Peach Pulse Archive 2010

HAPPY HOLIDAYS!

Here at Georgians for a Healthy Future, we wish you and your families and happy and healthy Holiday Season and New Year!  The Peach Pulse will return to its every-other-week format in the New Year.  Happy Holidays!

What’s New in Georgia

Georgians for a Healthy Future Unveils Our 2011 Policy Priorities

Georgians for a Healthy Future formally unveiled our 2011 policy priorities last week. The priorities were developed with broad input from community stakeholders, and we look forward to working with our coalition partners to advance them in the coming year. Our advocacy efforts will be focused on five core issues:

1)    Support Consumer-Friendly Implementation of the Affordable Care Act

2)    Protect and Strengthen Quality Care for Medicaid and PeachCare Beneficiaries

3)    Preserve Consumer Protections for Georgians in Private Health Insurance Plans

4)    Strengthen Georgia’s Public Health System

5)    Support a More Sustainable Revenue Structure, Including an Increase in the Tobacco Tax

For more details about each of these policy priority areas, please visit the Georgians for a Healthy Future website. If you’d like to work with us to advance them, please contact us.

Health Care Unscrambled: Recap

Last week, Georgians for a Healthy Future held our first annual policy breakfast, Health Care Unscrambled, to discuss the challenges and opportunities that lie ahead in 2011 for health care policy. Anton Gunn, Regional Director for the US Department of Health and Human Services (HHS), spoke about the Affordable Care Act and opportunities for collaboration and partnership between stakeholders and HHS as implementation of the law moves forward. Alan Weil, Executive Director of the National Academy for State Health Policy, spoke about key decision points facing states around implementation of the new law. Dr. Phaedra Corso from the College of Public Health at the University of Georgia presented Georgia-specific demographic and political information that policymakers and advocates should consider as they move forward on health reform. All three presentations are now available on our website. Our Executive Director, Cindy Zeldin, rounded out the breakfast by presenting Georgians for a Healthy Future’s 2011 policy priorities. We look forward to working with you in 2011 to advance these priorities, and we’ll keep you informed on developments and advocacy opportunities around these issues. Finally, we’d like to issue a special thank you to our sponsors as well as to all in attendance. We hope you will join us again next year!

Public Health Commission Releases Final Report and Recommendations

The Public Health Commission, charged by the Georgia Legislature to determine the most appropriate structure for the Division of Public Health, issued its final report to the Governor, Speaker, and Lieutenant Governor on December 1, 2010. The unanimous recommendation of the Commission is for the Division of Public Health to become an independent, cabinet-level state agency, with the Commissioner reporting directly to the Governor and serving as the state’s chief health officer. To download the Commission’s full report, click here. To learn more about how to become an advocate for public health, visit the Partner Up for Public Health campaign website.

New Department of Community Health Commissioner Named

Governor-Elect Deal has named David Cook, Executive Director of the Medical Association of Georgia, as the incoming Commissioner for the Department of Community Health. In January, he will replace Clyde Reese, who will transition to the role of Commissioner of the Department of Human Services. For more information, click here.

2011 Legislative Session Calendar

The 2011 Legislative Session is shaping up to be a busy one.  With only 40 short days to get everything done, advocates needs to be well prepared and informed of important events and issues as they occur throughout the session.  To that end, Georgians for a Healthy Future has created the 2011 Legislative Session Calendar.  This calendar is a storehouse for upcoming advocacy events that impact the health and well being of Georgians.  Check back often to see what’s happening and how to get involved.  To have your event added to the calendar, please email Amanda Ptashkin.

Georgia Budget & Policy Institute Release 4 New Reports

Last week, the Georgia Budget & Policy Institute released four new reports that explore health and tax reform and what it means to the state and its residents.  The first report, Tax Reform Facts: Sales Tax Exemption on Groceries, discusses alternatives for raising revenues other than shifting the burden to middle to low-income Georgians through a regressive grocery tax—a tactic that is feared to gain traction once session starts.  The second report, Medicaid Expansion Facts: What’s in Store for Georgia’s Medicaid Enrollment?, explains how the new health law increases eligibility for Medicaid and provides states significant new funding to pay for the expansion and how the billions in new federal funding will help increase health coverage for nearly 500,000 Georgians without insurance. The third report, Georgia and the Federal Government Ensure Elderly and Newborns Have a Safety Net, explains how the Georgia works to protect its most vulnerable residents. This fact sheet provides an overview about who is served by the Medicaid program, how costs vary by population, and the income-eligibility criteria for Georgia’s Medicaid and PeachCare programs.  The last report, New Federal Tax Credit Benefits 84% of Small Businesses in Georgia, examines the new tax credits that rise from the new health law and how they could help nearly 120,000 small businesses in Georgia better afford health coverage for their employees.  For more information, visit the Georgia Budget & Policy Institute website.

The Affordable Care Act and You

State of Georgia Begins Work on Health Insurance Exchange Feasibility Study

Recently, the Governor’s Office of Planning and Budget (OPB) was awarded a $1 million grant from the U.S. Department of Health and Human Services to assess the feasibility of establishing a state run health benefit exchange. Under the Affordable Care Act, a health insurance exchange, or structured marketplace where individuals and small businesses can purchase affordable health insurance with federal tax credits, must be up and running in every state by 2014. States may set up their own exchange (either a single exchange for individuals and small groups or two separate exchanges) or rely on a federal fallback exchange that the Department of Health and Human Services would set up. With technical assistance from Georgia State University and the University of Georgia, OPB has been convening stakeholders over the past two months to examine these issues. Georgians for a Healthy Future and our coalition partners have been participating in these workgroups to ensure that the consumer and patient voice is at the table. The workgroups have been tasked with identifying the factors to consider, potential approaches, and the data needed for decision-making around several structural features of the exchange.  The next meeting is January 14th.  To get involved with one of the workgroups and for more information about upcoming meetings, click here. To learn more about health reform implementation in Georgia, see OPB’s new website at www.healthcarereform.ga.gov. For a detailed look through the consumer lens at the choices states face as they set up an exchange, click here. For a closer look at the population that would utilize the exchange, click here.

