Advocacy and policy up close

I am a graduate student in the Public Health program at Georgia State University. As a part of my coursework, I completed a semester-long practicum with Georgians for a Healthy Future as the Legislative Health Policy Intern.

In my academic program, I have spent extensive time learning about health policy, the legislative process, and the healthcare landscape in the United States. While covering those topics in a classroom setting was informative, seeing the legislative process first hand was invaluable. During my time with Georgians for a Healthy Future, I had the privilege of experiencing the legislative process by visiting the Capitol for committee and advocacy meetings, tracking legislation, and meeting policy makers and advocates.

Some of what I learned in the classroom applied to my work at GHF, but I found that there are some things you can only learn through experience. I was surprised by the length of time that legislators spend discussing some bills. Minutia in bill language could be debated for a whole two-hour meeting, while some key details might be voted on within minutes. I often felt a rollercoaster of emotions as a passionate hearing drew my sympathy for a given issue, while opposition pushed back on the bill. Spending time in committee hearings solidified my understanding that health policy often lies in gray areas, despite initially appearing to be black and white.

In my time at Georgians for a Healthy Future, I have learned a great deal about the organization and working in advocacy. Something that surprised me about GHF is the great value of the small things they do, such as encouraging constituents to call their legislators, sharing facts and resources with partner organizations, and talking to consumers. Their efforts often go unseen by the general public but have significant implications for the citizens of Georgia. I have seen the fruits of their labors, and it excites me to know there is an organization working so hard to protect and give a voice to our most vulnerable Georgians. Their partner organizations are equally inspiring in working to better the health of people in the state.

look forward to taking my GHF experience and knowledge with me into the public health field. I have gained a greater understanding of health policy and how bills get passed. I have learned the importance of advocacy and that every person can have a voice. I have learned that there are so many deeply passionate, caring, and hard-working individuals working towards health equity in Georgia. I have learned that the road to policy is often long, but the payoff is worth the time and effort. I will take these lessons with me as I move into my career, and work towards the goal of creating a healthier state and nation for everyone.

-Hayley Hamilton

MPH Candidate 2017

Georgia State University


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Legislative Update: March 20

Surprise billing legislation passed by committee 

SB 8 was heard by the House Insurance committee this morning and passed unanimously. Among other transparency and notification requirements, this version of the surprise billing legislation requires that providers and hospitals must provide consumers with information about the plans in which they participate, and that upon the request of consumers, providers give an estimated cost of non-emergency services before they are provided. Insurers must inform consumers whether a provider scheduled to deliver a service is in-network, and if not, an estimation of how much the insurer will pay for the services, among other notification requirements. SB 8 will now go to the House Rules committee.


WHAT HAPPENED LAST WEEK

Senate passed the FY2018 budget

Last week, the Senate approved the FY 2018 budget. The budgets approved by the Senate and House differ slightly, so a conference committee will be appointed to meet and work out the differences. You can check the Differences Report for specifics on the variance between the House and Senate budgets, and we will provide a brief overview of the final version once the conference committee finishes its work.


Insurance coverage for children’s hearing aids passed

SB 206 was approved by the House of Representatives today, and will require private health insurance plans to cover hearing aids for children under 19 years old. The legislation stipulates that the costs cannot exceed $3000 per hearing aid and that the plans cover replacement hearing aids every four years or when the hearing aid fails before that time. Medicaid already covers hearing aids for children who qualify for coverage.


Pharmacy Patients Fair Practices Act passed by both chambers

Both HB 276 and SB 103 were approved by the Senate and House respectively last week and will get sent to the Governor for his signature. This legislation (which we previously covered here) will regulate practices of pharmacy benefit managers so as to allow consumers access to their pharmacy of choice, provide the opportunity for home delivery of medications, and prevent consumers from over-paying for prescriptions.

Legislation to synchronize multiple medications passed

SB 200 will make it easier for people to synchronize their prescriptions so that they can pick up multiple prescriptions at the same time. The bill requires that insurance plans pro-rate medication co-pays for partial prescription fills so that the schedules for medications can be synced if requested by a patient. Under current law, a person may have to pay a full co-pay even if a pharmacist is providing only a part of their 30-day medication in order to synchronize multiple prescriptions. SB 200 passed the House Insurance committee last week and was approved unanimously by the House this morning.


