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
Last week, Virginia became the latest state to expand health care coverage to low-income adults when the Virginia legislature voted to close the its coverage gap and Governor Northam signed the new budget. More than 400,000 Virginians are expected to gain coverage as a result, and the state anticipates declines in uncompensated care costs for hospitals, an increase in people receiving needed health services, and greater financial security for those set to gain coverage. The vote comes after years of advocacy and engagement from constituents and advocates who worked to convey to legislators the importance of health coverage and the impact the change would have on the lives of hundreds of thousands of Virginians.
Unlike Virginians, 240,000 hard-working Georgians cannot yet look forward to putting a health insurance card in their pockets. These friends and neighbors make too little to get financial help to buy health insurance and don’t qualify for Medicaid in Georgia, leaving them stuck in the state’s coverage gap.
Georgia remains one of 17 states that is still refusing billions in federal health care dollars to provide health coverage to low-income adults in the state. As in Virginia, Georgia’s Governor and state legislature can choose to close the coverage gap at any time, and here are five reasons they should do so as soon as possible:
- Thousands of Georgians would gain health coverage–240,000 Georgians would gain the peace of mind, access to care, and financial protection that insured Georgians have. These Georgians make less than $12,140 a year or $20,780 for a family of three. Most are working in sectors like retail, child care, construction, and food service, low-paying jobs that do not come with benefits.
- Georgia’s rural hospitals are economic anchor institutions–rural communities need their hospitals to provide accessible healthcare, sustain well-paid jobs, and facilitate economic stability. Closing the coverage gap would create at least 12,000 new jobs and $1.3 billion in new activity in Georgia’s rural communities each year.
- The resulting job growth is greater than what the state would gain by attracting Amazon’s HQ2–extending health coverage to more Georgians would create 56,000 new jobs across the state, more than the 50,000 jobs that Amazon is promising at its second headquarters. Even better, the new jobs would be scattered across the state rather than concentrated in and around Atlanta.
- Georgia’s tax dollars are currently sitting unused in Washington, D.C.–By refusing to extend health insurance to low-income Georgians, the state is missing out on $8 million per day ($3 billion dollars per year). Instead of giving up hard-earned tax dollars, Georgia’s policy makers could bring that money back to the state to help low-income parents, veterans, and workers put health insurance cards in their wallets.
- It is the biggest step Georgia can take to slow the substance use crisis —One quarter (25%) of Georgians who fall in the coverage gap are estimated to have a mental illness or substance use disorder. If they were covered by health insurance, treatment and recovery services would be within reach, allowing them to resume full, healthy lives. As a result, 36,000 fewer Georgians each year would experience symptoms of depression and the state could make significant progress in addressing its ongoing substance use crisis.
After five years of delay, Virginia’s leaders made the right decision and as a result, 400,000 Virginians will see healthier futures. Now is the time for Georgia’s decision makers to follow suite by putting 240,000 insurance cards in wallets all across the state.
Virginia State Capitol Image – Skip Plitt – C’ville Photography
Georgians for a Healthy Future hosted an educational forum titled Strong Foundations: Building a System of Care to Address the Behavioral Health Needs of Georgia Children on Tuesday, May 15. The forum explored the behavioral health needs of Georgia children and youth, Georgia’s publicly-supported behavioral health landscape, and successes and opportunities in the current system of care. The event also raised awareness about Georgia’s system of care in an effort to improve access to behavioral health services for children and youth.
The event began with Respect Institute speaker Tammie Harrison, who shared her experiences navigating the behavioral health care system and getting to a place of recovery.
Because many of the event attendees were new to the topic of children’s behavioral health (BH), GHF’s Executive Director Laura Colbert provided some foundational information about the prevalence of children’s BH conditions, contributors to poor BH, and the pathways to BH care and supports for young Georgians. You can find Laura’s PowerPoint slides here. She also debuted GHF’s new behavioral health fact sheet.
Dante McKay, Director of the Office of Children, Young Adults, & Families at the Georgia Department of Behavioral Health & Developmental Disabilities (DBHDD) provided attendees with an overview of DBHDD’s work, the 2017 System of Care state plan, and how the recently signed FY19 budget would impact the department’s ability to serve Georgia children and youth.
Dr. Erica Fener-Sitkoff, Executive Director of Voices for Georgia’s Children moderated a panel discussion of BH service providers, which included Wendy Farmer of Behavioral Health Link, Laura Lucas of Project LAUNCH (DBHDD), and Monica McGannon of CHRIS 180. The panelists discussed barriers to accessing BH services, which they said include continued stigma, lack of trained workforce, and transportation. The panel also identified innovative efforts, like Project LAUNCH and mobile crisis services, to bring BH services closer to consumers when and where they need it. When asked how Georgia’s next Governor could continue to make progress in the area of children’s behavioral health, panelists suggested a focus on workforce development, increasing access to community-based substance use treatment for teens, and prevention and early intervention.