Update on Medical Loss Ratio Rules in Georgia

In November, the U.S. Department of Health and Human Services (HHS) issued interim final rules around medical loss ratio requirements. These rules require insurers operating in the individual health insurance market to spend 80 percent of premiums on medical services and were issued following a deliberative process by the National Association of Insurance Commissioners (NAIC), which developed the model regulation, as charged to do under the health law. These requirements will encourage transparency and facilitate better value for consumers. However, this win for consumers is at risk in Georgia. Our Insurance Department has indicated it will seek an adjustment for Georgia insurers under a process laid out within the federal rules. States may apply for an adjustment if the rules will destabilize their insurance marketplace. To determine this, HHS will weigh five factors when considering adjustment requests:  number of insurers likely to leave the market, number of individuals affected, availability of other coverage options, impact on premiums, and availability of brokers and agents. Once a request is made, public comment will be accepted for 10 days, and HHS has 30 days to consider the request. If you would like to join with Georgians for a Healthy Future as we develop our written comments, please contact us. For more information on this issue, click here.

New Resources Available

New Resources are being released daily to help states and consumers understand the new health law.  Families USA has a new report dedicated to best practices states can take in implementing state health insurance exchanges and a new report on how health reform aims at improving the lives of seniors and people with disabilities. The Commonwealth Fund released a report examining how baby boomers will be impacted by the new law and found that boomers in Southern and Western states in particular will benefit from provisions in the law.

The National Academy for State Health Policy has updated their new State Refo(u)rum website with useful information on implementing the new health law from work plans and timelines to state-specific analyses.  The Kaiser Family Foundation has also released a new issue brief entitled the Impact of Health Reform on Women’s Access to Coverage and Care. The issue brief reviews how the new law is expected to affect access to care and affordability of health coverage for women and explains the provisions in the new law related to preventive screening services, reproductive health, maternity care and women on Medicare.

National News

Child Nutrition Bill Signed by President

This week, President Obama signed the The Healthy, Hunger-Free Kids Act.  The passage of this bill marks an important success in the fight against child hunger and childhood obesity, as it will expand access to healthy school meals and will establish higher nutritional standards for school lunches. A summary of the Act’s key provisions, prepared by the Food Research and Action Center, can be found here.  To read a recent Washington Post article highlighting 12 of the key changes in the new law, click here.

What’s New in Georgia:

Georgia Elects New Statewide Officers, Governor-Elect Deal Names Transition Team

Last Tuesday, Georgia elected new statewide officials, including Governor-elect Nathan Deal, Insurance Commissioner-elect Ralph Hudgens, and several other constitutional officers. Governor Deal named his full transition team today. The list of members is available here.  To find out where the incoming Governor stands on health care issues, see the recent candidate questionnaire from the Healthcare Georgia Foundation. Also, while the role of the Insurance Commissioner on health care issues is less well known than that of the Governor, the new Insurance Commissioner is responsible for regulating health insurance in Georgia and enforcing consumer protections in health insurance. To learn more about how the incoming Insurance Commissioner plans to approach health care issues, see the results of our candidate survey. In addition, several new legislators were elected to the Georgia General Assembly.  To see the election results, click here.

Trauma Funding Referendum Fails on Election Day

The Yes 2 Save Lives Campaign was delivered a fatal blow on Tuesday when 53% of Georgians failed to approve Amendment 2, which asked voters to approve a $10 motor vehicle tag fee to fund a trauma care system, which would have generated approximately $80 million in revenue dedicated specifically to fund trauma care throughout the state. As such, Georgia missed an opportunity to secure a dedicated funding source for:  training 911 professionals, paramedics, critical care nurses and physicians; increasing rapid transport; providing the latest life-saving equipment and technology; and upgrading more emergency rooms to trauma centers.  Currently, there are only four level-1 Trauma Centers to serve 9.8 million Georgians.  Incidentally, deaths from trauma injuries in Georgia are 20 percent higher than the national average because access to trauma care is severely limited.  Despite the failure of the amendment to gain approval by the voters, groups like Georgians for a Healthy Future, Health STAT and others will continue to stress the need and urgency for trauma funding.  To read a recent AJC article on Amendment 2, click here.

161 Georgians Enrolled in Pre-Existing Condition Insurance Plan Since July

One of the early provisions of the new health law that went into effect this year was the creation of the Pre-Existing Condition Insurance Plan (PCIP) which provides people with pre-existing conditions an opportunity to purchase insurance without exclusions or higher premiums because of their conditions.  The PCIP, often referred to as a high-risk pool, is a bridge measure until 2014 when the health insurance exchanges will be up and operational and prohibit exclusions based on pre-existing conditions.  Back in July, many states opted to implement and operate their own high-risk pools, but Georgia instead allowed the Federal Government to operate the plan.  Figures released last week show that so far, 161 Georgians have already enrolled in the PCIP, part of the 8011 across the nation reported to have enrolled.  To view the data across the country, click here.  An estimated one in five Georgians has a pre-existing condition which could prevent them from securing private health insurance coverage.  Given that statistic, it would appear that enrollment for the PCIP is lower than expected given the need for such coverage.  It is important to remember that this is still a new program which has only been operational since July and there are procedural requirements that may be hampering enrollment. For example, for anyone applying, they must have been without insurance for six months and have been denied coverage, in writing, because of their condition.  As such, it is far too early to judge the merits of the program, but as the months go on and enrollment continues, we will see how Georgians with pre-existing conditions fare.  To read a recent AJC article on this issue, click here.

New Resource:  Georgia Health News Launched

This week, longtime health journalist Andy Miller launched Georgia Health News, an independent, nonprofit news organization that provides crucial, substantive information about health care in Georgia, including original reporting, consumer resources, and a blog. Visit the site here.

