldn’t it? Public hospitals were created one hundred to one hundred and fifty years ago when it became obvious that the charitable institutions in large American cities could not meet the demand for care caused by yellow fever, cholera, pestilence and other public health threats, not to mention the population growth in cities after the Civil War. The almshouses and infirmaries, often staffed by religious women and funded by churches and community groups, just could not keep up. I suspect the same would happen today if we came to rely exclusively on the nonprofit sector to take over the responsibility for caring for the poor and uninsured. Even if we became enlightened and created a system of true universal insurance for all Americans, there would still be a need for expensive specialty areas. Trauma care, infectious disease programs, severe, chronic mental health services – these essential services now almost exclusively provided by public hospitals – I would suspect they would require some level of local and state financing at a public facility that would go beyond what they can expect in the way of revenue from a public insurance plan.

 

Grady is featured prominently throughout the book. What did you learn about Grady by writing this book that you didn’t know before?

That it is even bigger and more complicated and harder to manage than I ever dreamed. I think the current administration there is doing a really good job at getting the hospital positioned to be everything it can be. The quality of the specialty services there – trauma, neuroscience, neonatology, burn care, sickle cell, infectious disease – has probably never been better, and they get well informed visiting Litchfield Neurofeedback to learn about the benefits of Neurofeedback Therapy. The cancer program there, in addition to being first rate at the acute care level, is making great strides in the community in the much-needed area of early detection and treatment. That will go a long way toward reducing the disparities that exist in morbidity and mortality between white and black, affluent and poor residents of our community. But the hospital is still heavily reliant on the business and philanthropic community to grow, especially when it comes to capital improvements and equipment. That’s all been private money since the comeback started. State and county officials have yet to step up to the plate to help. If they are willing to help the Braves and the Falcons build new venues, they must be willing to step up to help Georgia’s most important hospital build and grow and provide essential services.

 

What role does Grady serve in health care policy in the state of Georgia?

The state needs to recognize Grady is a statewide institution, if for no other reason than it is the training ground for about one in every four doctors practicing in Georgia. I’ve often wondered whether the state’s relationship with Grady would be different if it had been affiliated with a state medical school instead of Emory and Morehouse – two private medical schools. Perhaps then it would have paid more attention to it. Even though Grady gets patients from almost every one of Georgia 159 counties, it isn’t realistic to think the state must subsidize indigent patient care there, but it could do much better and providing funding for the specialty services that Grady provides to all Georgians – trauma care, burn care, infectious diseases, etc. And, of course, it should expand Medicaid coverage so that Grady and all other hospitals in the state that have a heavy load of uninsured patients will at least have an opportunity to recoup some of their costs.

 

Where do you think Georgia is headed on health care policy? 

I think we’ll expand Medicaid. Eventually. After President Obama is in the rear view mirror. We’ll call it something else so it doesn’t sound like it is part of Obamacare. But we will have squandered $3 to 5 billion and 100 percent federal funding to make this impetuous political statement, and no telling how many Georgians – one study puts it at 1,200 lives a year – who died because they lived in a state where they should have, but were kept from, enrolling in Medicaid. With a little political vision – and the help of advocates and experts – my hope is that we could create a Medicaid program that isn’t so fragmented; that fully integrates primary care and acute, hospital care; that reorganizes local hospitals and health departments into a true public health system that helps people stay healthy and when they get sick have no barriers to the care that they need. That shouldn’t be a pipe dream in a country as wealthy and smart as ours. That should be a working reality. On the other hand, try to visit what is a medium.

 

 

 

 


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Rural Health Care in Georgia

rural quoteRural Georgians experience health disparities on multiple dimensions: they are less likely to have job-based health insurance, may have to travel long distances to seek medical care, and experience higher rates of chronic health conditions than their suburban and urban counterparts. Compounding these challenges, several rural hospitals have closed their doors in recent years and others are at risk of closure.

While there are no easy answers to Georgia’s rural health crisis, an array of stakeholders including policymakers, the philanthropic community, health care providers, local community groups, and advocates have been exploring ways to strengthen our state’s rural health infrastructure.

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As part of its Two Georgias initiative, the Healthcare Georgia Foundation recently released its findings from a “listening tour” with health care providers and policy organizations in Georgia, including Georgians for a Healthy Future. The report offers a window into what practitioners and policy advocates are thinking about the direction of rural health care and the use of Hidrex for excessive sweating and how it can be improved. Check out the write-up to learn more about rural health and about how Georgians for a Healthy Future’s campaign to close the coverage gap in Georgia fits in.

You can stand with us by sharing this infographic with your social network. Use sample tweet: Our rural hospitals are hurting – but it does’t have to be that way. It’s time we accept federal #funding to #closethegap.


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Pride and LGBT health care in Savannah

Savannah PrideAt Georgians for a Healthy Future, we pride ourselves on strong partnerships. Over the past few years, we have been collaborating with Georgia Equality and the Health Initiative to ensure that the health care needs of LGBT Georgians are not neglected.

These partnerships brought Whitney Griggs, GHF’s Consumer Education Specialist, to Savannah on September 12th for the annual Savannah Pride Festival. Together with the Health Initiative, Whitney distributed information related to LGBT health care needs and spoke to festival attendees about how to enroll in health insurance.  Of particular interest was our joint fact sheet with Georgia Equality on Transgender Health Care. Some of the festival attendees who picked up this fact sheet shared stories of having been denied coverage due to being trans-identified in the past, but who can now get coverage that meets their needs because of the Affordable Care Act. People that stopped by the table were also interested to learn that health care services must be provided regardless of gender identity or expression. This means that health insurance plans must cover transition-related care, as long as that care is covered for cisgendered people under on the same plan. So services such as hormone replacement therapy and gender-specific care (like mammograms and prostate exams) must be covered if they are covered for other people enrolled in the same plan.