If you missed the event, a recording of the webcast is available here.
To see photos, review materials, and read more about our Strong Foundations event, please visit the event page.
Despite several missed opportunities to address consumer health concerns during this year’s state legislative session, the FY2019 budget includes several impactful investments. Last week, Governor Nathan Deal traveled through Georgia and held budget signing ceremonies in Atlanta, Acworth, Blue Ridge, Statesboro, and Tifton for the $26 billion spending plan which will begin on July 1 of this year through June 30, 2019. The infusion of dollars into children’s mental health is especially noteworthy and exciting because of the impact it is expected to have across the state.
Governor Deal has recently made children’s behavioral health one of his top health care priorities and this year included in his proposed budget $20.6 million to fund recommendations from the Governor’s Commission on Children’s Mental Health. During its consideration of the state budget, he legislature ultimately increased the funding dedicated to these recommendations to $21.4 million.
These funded recommendations include behavioral health crisis services, supported employment and education for young adults with behavioral health needs, provider training and telehealth, and opioid abuse prevention for youth. Funding for suicide prevention will in part go towards expanding the capacity of GCAL, the Georgia Crisis and Access Line, which provides 24/7 online and telephone support for people who are seeking services for developmental disabilities, mental health, or substance use issues. Some of the additional funding is also dedicated to the Georgia Apex Program, a school-based mental health program that improves early identification, access to and coordination of needed behavioral health (BH) services for children with BH needs..
In the coming months, we will break down the Commission’s funded priorities and their impact on young Georgians. Look for our Healthy Minds, Healthy Bodies blog mini-series.
Looking for more information on this topic? Georgians for a Healthy Future will be hosting an educational forum later this month during which we will explore the behavioral health needs of Georgia children and youth, Georgia’s publicly-supported behavioral health landscape, and successes and opportunities in the current system of care. Join us in person or via webcast for this exciting and important event!
Surprise billing legislation progresses in both chambers
Both SB 8 and HB 71 were passed out of their respective Senate and House committees late last week. SB 8 has been held up because of a dispute between insurers and health care providers about reimbursement. The bill was amended to establish out of network payment for disputed charges at the 80th percentile of the “Fair Health” metric and was subsequently passed by the Senate Health & Human Services committee. HB 71 seeks to compel physicians who are credentialed at hospitals to accept an in-network rate when the patient is in-network at the hospital, even if the physician is not. It was passed unamended by the House Insurance Committee. Both bills await approval in the Rules Committees to receive floor debates and votes.
House passes FY2018 budget
The House of Representatives passed its version of the FY2018 budget on Friday. The budget includes increased reimbursement rates for certain primary care codes for Medicaid providers. Increased reimbursement rates are also funded for certain dental codes in PeachCare for Kids and Medicaid. The budget includes funds for two new federally qualified health centers in Cook and Lincoln counties, and 97 new primary care residency slots. The FY 2018 budget is now being considered by the Senate, which is expected to make its own changes before issuing its final approval. Check out Georgia Budget and Policy Institute’s blog and budget primer for more detailed information about how Georgia spends its health care dollars.
WHAT HAPPENED LAST WEEK
Changes to rural hospital tax credits
HB 54, introduced by Rep. Duncan, would expand the new rural hospital tax credit program from a 70% credit to a 90% credit, among other minor changes. The tax credit program went into effect this year, after enabling legislation was passed in 2016. The proposal to increase the tax credit to 90% came after legislators received feedback that the 70% credit was too low to entice potential donors. HB 54 was approved by the House Ways & Means committee on Feb. 9, and now awaits passage in the House Rules Committee.
Opioid abuse prevention bill
SB 81 remains in the Senate Rules Committee waiting for approval for floor debate and passage after committee approval late last week. The current version of the bill requires that all physicians register and consult the Prescription Drug Monitoring Program (PDMP) under certain prescribing conditions. It also requires that providers report certain opioid-based Schedule II, III, IV, and V prescriptions to the PDMP. The bill sets the penalty for willfully non-compliant providers on a continuum that ranges from a warning to a felony and fine for a fourth offense and beyond. The bill also requires the tracking and reporting of Neonatal Abstinence Syndrome (NAS) and codifies the Governor’s emergency order on an overdose reversal drug (naloxone), making it available without a physician prescription.
MARCH WITH US!