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Legislative Update: March 13

Senate Health Reform Task Force held first public meeting 

The Senate Health Reform Task Force was established by Lt. Gov. Cagle to study how federal health reform efforts would impact Georgia. The task force held its first public meeting on Friday and heard from two federal health policy professionals, Joseph Antos and Jim Frogue. Together, they provided a brief overview of the proposed American Health Care Act, some analysis of how the bill would impact Georgia, and suggestions for legislators to consider. The message from both presenters is that the AHCA is “not favorable” for Georgia because of the way the proposal cuts and caps Medicaid which would lock in Georgia’s pattern of low per capita Medicaid spending.

We agree that this proposal is “not favorable” for Georgia. Despite the harm it would do to our state, the bill seems headed for a vote in the House of Representatives. Call your Congressman today to tell him that this bill hurts Georgia!


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Advice for new advocates at the Capitol

The November elections have energized people of all political leanings to get more involved in advocacy, and many are doing so for the first time. Learning how each level of government works and how to effectively advocate for your interests can be difficult. GHF’s legislative health policy intern, Hayley Hamilton, has learned the ropes at Georgia’s Capitol and has some advice for people who are new to the Gold Dome:

Walking into the Gold Dome for the first time can be intimidating. Once you pass through the metal detectors and show your ID to the state trooper on duty, you find a sea of people all of whom seem to know each other. If you feel a bit overwhelmed walking in, know that you are not alone, but it gets easier with practice. The Capitol is a congenial place and you will find that everyone is happy to talk to you.

There is a rhythm of
daily events at the Capitol and each part of the days present a different opportunity for you to interact with your legislators. The chambers (House of Representatives and Senate) meet in the mornings to vote on bills and take care of other business. This part of the day is your best opportunity to speak with your legislator. If you want to meet with your legislator “on the ropes” (called this because of the red velvet rope line outside of each chamber) you fill out a short slip of paper outside the House or Senate to let your legislator know that you would like to speak with them. A page (usually a middle school aged student) will deliver the note inside the chamber, and if available, your legislator will come out to speak with you. When you speak to your legislator, it’s important to remember that they are representing you and your community, but they are also short on time. Be compelling and brief with what you have to say, but don’t underestimate the power of your story.

After the morning session, the House and Senate break for lunch and caucus meetings, and attend committee meetings in the afternoon. If you are unable to meet your legislator on the ropes, this is a good time to track them down for a quick chat in their office or catch them before or after a committee meeting. You can find your legislators’ office location, phone number, and email in our Consumer Health Advocate’s Guide. (An in-person visit is best, but a phone call is the next most effective method of sharing your thoughts and concerns with your legislators.) If you can’t nail them down for a short conversation in their office, meeting with their staff is a great second option. Tell the staff what you want your legislator to hear and then offer to follow up with the legislator via email.

Your legislator may be in committee meetings for much of the afternoon. These meetings are open to the public, and you can find committee schedules, locations, and agendas on the websites for the House and Senate respectively. During committee meetings, legislators will hear testimony and vote on bills. You may want to sign up to testify for a bill, just observe a meeting, or speak with a legislator before or after a meeting about a bill on the meeting agenda.

The old cliché of “practice makes perfect” applies to the Georgia’s Capitol and legislative session. The more you are at the Capitol or the more you contact your legislators, the easier it gets. Plus, GHF is here to help with our legislation tracker and weekly legislative updates during the session.

 –Hayley Hamilton

   MPH Candidate, 2017

   Georgia State University


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Legislative Update: February 21

 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


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Legislative Update: February 13

  Re-authorization of provider fee successfully passes through legislature 

On Friday Georgia’s House of Representatives voted to approve the hospital “provider fee” for another three years, and Governor Deal says he will sign the legislation tomorrow. The provider fee helps to fund Georgia’s Medicaid program by allowing the Department of Community Health to collect a tax on hospital revenues which is used to draw down additional federal dollars. The additional funds are disproportionately used to support rural and safety net hospitals that serve high numbers of indigent patients.


Oral health bills approved 

Also on Friday, the Senate passed SB 12 and the House passed HB 154, both of which allow dental hygienists to practice in safety net settings, school clinics, nursing homes, and private practices without a dentist being present. While the bills are overwhelmingly similar, the differences between them will need to be worked out between the chambers.


WHAT HAPPENED LAST WEEK

Passage of Opioid Abuse Prevention Bill

SB 81 continued to draw a lot of attention last week. The bill was eventually passed by the Senate Health and Human Services committee with several significant changes. The current version of the bill still requires that all physicians register and use the Prescription Drug Monitoring Program (PDMP), but only requires that providers report on Schedule 1 drugs and reduces the penalty for not reporting to a minimum of a misdemeanor. The current version of the bill also changed language that would have required children with ADHD to renew their prescription every five days.   