AIDS Drug Assistance Program Faces Funding Crisis:  Advocacy Opportunity

Georgia is one of nine states currently facing a funding crisis for the AIDS Drug Assistance Program (ADAP), which provides life-saving medications for low-income people living with HIV/AIDS. A waiting list was established for the program on July 1, and as of the end of October, there were 676 people on that list here in Georgia. The current funding gap is over $14 million. Advocates for people living with HIV/AIDS are seeking organizational sign-ons for a letter to President Obama and Members of Congress urging them to address this funding crisis with increased federal support. To learn more about the ADAP program, the consequences of this funding shortage for low-income people living with HIV/AIDS, and how to support the call for adequate funding of the program, please see Georgia Equality and the ADAP Advocacy Association.

The Affordable Care Act and You

State Health Refor(u)m

The National Academy for State Health Policy (NASHP) has devoted a section of its website to organizing and sharing resources developed by states to implement the new health law, including information about state legislation, coordinating councils, work plans, and timelines from across the country. The State Health Refor(u)m site is here. While there is no Georgia-specific information on the site at this time, the documents housed there are a helpful resource for advocates and policymakers working on implementation here in Georgia. We will hear from NASHP Executive Director Alan Weil about key decision points for states to consider at the Georgians for a Healthy Future policy breakfast on December 7^th. If you haven’t yet purchased your ticket for Health Care Unscrambled, you can do so here.

New Resource Available for Cancer Patients and Their Loved Ones

The American Cancer Society released a new consumer-friendly guide to help explain how the new health law will affect cancer patients and their loved ones.  The guide, entitled, “The Affordable Care Act: How it Helps People with Cancer and Their Families,”  describes how provisions of the law improve the quality of care and make health care more affordable, available and easier for patients to understand.  The guide also shares personal stories to illustrate exactly what the new law means for families affected by cancer.  To read the guide, click here.

New Resource:  The New Health Law and Free Clinics

The Georgia Free Clinic Network has released a new guide for charitable and free clinics and their management to help navigate the changing health care safety net landscape in light of the new health care law. This is the nation’s first comprehensive manual aimed at assisting free and charitable clinics to understand the new health law and make informed decisions. For more information, see the Georgia Free Clinic Network’s website.

HHS Announces New Federal Support for States to Develop and Upgrade Medicaid IT Systems

Under the new health law, beginning in 2014 health insurance exchanges will be a one-stop shop for consumers to review and purchase insurance coverage, including those eligible for Medicaid.  With the new law, there will be a large increase in the number of people eligible for the Medicaid program, and it will be critical that infrastructure and Information Technology (IT) is in place to meet this new demand.  Last week, the Department of Health and Human Services (HHS) announced new federal funding for states to streamline and upgrade their Medicaid eligibility systems in preparation for the changes.  Additionally, HHS announced guidance to help states design and implement the IT needed to establish exchanges.  These systems will help enroll people who qualify for Medicaid or PeachCare.  To read the HHS Press Release, click here.  This is different than a recent announcement regarding “Early Innovator” grants for IT Systems for the Exchange.  To learn more about that opportunity, click here.

New Funds Available to Support Community Health Centers

Last week, HHS Secretary Sebelius announced $335 million for existing community health centers across the country under the Expanded Services (ES) initiative. As part of the new health law, these funds will increase access to preventive and primary health care, including dental health, behavioral health, pharmacy, vision, and/or enabling services, at existing health center sites. Health centers requesting funds must demonstrate how the money will be used to expand medical capacity and services to underserved populations in their service areas. For more information and to view the grant application, click here.  Applications are due January 6, 2011 at 8 pm.  Currently, there are 26 Community Health Centers in Georgia that serve the needs of 76 counties.  They serve inner city neighborhoods, small towns and rural communities and make a difference in the lives of over 238,000 Georgians each year. To learn more about these Community Health Centers, visit the Georgia Association for Primary Health Care’s website.

What’s New in Georgia

Insurance Commissioner Candidate Survey Released

To educate Georgia voters on the role of the Insurance Commissioner with respect to health care issues, Georgians for a Healthy Future and Voices for Georgia’s Children surveyed all three candidates for Insurance Commissioner. Each candidate provided responses to eight questions about how they would approach the health insurance issues that fall under the purview of the office they are seeking. Today, our organizations are releasing a Voter Guide featuring those responses. Download the guide here.

On Election Day, Georgia voters will head to the polls to elect our state’s policymakers. Most voters are familiar with certain elected offices, like that of Governor, but many Georgians may be unaware of the importance, or perhaps even the existence, of the Office of State Insurance Commissioner.

The Insurance Commissioner runs the Georgia Department of Insurance and is elected every four years in a statewide vote. Among the core functions the Department of Insurance performs is the regulation of health insurance in Georgia. The Insurance Commissioner ensures that companies selling individual and small group policies in Georgia are financially solvent and enforces consumer protections and state laws regarding benefits that private insurers must include in policies sold in Georgia.

With the recent enactment of the Affordable Care Act, the new health care law, the role of the Insurance Commissioner has expanded. Our next Insurance Commissioner’s decisions will play an important role in shaping Georgia’s health insurance system for consumers in 2011 and well into the future.

Quality, affordable health coverage optimizes the health and wellbeing of Georgia’s children and families and ensures a healthy, productive workforce to grow our state’s economy. While the Insurance Commissioner alone is not responsible for the health of Georgia constituents, he or she will be one of a key group of elected and appointed state officials who together will implement different components of the new health law to maximize benefits for Georgians.

Georgia Receives Grant for Consumer Assistance Program

As part of the Affordable Care Act, the new health law, Georgia’s Department of Insurance applied for and received a grant for $822,156 on Tuesday to:

• Expand and enhance ability to provide assistance to consumers with health insurance issues, including ability to assist consumers wishing to formally appeal decisions made by their health insurer
• Improve capability to receive and track telephone calls from consumers seeking assistance by implementing calls center functionality
• Upgrade existing database systems to enhance the security of personally identifiable information and to obtain the ability to collect, track, and report data requested by Department of Health and Human Services

While these resources are needed to bolster existing capacity within the Department of Insurance, Georgia has not funded and has left vacant the role of independent consumer advocate since 2003. The Affordable Care Act includes stronger regulations on private health insurers and a range of new consumer protections. As these new provisions take effect, there will be a commensurate increase in the need for consumer navigation and assistance. An independent consumer advocate accountable only to consumers would be a welcome first step to meeting this increased need.