This Saturday: Atlanta March for Healthcare
Yesterday, we rallied at the Save My Care bus stop, and Saturday we will march at the Atlanta March for Healthcare! Join us as we fight to preserve the Affordable Care Act and the protections that it provides for Georgians. Hosted by the Georgia Alliance for Social Justice, the march will cap Congress’s week of recess and send them back to D.C. with the charge to #ProtectOurCare!
Saturday, Feb. 25, 3-5 pm
Gather at St. Mark’s United Methodist Church
We seem to be approaching cross-over day at the speed of light! Last week saw progress towards increasing provider directory transparency, Medicaid payment parity, ending surprise out-of-network billing, and even closing the coverage gap! Check out our updates below. If you’re looking for a complete list of all the bills we’re following, click here.
WHAT HAPPENED THIS WEEK
The Provider Directory Improvement Act (SB 302)
Last Thursday, the Provider Directory Improvement Act was passed unanimously out of the Senate Insurance and Labor committee. The bill now goes to the Rules Committee. We’re excited about the progress made and will keep you posted as the bill continues to move through the process. You can review our fact sheet on SB 302 and read our longer policy brief on the importance of accurate provider directories here.
Closing Georgia’s Coverage Gap
Last week, the Georgia Legislature held its first-ever hearing on closing the coverage gap. Closing the gap is the most important step our state policymakers can take to lower the number of uninsured, improve access to care, and stabilize the rural health infrastructure in our state. The hearing focused on discussion of SB 368, legislation introduced by Sen. Rhett to extend coverage to low-income, uninsured Georgians. While some pieces of the bill are problematic and the committee took no action, they started an important conversation. If you are interested in getting involved in the movement to close the gap, join our Georgia Health Action Network (GHAN) to receive updates on how you can help! If your organization supports closing the gap, please consider joining the Cover Georgia coalition to help amplify your voice.
Surprise Out-of-Network Billing
On February 16th, Sen. Unterman introduced SB 382, the Surprise Billing and Consumer Protection Act. This bill has been scheduled for a hearing today at 3:00 PM in the Senate Health and Human Services Committee. Addressing surprise out-of-network billing is an important issue for Georgia consumers, and the legislation is complex. Sen. Unterman has simultaneously also introduced SR 974, the Senate Surprise Billing Study Committee. Should SB 382 not move during this session, SR 974 provides legislators with the opportunity to study this important consumer issue during the off-session period.
Medicaid Payment Parity
The governor’s budget, introduced earlier this legislative session, maintained last year’s partial Medicaid payment parity. Full Medicaid parity would allow doctors to be reimbursed at the same rates for seeing Medicaid patients as Medicare patients. Last week, $26.5 million was added to the FY 2017 budget for this purpose. While this does not restore full parity, it is a significant step towards that goal. The FY 2017 budget has passed in the House and goes to the Senate for consideration.
Rep. Duncan’s HB 919 would provide up to $250 million in tax credits to individuals or corporations for contributions to rural health care organizations. This legislation has sparked a conversation about the ever worsening plight of our rural hospitals. However, state funding could be better utilized by helping those in rural communities get health insurance coverage, an approach which would also draw down considerable federal dollars (at least $9 in federal funding for every $1 of state funding). This would be much more effective in reducing the uncompensated care burden of rural hospitals, while also providing patients with the benefits of health coverage, something that HB 919 does not accomplish in its current form. Because of this session’s multiple bills that attempt to address Georgia’s uninsured population and health care infrastructure, we hope that lawmakers will take this opportunity to consider these issues in tandem through a study committee. This will allow all stakeholders to take part in an open conversation about how to best utilize state and federal dollars to save our rural hospital and provide quality health care to all Georgians.
In this week’s Consumer Health Advocacy Today, we sit down with Sen. Rhett to talk about his proposal to close the coverage gap. Here’s what he had to say.
Georgians for a Healthy Future and the Georgia Budget and Policy Institute are proud to release our joint publication: Understanding Medicaid in Georgia and the Opportunity to Improve It. Inside you will find infographics, new data, and compelling charts that simplify the complex issue of Medicaid in Georgia.
Part one explains who gets Medicaid in Georgia, how Medicaid protects Georgians during economic downturns, how Medicaid controls costs in the state, and more.
Part two outlines Georgia’s opportunity to close the coverage gap. Here you’ll find out what Georgia’s health insurance coverage gap is, how we can use Medicaid to close it, and who stands to benefit detailed by job sector, demographics, and veteran status.
Part three details economic and social benefits of closing the coverage gap. Why is closing the coverage gap a good deal for Georgia and the state’s economy? What are the savings other states realize by closing the gap? How does coverage affect a person’s financial and physical health?
Download the chart book here.