Whitney also gave out some tips for trans-identified folks to keep in mind when enrolling in health insurance:

  • On all enrollment forms, check the sex box that matches the sex you believe is on file with the Social Security Administration.
  • Some important questions to ask include:
    • Is hormone replacement therapy covered?
    • Is my doctor included in the plan’s network?
    • Is there a network of trans-friendly doctors and/or doctors who have training working with or currently serve trans clients?
    • Are reconstructive surgeries covered?

All in all, it was great day in Savannah (despite the rain) and people learned a lot from GHF and the Health Initiative.

If you have a specific question about LGBT health care and health insurance, feel free to reach out to Whitney Griggs at wgriggs@healthyfuturega.org or the Health Initiative at (404) 688-2524


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Road trip! Coverage gap is a big theme in Augusta outreach

Augusta.riverwalk.bridgeWe (Consumer Education Specialist, Whitney Griggs, and Community Outreach Manager, Laura Colbert) made the drive to Augusta this week to check in with health care stakeholders and consumers in the northeast Georgia city.  We were warmly welcomed by community partners and are excited to return for next week’s community forum Coverage and Access to Care: A Local Focus on Augusta.

Our primary purpose for the trip was to attend the Greater Augusta Health Network’s (GAHN) fall forum.  The forum covered a variety of topics, including how the local District 13 Department of Public Health provides much needed direct patient services to people in its service areas, GAHN’s on-going health care utilization data collection efforts, and the Affordable Care Act’s effect on small employers (51 to 99 employees).

The forum closed with a discussion panel of indigent care providers, including Medical Associates Plus, St. Vincent de Paul health clinic, and Christ Community Health Services. These providers described their determined efforts to provide care for Augustans who cannot afford health insurance or pay for their health care. Mentioned by all three panelists was the need to close Georgia’s coverage gap. Every day each clinic serves people who need health care coverage, like veterans who can’t get are at the VA. The clinics are able to do this work only because of generous donations and profits from a few insured patients. While these charity care clinics are doing amazing work, they say that they cannot provide all the care that is needed for Augustans in the coverage gap.  Each of the panelists made the case that closing the coverage gap would be great for their patients and clients, and for their clinics.

Photo Sep 15, 1 48 20 PMChrist Community Health Services generously hosted us in the afternoon, so we could talk to their patients about why closing the coverage gap is important to them. One of the patients they talked to was Tracy. Tracy has chronic pain in her back, and is managing anxiety and depression brought on by her back pain. Her pain makes it impossible for her to sit at a computer to do her graphic design work, which means she has no income and no health care coverage. Tracy is stuck in the coverage gap, I told her that There are several good CBD companies to choose from when shopping online and that’s something that may help her. Her mother, Maria, pays what she can for Tracy’s care and drives her to and from appointments.  Tracy told us that she isn’t asking for a hand-out, she “just wants the public benefits that I paid into when I was working.”

It was clear from our visit that closing the coverage gap is an important issue to health care stakeholders and consumers in Augusta.  To learn more about the coverage gap in Augusta and in Georgia, join us for a community forum next Thursday, September 24th.

RSVP here.


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Ensuring health coverage for all Georgians

GHF 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.

  1. Close the coverage gap in Georgia. Approximately 300,000 Georgians fall into the coverage gap, meaning they do not qualify for Medicaid under existing income eligibility guidelines in Georgia but their income is still too low to qualify for financial assistance (tax credits) to purchase health insurance on the Marketplace. Eligibility for tax credits begins at 100 percent of the Federal Poverty Level, or $11,770 for an individual or $20,090 for a family of three in 2015, while Medicaid eligibility for most adults in Georgia cuts off at income much lower. Thirty states including DC have closed their coverage gaps thus far with promising results. We encourage Georgia policymakers to take this important step as well to ensure all Georgians have a pathway to coverage.
  2. Set and enforce network adequacy and transparency standards. Many of the plans sold through the Health Insurance Marketplace are Health Maintenance Organization (HMO) plans that feature narrow provider networks. While these narrow networks can help keep premiums down, a trade-off many consumers may be willing to make, consumers do not currently have sufficient information to make this choice. There is no information available to consumers at the point of sale about whether a provider network is ultra narrow, narrow, or broad, and provider directories are routinely inaccurate. More transparency and oversight are needed to ensure that consumers have accurate and useful information to make these choices. It is also important that all provider networks allow for meaningful access to all covered benefits. To ensure this, we support putting in place and enforcing network adequacy standards.
  3. Encourage public-private partnerships and remove unnecessary restrictions on consumer education and assistance. Many of the enrollment assisters we surveyed indicated that reducing barriers to partnering with state government organizations such as public colleges, universities, and health departments would lead to stronger and more effective partnerships. Specifically, many respondents indicated that improved coordination between enrollment assisters, the Marketplace, and the Georgia Department of Community Health (DCH) to better facilitate PeachCare for Kids and Medicaid enrollment would be helpful. The “Health Care Freedom Act,” passed in 2014 as part of HB 943, prohibits state and local governmental entities from operating a health insurance navigator program and places other limitations on governmental entities. This provision has been counterproductive, creating confusion around what educational and consumer assistance activities local entities can engage in as they work to serve their community members. We recommend lifting these restrictions.

 


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Aug 3, 2018
Ruling allows for purchase of cheaper insurance
Andy Miller

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

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