A number of other states receiving grant awards used their funds to create this sort of position or department, including North Carolina and Tennessee. To learn how other states are utilizing the Consumer Assistance Program grants, click here.

New Report Shows that 934K Georgians to Receive Premium Health Care Tax Credits in 2014

A new report released by Georgians for a Healthy Future and Families USA shows that 933,900 Georgians will be eligible for new tax credits beginning in 2014 that will significantly reduce the cost of private health insurance for individuals and families. The tax credits will offset a portion of the cost of health insurance premiums, and Georgians’ tax reductions will approximate $3.6 billion in that year.

Some key findings of the report show that working families will benefit the most:

• Approximately 823,700 Georgians will be in families with a worker who is employed full-time
• Another 71,500 people will be in families with a worker who is employed part-time

The tax credits will benefit both Georgians who are currently uninsured , who will utilize the tax credit to help purchase health insurance and Georgians who are currently insured who will use the tax credit to relieve some of the burden of health costs by making premiums more affordable.

• Approximately 466,400 uninsured Georgians will be eligible for a premium tax credit to purchase insurance
• Another 467,600 insured Georgians will be eligible for a premium tax credit to help with the cost of insurance

These tax credits will be financed entirely with federal dollars and will be available to Georgians purchasing insurance through the new health insurance exchanges. The state of Georgia was just awarded a grant from the Department of Health and Human Services to begin planning for an exchange here in Georgia. This is an opportunity for our state to ensure this marketplace navigates consumers to the appropriate health insurance option, whether that be Medicaid, PeachCare for Kids, or private insurance that will now be made affordable through these hefty tax credits.

To read the report, Lower Taxes, Lower Premiums, in its entirety, click here.

Mental Health Care in Georgia to Improve with Recent Court Decision

This week, the State of Georgia and the United States Department of Justice settled the Justice Department’s litigation against the state based on both conditions in the state’s seven psychiatric hospitals and the lack of community services for people with mental illness and developmental disabilities.  Olmstead was at the heart of the lawsuit and is central to the settlement agreement.  In Olmstead, the U.S. Supreme Court held that people with disabilities have the right to receive services in the community rather than in institutions.

Highlights of the settlement include:

• 9000 people with mental illnesses will receive services
• Increased funding for individuals with mental illnesses and developmental disabilities by approximately 59 million over next year and a half.
• 150 – 250 additional people with developmental disabilities will obtain Medicaid vouchers each year over next five years
• Increased family supports to 2350 additional people with developmental disabilities by 2015
• Housing subsidies for 2000 people with severe and persistent mental illness by 2015
• 22 Assertive Community Treatment Teams that will serve 100 people each that will be brought to fidelity by 2015
• New case management, peer support, crisis stabilization, and supports for individuals with disabilities.

The settlement, over a decade in the making, is a success for the mental health and developmental disability community and will make great strides to ensuring that these populations receive the care they need in the setting that is right for them. To learn more, click here for a recent AJC article and to read the Department of Justice press release, click here.

Public Health Commission Meeting

The Public Health Commission met for the fourth time on Monday, October 18.

The Commissioners voted to instruct their contract consultant to draft a report for their review that recommends Public Health become an independent agency, with an “attached” agency being the back-up preference. The next meeting of the Public Health Commission is scheduled for November 15 and its final report is due on December 1, 2010. For more information about the Public Health Commission, click here.

The Affordable Care Act and You

New Interactive Timeline for Implementation

The Kaiser Family Foundation has updated their Health Reform Source to include an interactive implementation timeline. The timeline is designed to explain how and when the provisions of the health reform law will be implemented over the next several years. You can show or hide all the changes occurring in a year by clicking on that year. Click on a provision to get more information about it.  To view the timeline, click here.  Additionally, if you have not done so already, be sure to check out KFF’s video Health Reform Hits Main Street here.

National News

Child-only Health Plans

Among the provisions of the Affordable Care Act that went into effect on September 23^rd was a requirement that insurers no longer deny coverage to children with pre-existing conditions. While only a small number of children are impacted by this change, they tend to be particularly vulnerable (without access to employment-based health insurance through a parent and ineligible for Medicaid or CHIP). In a controversial response to the new requirement, several insurance companies announced that they would stop selling child-only policies due to concerns that families would apply for these plans only after a child became sick. On October 13^th, U.S. Department of Health and Human Services (HHS) Secretary Sebelius sent a letter to the National Association of Insurance Commissioners clarifying the HHS regulation and outlining options for insurers and states. To read the letter, click here. For additional information on this issue from the Georgetown Center for Children and Families, click here.

Health Care Lawsuit Moves Forward in Florida

Last week, the U.S. District Court in Pensacola, Florida permitted a lawsuit against the Affordable Care Act to move forward.  Dismissing four other claims, Judge Vinson allowed the case to proceed to address the constitutionality of two main issues: the individual mandate and the Medicaid expansion.  Georgia is one of twenty states involved in the suit.  Despite this ruling in Florida, judges in Maryland, California, and recently Michigan have dismissed cases challenging the constitutionality of the Affordable Care Act.  Additionally, despite the legal challenges to the law, many provisions have already gone in to effect and will continue to do so while the issue is litigated.  Already, this law has:

• Ensured that kids with pre-existing condition have access to coverage;
• Given tax-credits to small-businesses that provide insurance to their workers;
• Allowed recent college graduates looking for jobs to stay on their parents plans;
• Sent checks to seniors to help pay for their prescriptions; and
• Protected consumers from insurance company abuses.