Surprise billing legislation heard in committee 

The Senate Health and Human Services committee began its consideration of SB 8, legislation that would protect consumers from surprise out-of-network medical billing. Testimony was heard from insurers, health care providers, hospitals, and the consumer advocacy group, Georgia Watch. While all stakeholders seem to be in agreement that consumers should be held harmless when seeking care at an in-network facility and through no fault of their own encounter an out-of-network provider, there are significant differences on the matter of provider reimbursement for services provided in those situations. No vote was taken on the legislation but is expected to be re-considered by the committee this week. HB 71, legislation that address surprise billing in a different way, is expected to receive its first hearing this week in the House Insurance committee.

Resolution introduced to encourage block grants for state Medicaid program 

HR 182 was introduced last week with the purpose of providing legislative permission to the Governor and the Department of Community Health to seek per capita block grant funding for Georgia’s Medicaid program. While resolutions are non-binding and do not impact state law, this resolution could begin a risky conversation among lawmakers. Shifting Georgia’s Medicaid program from its current federal-state partnership structure to a block grant program would mean cuts in services and in beneficiaries, putting Georgia’s most vulnerable children, parents, elderly, and people with disabilities at risk. Check out GHF’s block grant fact sheet for more information about the dangers of restructuring the Medicaid program. It is unclear if this resolution will get a hearing or a vote.


Mark Your Calendar!

Save My Care Rally: February 20th

With Congress taking steps to repeal and replace the Affordable Care Act and thus blocking the access to care so many Georgians have gained in the past several years, it is more important than ever to stand up and let them know that Georgians want to #ProtectOurCare.

On February 20th, join the Save My Care bus, GHF, and hundreds of Georgians for a rally in Atlanta. Georgia’s members of Congress will be at home for recess and it’s the perfect time to make sure your elected officials hear you loud and clear.


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Legislative Update: Feb. 6

Hearing on surprise billing legislation scheduled for tomorrow 

SB 8, which seeks to protect consumers from surprise out-of-network medical bills, is scheduled to receive a hearing in the Senate Health & Human Services committee on Tuesday at 2 pm. SB 8 would establish a standard payment structure for physicians seeking reimbursement for surprise out-of-network services, and would hold consumers harmless in surprise billing situations. HB 71, the companion bill sponsored by Rep. Richard Smith, is expected to be assigned to a sub committee of the House Insurance committee on Tuesday at 8 am.

You can help!

If you have received a surprise out-of-network medical bill, share your story with our partners at Georgia Watch. Consumer stories help illustrate to legislators why legislation is needed to help protect consumers like you. Click here to share your story!


What Happened Last Week

Senate passes provider fee renewal

On Thursday the Senate passed SB 70 which renews the provider fee (also called the “bed tax”) for another three years in order to fund Georgia’s Medicaid program. This allows the Department of Community Health to collect the 1.45% tax on hospital revenues in order to draw down federal Medicaid dollars. These additional dollars are disproportionately used to support rural and safety net hospitals who serve high numbers of indigent patients. The bill will now move to the House where it expects an easy passage.


“Expand Medicaid NOW Act” reintroduced

House Minority Leader Stacey Abrams introduced HB 188, the Expand Medicaid NOW Act, last week. While we do not expect this bill to gain much traction because of the evolving health reform efforts at the federal level, it calls attention to the need to provide health care coverage to the 300,000 Georgians who are stuck in our state’s coverage gap because they do not currently qualify for Medicaid and cannot access health insurance through the Affordable Care Act’s Marketplace. The bill has been referred to the House Appropriations Committee.


Oral health legislation moves forward

Both HB 154 and SB 12, bills that allow dental hygienists to provide cleanings and other specified services in schools, safety net clinics, nursing homes, and private dentists’ practices under “general supervision”, received committee hearings and votes last week. Both bills will move to their Chambers’ respective Rules Committees to be approved for floor votes by the House and Senate.