The pre-game to the 2016 Georgia legislative session kicked off with the convening of House and Senate study committees last week. Study committees meet during the off-session to take a deeper dive into specific policy issues that may arise when the session gets underway. Each committee will produce a report on its findings and recommendations by the end of the year and potentially introduce legislation during the 2016 session. Click here for a complete listing of House and Senate study committees.
GHF is following and participating in health-related study committees that directly impact consumers. Here’s what you need to know.
Senate Study Committee on the Consumer and Provider Protection Act (SR 561)
In light of changing practices and norms in the insurance market Senate Bill 158 the Consumer and Provider Protection Act was introduced in 2015. This bill outlined provisions for consumer and provider protections regarding health insurance and created the Senate Study Committee on the Consumer and Provider Protection Act. The aim of this committee is to understand how the current insurance environment is affecting the stability of providers and consumers’ access to care. The committee consists of legislators and representatives from the provider, insurer, and consumer communities, including GHF’s Executive Director Cindy Zeldin as the consumer representative. The committee plans to examine the operations of rental networks, contractual issues between insurers and providers, and network adequacy.
The first meeting of this committee was held on September 14th at the State Capitol and focused on “rental networks,” also known as silent PPOs. The committee heard testimony from physician and insurer groups as well as from the Department of Insurance. Rental networks occur when third-party entities “rent out” physician-insurer negotiated rates to other payers. The second study committee meeting is scheduled for October 26th at Tift Regional Health System in Tifton and will focus on “all-products clauses” and provider stability issues. The committee will then be back at the State Capitol on November 9th for a meeting focusing on network adequacy and provider directories.
Georgians for a Healthy Future has identified network adequacy and the need for more accurate and user-friendly provider directories as important, emerging consumer issues. Network adequacy refers to a health plan’s ability to deliver the benefits promised by providing reasonable access to a sufficient number of in-network primary care and specialty physicians, as well as all and other health care services an insurer guarantees to provide. GHF will present recommendations on meaningful standards to measure and ensure that provider networks are adequate, as well as how to design provider directories effectively for consumer use. If you are interested in providing testimony or input to this committee, please contact Senator Burke, the study committee chair. Please also let GHF know if these issues have emerged for communities or populations you serve so we can provide the strongest and most informed consumer voice we can on the committee.
Senate Study Committee on Youth Mental Health Substance Use Disorders (SR 487)
The first meeting of the Senate Study Committee on Youth Mental Health Substance Use Disorders convened last week at the State Capitol. The committee is charged with examining prevention strategies and identifying promising approaches to address youth Attention Deficit Hyperactivity Disorder (ADHD) and Substance Use Disorders (SUD). The first meeting included overview presentations from representatives of the Department of Education, Department of Behavioral Health and Developmental Disabilities, and Georgia Council on Substance Abuse (GCSA). The next meeting on October 7th will focus on ADHD and the meeting following that, on October 22nd, will delve into substance use disorders. Georgians for a Healthy Future has been working over the past two years with the Georgia Council on Substance Abuse to raise awareness about the promise of taking a public health approach to substance use disorders that focuses on prevention. We are teaming up with GCSA to host a lunch-time policy forum and discussion on this approach on October 22nd at the Loudermilk Center prior to the study committee’s meeting later that afternoon. Please save the date and we’ll send more details soon. If you are interested in testifying at the October 22nd study committee meeting to talk about prevention, please let Senator Unterman’s office know (you can also reach out to GHF and we can try to pass along your request).
Senate Study Committee on Women’s Adequate Healthcare (SR 560)
The Senate Study Committee on Women’s Adequate Healthcare met to discuss the current condition of women’s healthcare in Georgia, areas with existing deficits, and the growing number of women who are at risk of unhealthy outcomes. The Department of Public Health, Department of Human Services and Georgia Obstetrical and Gynecology Society along with Dr. Daniel G. Becker and Dr. Scheinberg vaginal rejuvenation surgeon presented data and information on areas in which women’s health is in high risk and he being one of the top cosmetic surgeon make this data matters, although some women don’t like surgery and prefer to use other products as analbleachingblueprint.com/vaginal-lightening-cream for this, the policy options to move the needle in the right direction on major health indicators. The next meeting will be health on October 6, 2015, from 9am- 2pm, at Georgia Regents University in Augusta.
House Study Committee on School Based Health Centers (HR 640)
Committee members for the House Study Committee on School Based Health Centers met to explore the associations between health and education and ways in which school based health centers can be leveraged to increase access, provide affordable care, and produce cost savings. The committee heard from Voices for Georgia’s Children, the Partnership for Equity and Child Mental Health, and the Global Partnership for Telehealth on the details of the relationship between health and education outcomes. The committee tentatively scheduled the next meeting for September 29th and two additional meetings to follow.
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.