To read more about the lawsuit, click here and here.

What’s New in Georgia:

New Medicaid Figures in Georgia

In December 2009, nearly 1.5 million Georgians (874,000 children and 573,000 adults) were enrolled in the Medicaid program, an increase of 8.8 percent over December 2008 figures, according to the Kaiser Family Foundation. In the wake of the 2009 recession and unprecedented declines in employment-based coverage, Medicaid programs across the country saw the largest leaps in enrollment since the 1960s. While the Medicaid program provided coverage to many Georgians who lost workplace health insurance and would have otherwise gone uninsured, the number of Georgians without health insurance still leapt to nearly 2 million in 2009.

The Kaiser Family Foundation (KFF) release provides state-by-state data on Medicaid enrollment in 2009 as well as figures on FY 2010 Medicaid spending from a 50-state survey of Medicaid officials. For more state figures, visit the snapshot here.  For the survey of Medicaid officials, click here. For a recent AJC article discussing this topic, click here.

Georgia Community Health Centers receive more than $8 million in federal funds through the Affordable Care Act

On October 8^th, the Department of Health and Human Services announced $727 million in awards to 143 community health centers across the country. Over the next five years, under the Affordable Care Act, $11 billion in funding for the operation, expansion, and construction of community health centers will be available, nearly doubling the capacity of these centers to provide primary care services to patients regardless of insurance status or ability to pay. Two community health centers in Georgia received grants totaling more than $8 million. The full list of grantees is available here. For more information about community health centers in Georgia, see the Georgia Association for Primary Health Care.

Step up for Kids Day

On Monday, October 4, Voices for Georgia’s Children, in partnership with Every Child Matters, held their annual Step Up for Kids Day at the Sheltering Arms Early Education and Family Center.  The speakers discussed the importance of investing in children from birth to age five, thus providing a strong foundation for their future success. Parents, teachers and legislative leaders powerfully described the need to invest in the early years of children’s lives and urged those in attendance to get involved and speak up for children’s issues.  To learn more about the event and ways you can get involved, visit the Voices for Georgia’s Children website.

Yes 2 Save Lives

With less than a month to go until the general election, efforts to improve the state of Georgia’s trauma system are in full swing.  The Yes 2 Save Lives campaign was formed to educate Georgians about the current status of trauma care across the state and to build support for a constitutional amendment to allow for an annual $10 car registration fee. Funds would be directly used to provide a dedicated funding source to improve and expand the trauma care system across the state.  Deaths from trauma injuries in Georgia are 20 percent higher than the national average.  It is estimated that funds collected will generate $80 million a year and go directly toward improving our statewide trauma care system.  To check out the latest ads from the Yes2SaveLives campaign, click here.

HealthSTAT will feature a panel of experts on trauma care at their next meeting, Wednesday, October 20, at 8:00pm at Manuel’s Tavern.  They will also have campaign materials and yard signs available.  Contact Michelle Putnam at HealthSTAT if you are interested in learning more about the campaign or need any campaign materials.

Revenues Continue to Rise in September

State revenues in September increased by 5.7 percent over September 2009 revenues, according to data released by the Georgia Department of Revenue. While this increase is good news, vital services are still at risk as the long road to recovery continues. For more information about what the revenue numbers mean and the impact on the state budget, see the Georgia Budget & Policy Institute.

Special Council on Tax Reform and Fairness Continues its Important Work

At a September 29^th meeting, the Special Council on Tax Reform and Fairness for Georgians which is charged with studying the state’s revenue structure and making recommendations for legislation, heard presentations from a variety of business industries, learned how city and county taxes work, and dedicated the last hour of the meeting to presentations from emerging industries in Georgia. The meeting minutes are available here.

The Affordable Care Act and You:

Georgia Preparing for Health Insurance Exchanges

Georgia has been awarded a $1 million planning grant for the development of a health insurance exchange where consumers can shop for coverage.  The Governor’s Office of Planning and Budget will administer the grant and use it do the following:

• Form an Exchange Work Group to carry out the activities of the Georgia Health Benefit Exchange Feasibility Study. An Exchange Advisory Committee will also be formed with broader representation from key State agencies and stakeholder groups.
• Gather stakeholder input through an advisory committee, large group meetings to educate and inform stakeholders, focus groups, and web-based surveys. Website and email notices will be used to keep stakeholders and the general public informed.
• Determine whether or not Georgia should establish an Exchange and the implications of doing so on insurance markets both in Georgia and nationally.
• Provide recommendations on governance structure and regulatory changes required to establish as Exchange to decision makers.

Healthcare.gov Gets an Upgrade:

In an on-going effort to provide health care consumers with the most up-to-date and useful information about the new health care law, the web portal, www.healthcare.gov, has added more information aimed at helping people navigate the health care waters.  On October 1, they added important new pricing and benefits information for private insurance plans offered to individuals and families, giving consumers the power to compare costs and the protections offered by different plans.  In addition, information about preventive care has been updated to reflect services that insurers are now required to cover at no cost.  To learn more about new additions to the web portal, watch this video.

New Resources Available

New resources are now available, courtesy of AARP, to help people understand the implications of the new health care law.  The first is a fact sheet that is aimed at helping people in rural areas understand what the new law means for them.  Click here to learn more. Second, AARP has held and will continue to hold a series of webinars aimed at explaining the law and what it means for different populations.  Click here to access the archived webinars or to sign up for one in the future.  Lastly, there is a helpful question and answer document aimed at highlighting and dispelling Medicare and Medicaid scams.  Click here to access that document.

Missed Opportunity: Rate Review Grant Funding

The Affordable Care made significant changes to the purchase and regulation of health insurance, including the allocation of funds for states to improve accountability and oversight over insurance industry premium increases — a rate review process open to the public. On August 16, the Department of Health and Human Services announced grant awards of $1 million apiece to forty-five states and the District of Columbia; Georgia did not apply for the funding.  Georgia was one of only five states that did not apply for the rate review funds (the other four being Alaska, Wyoming, Iowa, and Minnesota).  The application process was reopened for the five states who had not applied for the funding but Georgia has no immediate plans to apply for those funds.

