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
Earlier this week, GHF provided a summary of the recommendations from several Senate study committees and how their findings may affect the health care system and consumers in the state. The Georgia House of Representatives also convened study committees to examine issues directly related to health care, and two of these committees recently released their final recommendations.
The House Study Committee on Georgians’ Barriers to Access to Adequate Health Care (HR 240) examined a broad array of health care issues with a focus on the burden of chronic disease in Georgia. The committee, chaired by Representative Sharon Cooper, issued an exhaustive final report that included several legislative recommendations that could impact consumers. The most pertinent recommendations include:
Increasing access to immunizations: Allow schools to require the second dose of the meningitis vaccination in 12th grade; require hospitals and nursing homes to offer shingles and flu vaccinations; allocate an additional $1 million to the Department of Public Health for additional staff and screenings for the viral hepatitis program; require the Department of Juvenile Justice to check vaccination records and offer vaccinations for juveniles in their care.
Improving testing and treatment for HIV/AIDS: Rewrite state laws to focus criminalization on intention to transmit HIV, as opposed to knowledge of HIV infection; ensure access to HIV treatment regimens for sexual assault victims; increase funding to the Department of Public Health to expand their ability to test for HIV; encourage state-funded health care programs such as Medicaid to expand their outreach for HIV testing.
Facilitating continued enrollment in Medicaid: Engender a policy shift that would allow for the suspension of Medicaid benefits, as opposed to outright termination, for people entering incarceration in the state.
Addressing respiratory diseases: Build upon the existing state asthma plan, which expires in 2018, to include a broader scope of chronic respiratory diseases; expand the screening process for people at risk of COPD to help confirm additional diagnoses.
Expanding access to mental health services: Expand funding for the Department of Behavioral Health and Development Disability’s community service boards; allocate funding for psychiatric residents who specialize in mental health treatment; encourage the use of e-prescriptions for opioid medications in an effort to curb opioid abuse.
You can read the full committee report here.
The House Rural Development Council (HR 389) closely examined a variety of issues that impact rural communities in Georgia and a recurring theme across the state was a need for increased access to quality health care. After 18 meetings in all parts of rural Georgia, the council released several recommendations that could have a significant impact on rural health care consumers.
One of the most noteworthy recommendations encouraged the Department of Community Health to apply for an 1115 Medicaid waiver that would allow participating hospitals and community providers to form a closed network in order to provide care to a set number of uninsured community residents. This waiver would allow Georgia to pull down additional federal funds to provide health care to some of the state’s uninsured population and to test out new ways to deliver high quality care at a lower cost. Unfortunately this idea falls far short of expanding Medicaid, which would provide health coverage to low-income, uninsured Georgians statewide and is the most significant step our state could take in improving access to care for rural Georgians. (Note: the council report refers to this capitated, value-based delivery model as a “block grant,” but this waiver would differ from a block grant in some nuanced, but important ways.)
Like the Senate Study Committee on Barriers to Georgians’ Access to Adequate Healthcare, the council heard a significant amount of testimony on the dearth of practicing medical professionals in rural counties and, as a result, their final recommendations mirror those of the Senate committee. They suggest expanding the scope of practice for mid-level practitioners to allow them to perform certain medial services not currently allowed and implementing a preceptor tax credit program to incentivize medical practitioners to train future healthcare professionals in rural areas.
Finally, the council recommended establishing a Rural Center for Health Care Innovation and Sustainability, which will be responsible for promoting a curriculum of best practices for rural health care. The center will also be used to provide mandatory training for the executive leadership and boards of rural hospitals.
You can read the full committee report here.
As always, you count on GHF to keep you up-to-date on how these recommendations may turn into legislative action when the General Assembly convenes in January. Stay tuned!
Commentary from Cindy Zeldin, Georgians for a Healthy Future’s Executive Director
The nation’s uninsured rate has plummeted over the past year and a half. Here in Georgia, more than 400,000 people have enrolled in health insurance, bringing our state’s uninsured rate down to 15 percent. While there is still much work to be done to ensure that all Georgians have a pathway to coverage (like expanding Medicaid), it’s also important to make sure that those who are newly covered are able to access needed health care services.
Are newly insured Georgians accessing the care they need? For the most part, the answer seems to be yes. The early evidence shows that most people who signed up for health insurance have been able to find a doctor with relative ease and get an appointment for primary care within a week or two.
This is a development worth celebrating, but there are also some warning signs on the horizon that policymakers should heed: according to a recent study by the University of Pennsylvania, Georgia had the highest percentage of health plans utilizing “narrow networks” of providers. In addition, reports of provider directory inaccuracies and networks too skinny to deliver all of the services in a plan’s benefit package have started to emerge.
Narrow networks offer a limited choice of providers in exchange for a lower premium. While many Georgians are willing to make this trade-off, others need a broader network to meet their health needs. And everyone deserves the tools and information to make that choice and to know that they can access services for all covered benefits.
Health care consumers now have access to standardized information about premiums, benefits, deductibles, and other health plan features that make it easier to pick the right plan. Yet provider network size and composition remain a black box for consumers, holding them back from making the best, most informed decision they can. Combined with a rapid trend toward narrow networks, this could put some consumers at risk of not being able to access all of the providers and services they need (or at risk for high medical bills if they have to go out-of-network).
These trends are being examined as part of the Senate Study Committee on the Consumer and Provider Protection Act (SR 561). I was honored to be appointed to this committee to represent Georgians for a Healthy Future and to bring the consumer perspective to the committee. The committee’s third meeting, slated for the morning of November 9th at the State Capitol, will focus on network adequacy, or whether there are adequate standards in place to ensure that consumers enrolled in a health plan have reasonable access to all covered services in the plan.
As a committee member, it is my goal to make sure the voices and needs of consumers are heard and considered. It is becoming clear that consumers don’t yet have 1) access to all of the information they need to select a health plan that best meets their needs and 2) protections that ensure their health plan will provide timely and meaningful access to all covered services. Fortunately, these are problems we can address.
I will be supporting enhancements to provider directories that give consumers the information they need and deserve (such as enhanced search functionality and a simple way to report inaccuracies) as well as network adequacy standards for Georgia that ensure no insured Georgian has to travel an unreasonably long distance or wait an excessive amount of time to access the care they need. I’ve also learned a great deal about this issue by watching the National Association of Insurance Commissioner’s work in this area, and was happy to sign on in support of the policy recommendations around network adequacy that the NAIC’s consumer representatives issued last year.
I am excited about this opportunity to make our health system work better, and GHF will keep you posted on new developments. If you’re interested in providing testimony to the committee, please let us know and we can forward your request to Senator Burke, who chairs the study committee.