“This has been moving at lightning speed, and it makes really big changes to our healthcare system,” said Cindy Zeldin, executive director of Georgians for a Healthy Future.
As the health care debate ramped up in Washington, February’s Congressional recess presented opportunities for Georgia’s health care advocates to voice their concerns about plans to repeal and replace the Affordable Care Act. GHF participated in two events that highlighted the progress that has been made in Georgia under the ACA and the need to build on its successes rather than repeal it.
The week began with a rally as the Save My Care bus tour stopped at Liberty Plaza across from the Georgia Capitol. House Minority Leader Stacy Abrams energized the crowed and spoke of the importance of health care for every Georgian. GHF’s Executive Director Cindy Zeldin reminded the audience that because of the ACA the uninsured rate in the US is lower than it has ever been before and that new consumer protections provided to Georgians with pre-existing conditions, LGBT Georgians, and low-income families helped to narrow disparities in health care access. Georgia consumers Jan and Vicki shared their stories of how the ACA has helped them access the health care they needed when they needed it. You can watch the full rally here.
On Saturday, GHF marched at the Atlanta March for Healthcare organized by the Georgia Alliance for Social Justice. Marchers traveled down Peachtree Street from Midtown to downtown’s Woodruff Park where a rally was held. Along with partner organizations active on health care issues, Cindy reminded those at the rally of how much progress had resulted from the ACA and how interconnected health care is to other social justice issues like racial, gender, and economic equality.
GHF will continue to work to #ProtectOurCare as Congress attempts to pass the American Health Care Act, a proposal that attempts to cut and cap Medicaid and increase costs for low-income families and older Georgians. We hope you’ll join us to rally, march, call, and organize for affordable, accessible, high quality health care for all Georgians.
Georgians for a Healthy Future’s Executive Director Cindy Zeldin participated as a featured guest at WABE’s A Nation Engaged community forum at the Carter Center in Atlanta on the evening of January 17th. The forum, an initiative of WABE’s A Closer Look radio show, featured a range of thought leaders, community activists, policy experts, and previous guests of the program. The conversation was wide-ranging and incorporated different views and perspectives. Georgians for a Healthy Future was honored to be invited and to be part of the lively event. You can see more details and listen to the entire special broadcast here.
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:
- Learn: Download our 2017 policy priorities, read up on how the legislative process works, and track health-related legislation
- Engage: Sign up for our Georgia Health Action Network (GHAN) action alerts
- Participate: Identify and contact your specific legislators on issues you care about
Stay tuned for updates throughout the session.
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. 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
Tuesday’s election results have the potential to dramatically shift the health care landscape nationally and here in Georgia. It’s too soon to know precisely what policy changes will occur and what their impact will be, but advocacy at both the state and federal levels on behalf of Georgians who need access to quality, affordable health care has never been more important.
The President-Elect and Congressional leadership have vowed 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. Repeal is a serious threat and the consequences would be devastating: twenty million Americans and nearly 500,000 Georgians would lose their coverage, while millions more would be stripped of basic protections and face higher costs. Congressional leaders have also signaled their intention to make cuts to Medicaid and other critical health care programs, which would further threaten coverage and access to care for Georgia children and families.
Georgians for a Healthy Future is committed to lifting up the voices of Georgians whose basic access to care hangs in the balance and ensuring these voices are heard and considered as policy decisions are made. We cannot return to the days when anyone with a pre-existing condition like cancer or diabetes can be denied coverage, where women can be charged more for health insurance simply because of their gender, and where LGBT Georgians can be discriminated against in health care. We cannot allow the hundreds of thousands of Georgians who have finally experienced the sense of security that comes with health coverage to go back to being uninsured and out of options. In short, we plan to fight and we need your support and partnership.
We ask you to partner with us in the coming weeks and months as our work enters this new phase. Here is what you can do:
Thank you for all that you do.
FOR IMMEDIATE RELEASE – August 31, 2016
Georgians for a Healthy Future – Laura Colbert, email@example.com (404) 567 – 5016 x 2
Georgia Budget & Policy Institute – Laura Harker, firstname.lastname@example.org (404) 420 – 1324 x 103
Mercy Care – Diana Lewis, email@example.com (678) 843 – 8509
Atlanta, GA – August 31, 2016
Today the Georgia Chamber of Commerce released their proposal to address Georgia’s coverage gap, and expand access to health coverage for low-income Georgians.
Leaders of the Cover Georgia coalition responded with the following statements.
Cindy Zeldin, Executive Director of Georgians for a Healthy Future, a health care consumer advocacy organization that heads the Cover Georgia coalition said:
“We are encouraged that business leaders and health care industry stakeholders have prioritized health care coverage as a necessary component of economic vitality. The set of policy options put forth by the Georgia Chamber provides a strong starting point. We look forward to a statewide conversation in the coming months about the best approach to ensure all Georgians have a pathway to coverage and access to care.”
Laura Harker, Policy Analyst for Georgian Budget & Policy Institute, a nonprofit focused on Georgia’s fiscal and economic outlook:
“We are encouraged that Georgia leaders are talking more than ever about the need to expand health care access and give the state’s health care system a timely boost. Closing the coverage gap is a smart investment for Georgia that would bring in billions of federal dollars and reduce uncompensated care costs.”
Tom Andrews, President of Mercy Care, a network of health clinics that provide primary care and support services to those who are homeless and uninsured said:
“On behalf of the 88% of our patients who are uninsured, we cannot adequately express the positive impact any one of these plans would have on the health of the patients we care for.”