Pre-Existing Condition Insurance Plan Briefing Now Available:

One of the earliest elements of the Affordable Care Act, the Pre-Existing Condition Insurance Plan (PCIP) went into effect over the summer. In Georgia, there are an estimated 224,658 individuals who are potentially eligible for the PCIP, according to a new issue brief from the Commonwealth Fund. Georgia was one of 24 states that opted not to establish its own plan; however, uninsured Georgia consumers with pre-existing conditions can sign up for the federal PCIP. The new Commonwealth Fund report examines eligibility, benefits, premiums, cost-sharing, and oversight of the PCIP programs, as well as variation of the plans from state to state. The issue brief is available here.

National News:

On the national level, there have been many issues our partner organizations have been following. Here is an update on some of these pieces of legislation.

School Nutrition Bill Fails

The Child Nutrition and WIC Reauthorization Act expired on September 30, 2010 without a vote by the House of Representatives. In August, the U.S. Senate passed the Healthy, Hunger-Free Kids Act (S. 3307), which in part expands access to healthy school meals, establishes higher health standards for school lunches, and regulates the food available in school vending machines. On the House side, the House Education and Labor Committee passed the Improving Nutrition for America’s Children Act (H.R. 5504), but the full U.S. House of Representatives had not yet voted on that legislation. Though authorization of the child nutrition programs, including school meals, the special nutrition programs for women, infants and children known as WIC and other feeding programs, expired Sept. 30, they were extended by the resolution that will fund the government until Congress returns.  Despite the setback, advocates will continue to work on this issue.  It is speculated that the issue may be taken up after the November election.

The National Neurological Diseases Surveillance System Act Passes House

The National Neurological Diseases Surveillance System Act (H.R. 1362) would direct the Centers for Disease Control and Prevention (CDC) to create a national surveillance program on neurological diseases, such as MS and Parkinson’s. This legislation will establish a national data surveillance system that will track and collect data on the epidemiology, incidence, prevalence, and other factors of neurological diseases, including multiple sclerosis and Parkinson’s. Currently, such a national coordinated system does not exist to collect data on MS. The development of a surveillance system will address this gap by gathering all existing data on the incidence and prevalence of MS in one location. As a result, this system could help uncover and inform promising areas of MS research such as: genetic and environmental risk factors, and support the discovery of disease therapies, treatments, and one day—a cure.

What’s New in Georgia

Care Beyond College

September 23rd marked the 6-month anniversary of the signing of the Affordable Care Act.  On the 23^rd, several key provisions impacting children and families took effect.  To highlight these new provisions and what they mean for Georgia families, Georgians for a Healthy Future hosted a public forum at Emory University entitled “Care Beyond College.”  Among the elements of the law now in effect is a provision allowing young adults up to age 26 to remain on a parent’s insurance plan regardless of school status. Other pieces of the Affordable Care Act that went into effect this week include the elimination of lifetime benefit caps, a requirement that there be no cost sharing tied to preventive services in private health plans, the elimination of pre-existing condition exclusions for children, among others. A summary of the new provisions now in effect can be found here.

At Thursday’s “Care Beyond College” event, a line-up of speakers shared their unique perspectives on the health law and the new provisions.  Joann Yoon, Associate Policy Director of Child Health for Voices for Georgia’s Children, explained how the new provisions will work and shared a personal story about her experience trying to maintain coverage when she graduated from law school. Dr. Minesh Shah, a Primary Care Internal Medicine Physician at Grady Health System, shared his experiences in serving young adults who often go without coverage to the detriment of their health and often times their academics.  Dr. Michael Huey, Executive Director of the Emory Student Health and Counseling Services, was on hand to speak specifically to the Emory community and how changes in the Affordable Care Act will affect the student plan on campus.  Vicky Kimbrell, a parent and legal services attorney, shared her personal story of being a health care attorney with an uninsurable 22-year old who will now benefit from the dependent care provision of the law.  To round out the forum, Representative Pat Gardner shared her thoughts on the legislature’s role in making sure implementation goes smoothly and works for Georgia’s families.

Several resources and information sheets were shared to further explain the new provisions of the law.  For the U.S. PIRG “The Young Person’s Guide to Health Insurance,” click here.  For the Center for Children and Families briefing, “September 23 Health Care Reforms: Making Insurance Work for Children and Families,” click here.  For the Georgia “Getting Covered” fact sheet, click here.

Nearly Two Million Georgians Uninsured in 2009

On September 16^th, the Census Bureau released new figures on health insurance in the United States. In 2009, the number of uninsured Americans topped 50 million, propelled by unprecedented declines in employer-sponsored coverage during the recession. Here in Georgia, there were 1.9 million individuals without health insurance, or one in five Georgians. The Affordable Care Act will extend coverage to most of these uninsured Georgians by 2014, when the law is fully implemented. To read the Census Bureau’s report on the new health insurance figures, click here. To read more about the implications for Georgia, click here.

Health Care 2010 and Beyond: A Symposium Exploring the Health Care Law and What it Means for Georgia

During the month of September, Georgians for a Healthy Future partnered with the Georgia Budget and Policy Institute, Voices for Georgia’s Children, and AARP to engage community leaders, public health professionals, medical providers, and other stakeholders in six cities throughout the state of Georgia in a discussion about the Affordable Care Act and what it means for Georgia. We visited Athens, Rome, Butler, Tifton, Macon, and Savannah. If you are interested in copies of the power point presentations that the speakers gave or in the materials we distributed, please e-mail us. You can also view our photos from the symposia here.