Debate over opioid abuse prevention bill 

SB 81 received its first hearing in the Senate Health & Human Services committee last week. The bill seeks to address the growing opioid abuse epidemic in Georgia in a number of ways, including: 1) Extending the Prescription Drug Monitoring Program, a database of prescriptions written for certain narcotics and requiring physicians to consult this registry prior to prescribing under certain conditions; 2) Codifying the Governor’s emergency order increasing the availability of anti-overdose drug, Naloxone; 3) Requiring the tracking and reporting of Neonatal Abstinence Syndrome; and 4) Establishing penalties for providers who are not in compliance with drug prescription reporting requirements. While few dispute the need to address this issue, the scope of drug and drug classes that the bill covers, along with the severity of the penalty that physicians may be subject to for violating the law are currently points of contention. No vote was taken in Thursday’s committee hearing, but suggested changes were made and the bill is expected to be back before the same committee later this week.


Resources for you

Georgians for a Healthy Future has tools you can use to track and understand the Georgia legislative session. Stay up-to-date on the bills that matter to you with our legislation tracker and sign up for Georgia Health Action Network (GHAN) action alerts so you know when to engage.

Get Your 2017 Consumer Health Advocate’s Guide!

GHF’s annual Consumer Health Advocate’s Guide is your map for navigating the Georgia legislative session. The Guide provides information on the legislative process, and contact information for legislators, key agency officials, and health advocates. This year, we’ve added a glossary of terms to help you understand what is happening under the Gold Dome. This tool will help advocates, volunteers, and consumers navigate the 2017 Georgia General Assembly.  Download your copy here.


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2017 Advocate’s Guides & Week 3 Legislative Updates

 

Get your 2017 Consumer Health Advocate’s Guide!
GHF’s annual Consumer Health Advocate’s Guide is your map for navigating the Georgia legislative session. The Guide provides information on the legislative process, contact information for legislators, key agency officials, and health advocates, and a new glossary of terms to help you understand what is happening under the Gold Dome. This tool will help advocates, volunteers, and consumers navigate the 2017 Georgia General Assembly.

 

 

 

 

 

 

 

 

 


 

Surprise medical billing legislation expects a hearing
As we announced last week, Sen. Renee Unterman and Rep. Richard Smith each introduced legislation (SB 8 and HB 71) to protect consumers from surprise out-of-network medical bills. Both seek to eliminate this problem for consumers, but they resolve it in different ways. The bills are at the initial stages of the legislative process, so it’s too early to tell what the final solution may look like, but all sides agree that patients should be protected when accessing health care at an in-network facility. We expect to see the first hearing on the legislation this week in the House Insurance Committee.
WHAT HAPPENED LAST WEEK
“Repeal and replace” Task Force 
The Senate has established a “Repeal and Replace” Task Force to address any changes to or repeal of the Affordable Care Act and the potential impacts on Georgia. Senators Burke, Judson Hill, Watson, and Unterman have been appointed to serve on the task force. They have begun initial closed-door meetings, but we expect that the process will include public meetings in the future.


AFY 2017 and FY 2018 Budgets 
The House of Representatives passed the amended FY 2017 budget, also called the little budget. Very few changes were made from the Governor’s recommended budget. Appropriations hearings continued on the FY 2018 budget.


Oral Health Legislation 
Rep. Sharon Cooper introduced HB 154 last week. This bill is more limited in scope than Sen. Unterman’s SB 12, but both allow for general supervision of dental hygienists under certain circumstances. “General supervision” means that a dentist can authorize a licensed dental hygienist to perform certain duties but does not require the dentist to be present when those duties are performed. The primary purpose of both bills is to reduce the barriers to dental care for children, seniors, and people with disabilities in Georgia.


Opioid Abuse omnibus bill introduced 
Sen. Unterman introduced SB 81, titled the “Jeffrey Dallas Gay, Jr. Act”, which addresses the ongoing opioid abuse crisis in a number of ways. The legislation enables greater access to naloxone, a medication used to combat opioid overdoses, by allowing the Commissioner of the Department of Public Health to issue a standing order permitting over-the-counter access or under other imposed conditions. The bill also requires prescribing physicians to discuss with their patients the potential risks associated with use of a controlled substance. Under this legislation, inspections would be required for all licensed narcotic treatment programs in the state, as well as the submission of patient outcomes data by the programs to the Department of Community Health. This bill contains many provisions to prevent and treat substance use disorders and we will provide a fuller analysis soon.

 

 

IN CASE YOU MISSED IT 
Webinar: Health Care Policy in 2017
On Thursday, Director of Outreach and Partnerships Laura Colbert hosted a webinar to discuss the expected and proposed changes in health care policy at both the state and federal levels.She reviewed the most recent information about “repeal & replace efforts”, Protect Our Care advocacy, and health care in the 2017 Georgia legislative session. If you missed the webinar, don’t worry! You can see it on demand here.