Cover Georgia is a coalition of more than 70 organizations that have come together to educate the public, engage Georgia’s policy makers, and advocate to close Georgia’s coverage gap by expanding Medicaid. We believe a coverage solution is one that extends coverage to all those Georgians caught in the coverage gap, does not erect unnecessary barriers to care, and maximizes the federal dollars set aside for Georgia.
More resources about the coverage gap:
- A Chartbook for Understanding Medicaid in Georgia and the Opportunity to Improve It
- Georgia Left Me Out: Coverage Gap Fact Sheet
- Strengthening Georgia’s Rural Hospitals and Increasing Access to Care
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.
Why did you decide to write this book?
I have been writing and editing stories about medicine and health care policy for about 30 years. 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?
They 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. 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.
Progress at the Gold Dome
Last week, the Georgia Legislature held its first-ever hearing on closing the coverage gap. Closing the gap is the most important step our policymakers can take to lower the number of uninsured, improve access to care, and stabilize the rural health infrastructure in our state. Scroll down for the latest legislative updates and how you can get involved. You can also listen to Cindy Zeldin explain the legislative movement in her interview Tuesday on WABE’s “A Closer Look” (skip ahead to 59:18).
What is the coverage gap?
Georgia’s coverage gap and its consequences (struggling rural hospitals, Georgia’s high rate of uninsurance, etc.) are popular topics of conversation around the Capitol and among stakeholders recently. Three different proposals have been introduced in the Georgia General Assembly that attempt to address these issues. Details of each bill are included below. Additionally, the Georgia Chamber of Commerce has been studying the economic impact of Georgia’s coverage gap and how to craft a Georgia solution. They are expected to release formal recommendations later this year. Read more about that here. Because of the state’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 hospitals and provide quality health care for all Georgians.
SB 368 – An Alternative Approach to Medicaid Expansion
SB 368 was introduced by Sen. Michael ‘Doc’ Rhett and would expand coverage to low-income, uninsured Georgians. The bill is modeled off of Arkansas’s “private option” version of expansion where Medicaid dollars are used to buy insurance for low income people from the private market. The bill was heard in committee last week, but no action was taken. While some pieces of the bill are problematic, the Senate Health and Human Services Committee started an important conversation.
Watch an interview with Senator Rhett on his bill.
HB 823 – Expand Medicaid NOW Act
This bill was introduced early in the legislative session by House Minority Leader Stacy Abrams. It proposes a traditional Medicaid expansion, like Kentucky & Louisiana, and has not been heard in committee. You can read more about Rep. Abrams’s proposal here.
HB 919 – Tax Credits for Rural Hospital Donations
Passed out of the House Ways & Means Committee on Monday, Rep. Geoff Duncan’s bill would provide up to $250 million in tax credits to individuals or corporations for contributions to rural health care organizations. While this legislation has sparked a conversation about how to best support our struggling rural hospitals, 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 ever $1 of state funding). Hear Georgia Budget & Policy Institute’s Tim Sweeney on the topic here.
How Can You Help?
For the busy advocate…
It doesn’t take a lot to make an impact! We have two quick actions you can take that will take less time than reading this email!
1) Join the Georgia Health Action Network (GHAN). By signing up for GHAN you’ll receive action alerts that will keep you updated on the issues impacting your health care and quick actions you can take.
2) Sign the petition to close Georgia’s coverage gap!
If you’ve already signed the petition…
If you’ve already signed the petition and are ready to take another action, join us in educating your network about why this is such an important issue for all Georgians. How? Two ways:
1) Ask your friends and family to join our email list! It’s the most effective way we communicate with people interested in learning more about consumer health care issues in Georgia. There’s a super quick sign up form on our website homepage.
2) Share this video with your social network. The coverage gap is complicated and so many people still don’t know what it is! This 2 minute video explains the problem and who it impacts clearly.
If you want to really make your voice heard…
For the advocate looking to invest time and energy in an issue they really believe in, we have two key ways you can get involved and make a difference.
1) Write a letter to the editor for your local paper. Educating your community about how the coverage gap impacts their friends, family, and neighbors is so important. It helps to remove the politics from such a complex policy issue impacting hundreds of thousands of Georgians. Never written a letter to the editor? No big deal! Email Whitney and she’ll get you started.
2) Meet with your legislator! All politics is local and for many legislators, knowing that an issue is important to their constituents makes all the difference in the world. Laura, our Director of Outreach & Partnership, can help you set up a meeting.
In December, the ACA Implementation Research Network released its Georgia state report at a policy forum held at the Community Foundation for Greater Atlanta. The report provides a detailed look at the key decisions made by Georgia policymakers around the implementation of the Affordable Care Act over the past five years. Georgians for a Healthy Future’s Executive Director Cindy Zeldin participated in a discussion with advocates, policymakers, and stakeholders to reflect on the report’s findings. The conversation ranged from health insurance enrollment best practices to health system reform to what it will take to close the coverage gap in Georgia. The ACA Implementation Research Network is jointly operated by the Nelson A. Rockefeller Institute of Government, the Brookings Institution, and the Fels Institute of Government at the University of Pennsylvania. The Georgia state report was written by Michael Rich, Professor of Political Science and Environmental Sciences at Emory University. Download the Report.
Several health-related study committees met during the summer and fall months, and most of them are wrapping up their work. The Consumer and Provider Protection Act Study Committee held its final open meeting in November with a focus on network adequacy and provider directories. Claire McAndrew from Families USA, a national consumer health advocacy organization, and Georgians for a Healthy Future’s Health Policy Analyst Meredith Gonsahn delivered testimony on the importance of setting network adequacy standards and ensuring provider directory accuracy and usability. Look out for a final report from the committee later in December!