Public Health Commission Meeting Underscores Need to Highlight Importance of Public Health

The Public Health Commission, charged by the Georgia Legislature with identifying and recommending an appropriate organizational structure for the Division of Public Health, held its third meeting in Atlanta on September 13th.  The Commission heard from legislators, state officials, and policy experts. The legislators highlighted the need for clearer communication between the Division of Public Health and legislators about the mission and function of public health in Georgia. According to the testimony, creating a new state agency in the current budgetary climate is a challenge compounded by a lack of overall confusion within the Legislature about the role of public health. More information about the Commission is available here. A presentation given by the Georgia Budget & Policy Institute at the September 13^th meeting explaining public health and the state budget is available for download here. The next meeting of the Commission is scheduled for October 18^th.

Next Meeting of the Special Council on Tax Reform and Fairness

The next meeting of the Special Council on Tax Reform and Fairness will be held on Wednesday, September 29th at 1:00 PM in the auditorium of Cecil B. Day Hall at Mercer University’s Cecil B. Day Graduate and Professional Campus in Atlanta. The purpose of the council is to study the state’s revenue structure and make recommendations for legislation by January 10, 2011. Georgians for a Healthy Future is monitoring the work of the council because we want to ensure that our state has adequate revenues to meet the essential health care needs of Georgia’s most vulnerable children and families. More information about the council, including meeting minutes and background materials from previous meetings, is available here.

National News

Update on the Prevention and Public Health Fund

The Prevention and Public Health Fund, a $15 billion fund designated by the Affordable Care Act for use in communities across the country to target key public health issues such as tobacco cessation and obesity prevention and to strengthen local and state public health infrastructures was at risk of being gutted through an amendment under consideration in the United States Senate last week. In a 52-46 vote, the amendment failed and this vital fund was preserved. More information about the fund is available on the website of the Trust for America’s Health. Information about last week’s Senate vote is available here.

HHS Reopens Application Process for Rate Review Grants

On September 1^st, the Department of Health and Human Services reopened the application process for states to apply for federal grants of $1 million per state to review proposed health insurance premium increases and take action against unreasonable rate hikes. In the first round of applications, Georgia was one of only five states that did not apply for the grant. Only those 5 states are eligible to apply for the second round of grants, and applications are due to HHS by September 30, 2010. Should Georgia apply, this grant opportunity would enable our policymakers to develop strategies to protect consumers against unfair premium increases. More information is available here and here.

The Affordable Care Act and You

New Provisions Go in to Effect: New Resources Available

September 23 marked the 6-month anniversary of the signing of the Affordable Care Act and with it came many new provisions that will benefit families all across Georgia.  A number of new resources are now available to explain these new provisions and help health care consumers understand exactly how they can benefit from the new changes.  Consumers Union released a consumer’s guide to health reform, available for download here. Community Catalyst has a publication, entitled “Six Months In: Who is the Affordable Care Act Benefiting in your community?”  You can read that publication here.  Additionally, Families USA has compiled several useful fact sheets, publications, videos and other useful resources describing, in detail, the new protections.   You can access that information here.

Health Reform Hits Main Street

Got a few minutes to be entertained and educated at the same time? This new animated video from the Kaiser Family Foundation hits the highlights of the Affordable Care Act in a fun-to-watch and easy-to-digest format. Share it with all of your friends! A new health reform gateway from the Kaiser Family Foundation also features a customizable health reform implementation timeline and an interactive map of the United States containing state-by-state health care data and news.

Health Reform and Rural Communities

Rural communities in Georgia face a unique set of health care challenges, particularly in the area of access to medical care. Several provisions of the Affordable Care Act aim to increase the number of physicians and health care providers practicing in rural communities. The Center for Rural Affairs analyzed the elements of the new law that target an expansion of the rural provider workforce in a new issue brief entitled “Health Care Reform, What’s In it:  Rural Communities and Rural Medical Care.” The report is available here.  Earlier this week, the Georgia Rural Health Association held its annual meeting in Young Harris, Georgia. The meeting featured a strong line up of presentations and break-out sessions.  Visit the GRHA website for more information and to obtain copies of the presentations.

WHAT’S NEW IN GEORGIA:

Young and Insured:

On September 23, 2010, the dependent care provision of the Affordable Care Act goes into effect, allowing young adults up to age 26 to remain on their parents’ health insurance plans regardless of their school status.  To raise awareness about this new coverage option and to provide information about how it will work, Georgians for a Healthy Future will be holding an event on the Georgia State University Campus on Thursday, September 23^rd.  Speaking at the event are students as well as parents affected by the new provision, a physician to illustrate the provider-perspective, and others with a stake in this new insurance option.  We encourage all those in the Atlanta area with an interest in learning more about this new coverage option for young adults to attend this event and encourage young adults and parents to attend.  For more information, email Amanda Ptashkin.  Additionally, the national group Young Invincibles has launched a new website to help those that will now be eligible for dependent care to learn more about it.  Visit www.gettingcovered.org for more information.

Is it Worth $10 to Save a Life?

Only 15 designated trauma centers serve the state’s 9.3 million people–an inadequate number leaving too many Georgians without rapid access to life-saving trauma care. As a result, of the 40,000 cases of major trauma each year in Georgia, only 10,000 are treated at one of these designated trauma centers.  In November, Georgia voters will be asked to approve a constitutional amendment for an annual $10 car registration fee.  The $10 vehicle registration fee will dedicate funding for specialized medical services that help people survive serious injuries across the state.

Trauma care in Georgia is far from what it needs to be to address the needs of the state’s population.  Only four hospitals in the state are equipped to deal with the most critical injuries. Dedicated funding will help open new trauma centers, and keep those that exist from closing.  To learn more about the campaign to pass the ballot initiative and what you can do to get involved, visit www.yes2savelives.com or contact Howard Franklin to have your organization join the advocacy efforts.

Tax Revenues Continue to Rise in August:

On Wednesday, Governor Perdue announced that tax collections for August 2010 were up by almost 13 percent over August 2009 collections, marking the third consecutive month of gains over the previous year’s month. As a result, Fiscal Year 2011 tax collections are up 8.6 percent over last year’s numbers at this point in the FY 2010 Fiscal Year. The FY 2011 assumes 4 percent growth over FY 2010 for the entire year; for now, the budget cuts that Governor Perdue ordered earlier this summer remain in effect. For more information, click here. For additional state budget analysis and information, see the Georgia Budget & Policy Institute.