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Legislative Update: The First Two Weeks

Legislation introduced to protect consumers from surprise medical bills!
This morning, Sen. Renee Unterman and Rep. Richard Smith each introduced legislation to protect consumers from surprise out-of-network medical bills. A surprise medical bill can occur when an insured consumer unknowingly receives care from an out-of-network provider at an in-network health care facility. The consumer is then responsible for the excess medical costs which can add up quickly. The bills introduced today would help to protect consumers from these large, unexpected bills.You can help!

  • Contact Sen. Unterman and Rep. Smith to thank them for their attention to this important consumer issue.
  • If you have received a surprise out-of-network medical bill, share your story with our partners at Georgia Watch. Consumer stories help illustrate why legislation is needed to protect Georgia consumers like you.

 

 

 

FY 2018 Budget 
One of the legislature’s major responsibilities is to pass a state budget each year. Governor Deal proposed a $25 billion state budget in his State of the State address for Fiscal Year 2018, and last week the legislature held budget hearings to gather input from state agencies about their proposed departmental budgets. Three state agencies have jurisdiction over health and health care: the Department of Community Health (DCH), which oversees Medicaid, PeachCare, and other state health care programs; the Department of Public Health (DPH), which administers public health and prevention initiatives and programs in Georgia; and the Department of Behavioral Health and Developmental Disabilities (DBHDD), which provides treatment, support services, and assistance to people with disabilities, behavioral health challenges, and substance use disorders. Because of the critical role that Medicaid plays in covering low-income children and other vulnerable Georgians, it is important that it be adequately funded. Issues to watch this legislative session around Medicaid and the state budget include the renewal of the “hospital tax” or provider fee, increases in Medicaid reimbursement rates for certain primary care providers, and funding for autism services for children under 21. The Georgia Budget and Policy Institute’s Budget Primer is a great tool for learning more about how the state budget works and what to look out for during the session. You can also find power points and archived agenda from last week’s budget hearings here as well as the budget “tracking sheet” here.
Proposed Legislation
 

Oral Health–SB 12 
This bill would provide for “general supervision” of dental hygienists in Georgia, meaning that with a dentist’s permission dental hygienists could provide cleaning services to patients when a dentist is not present. The purpose of this legislation is to expand access to oral hygiene services in safety net settings like school based health centers, long term care facilities, and charity clinics. Read more about this legislation here.


Expansion of the rural hospital tax credits–HB 54 
Introduced by Rep. Duncan, this legislation 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.


Expected legislation 
It is early in the legislation session, so many health-related bills are still in the works. We expect to see legislation arise from two study committees that met this fall. The Senate Study Committee on Opioid Abuse is expected to result in legislation that strengthens the Prescription Drug Monitoring Program and permanently allows naloxone to be sold over the counter, among other strategies to curb the opioid abuse crisis. Some legislation or action is expected from the House Study Committee on Children’s Mental Health as well. That may include the creation of a Children’s Mental Health Reform Council, similar to the Governor’s successful Criminal Justice Reform Council. Finally, we have heard serious discussions about raising Georgia’s tobacco tax. No legislation has yet emerged but we do expect to see a bill introduced in the coming weeks.

If legislation is introduced addressing any of these issues or other health care-related topics, we will include updates in our weekly emails throughout the legislation session. You can also track health care-related legislation on our website any day of the week.


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Join us for a preview

It is a time of uncertainty for health care. Congressional leaders have already begun the process to repeal the Affordable Care Act, landmark legislation that established a framework for coverage that has resulted in the lowest uninsured rate ever recorded, rights and protections for health care consumers, and provisions to advance health equity. With the 2017 Georgia legislative session underway, state leaders have acknowledged that something must be done about Georgia’s high number of uninsured, the state’s struggling rural health care system, and the impending funding cuts to hospitals. With so much uncertainty and change, it may be hard to keep track of what’s going on in health policy.

Join us for a webinar to learn about and discuss expected and proposed changes at the both the state and national levels. We will provide you with the most recent information about “repeal & replace” efforts and #ProtectOurCare advocacy, and how that will impact Georgia. We will also preview health care in Georgia’s 2017 state legislative session and tell you how you can get involved in the health care issues that you care about through advocacy and public engagement. Join us for a look ahead at health care policy in 2017. Register here to join us!

 


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