NATIONAL NEWS:

Public Health and Prevention Trust Fund at Risk:

The Affordable Care Act includes a major new investment in prevention and public health:  The Prevention and Public Health Fund is designated for use in communities across the country to target key public health issues such as tobacco cessation and efforts to reduce obesity by encouraging better nutrition and increased physical activity. The funding will also be used to strengthen state and local public health infrastructure, support data collection and analysis for community-based and clinical-based prevention activities and to expand and improve training for the public health workforce. Here in Georgia, these funds will be critical to strengthen our public health system. The fund, however, is at risk of being gutted through an amendment proposed by U.S. Senator Mike Johanns (R-NE) on which the U.S. Senate will vote on September 14th.

The Johanns amendment would use the Prevention and Public Health Fund as an offset to repeal a tax compliance provision (also created under the Affordable Care Act) through the Small Business Jobs and Credit Act. The shortfall that this creates would be paid for by eliminating the $11 billion from the Prevention and Public Health Fund. If this amendment passes, there will be no funding to support these crucial public health initiatives. An alternative amendment proposed by U.S. Senator Bill Nelson (D-FL) would also address the concerns raised by small businesses on the tax compliance provision but would preserve the Prevention and Public Health Fund. More information is available here. Please contact Georgia Senators Johnny Isakson and Saxby Chambliss and ask them to support the preservation of the Prevention and Public Health Fund. To learn more and take action, click here.

Connecting Kids to Coverage Challenge:

On September 3rd, Secretary of Health and Human Services Kathleen Sebelius announced a renewed effort to cover the nearly 5 million uninsured children throughout the country, including 193,000 children here in Georgia, who are eligible for but not enrolled in existing Medicaid and CHIP programs. In Georgia, 80.6% of children eligible for these programs are enrolled, which is not statistically different from the national average. In conjunction with this announcement, two companion reports were released in the journal Health Affairs, one releasing state-by-state data on eligible but enrolled children and the other describing tools to enroll eligible children. To learn more about the challenge, including the range of organizations who are participating, see www.insurekidsnow.gov. For more information about children’s health here in Georgia, see www.georgiavoices.org.

Opportunity to Support Child Nutrition Programs:

The Child Nutrition and WIC Reauthorization Act expires on September 30, 2010. In August, the U.S. Senate passed the Healthy, Hunger-Free Kids Act (S. 3307), which in part expands access to healthy school meals, establishes higher health standards for school lunches, and regulates the food available in school vending machines. On the House side, the House Education and Labor Committee passed the Improving Nutrition for America’s Children Act (H.R. 5504), but the full U.S. House of Representatives has not yet voted on that legislation. When Congress returns from summer recess on September 13, they are expected to act on this issue. While both pieces of legislation improve the nutritional quality of food served to children in schools and improve access to meals, the House language is more comprehensive in its approach to addressing child hunger. Voices for Georgia’s Children is urging Members to support legislation to strengthen child nutrition programs as much as possible via a letter to Members of the Georgia Delegation of the U.S. House of Representatives. To read a copy of the letter and to add your organization’s signature and support to it, please contact Whitney Brown at Voices for Georgia’s Children at wbrown@georgiavoices.org.

AFFORDABLE CARE ACT AND YOU:

California Passes Legislation to Establish Health Insurance Exchange:

The Affordable Care Act requires states to establish health insurance exchanges to restructure the individual health insurance marketplace by 2014, or to allow their citizens to access a federal fallback exchange. California is on track to become the first state to establish such an exchange, having passed legislation to do so on August 25th. California’s Governor is expected to sign the legislation. More information is available here. All states have the opportunity to apply for federal grant dollars to begin planning for the establishment of a health insurance exchange. We will keep you updated as we learn about Georgia’s plans.

Healthcare.gov Web Portal Now Available in Spanish:

This week, the Department of Health and Human Services unveiled www.CuidadodeSalud.gov, a Spanish language website that will connect consumers to new information and resources that will help them access quality, affordable health care coverage.  The website is a one-stop-shop for information about the implementation of the Affordable Care Act as well as other health care resources.  The website connects consumers to quality rankings for local health care providers as well as preventive services.

Latinos suffer disproportionately from chronic health diseases such as diabetes and cardiovascular disease.  Latinos also have the highest rate of uninsured, with more than one in three going without insurance.  Cuidadodesalud will help address these disparities by including price estimates for health insurance plans as well as new information on preventing disease and illness and improving the quality of health care.  The website also includes a series of mechanisms through which users can indicate whether pages were helpful to them, so feedback can be used to grow and strengthen the site.

National News:

State Guidance Now Available for FMAP Funds

Last week the Center for Medicare and Medicaid Services (CMS) released guidance on how states can apply for money now available through the extension of the enhanced federal Medicaid funding, known as FMAP.  That extension was recently signed by the President and will provide Georgia with $230 million in Medicaid funding that the state needs to stave off deep cuts to essential health services.  According to CMS, “as a condition of receiving these additional Federal funds…the Chief Executive Officer of the State must submit a request…within 45 days of enactment, or by September 24, 2010.”  In order to receive the funding, the Chief Executive Officer of the State must submit a letter of intent to the Secretary of Health and Human Services and affirm that certain conditions are met. To view the letter and learn more about the requirements, read the CMS bulletin here.

The FMAP funding extension was already built in to the 2011 budget, but the amount Georgia will receive is less than was anticipated and will still leave the state with a budget gap.

What’s New in Georgia:

Department of Community Health Presents Options for Budget Cuts to Health Programs

On Thursday, the Georgia Department of Community Health presented its proposed options for cuts to the amended FY 2011 budget and the FY 2012 budget in response to a requirement from the Governor to reduce all programs in FY 2011 by 4, 6, and 8 percent and all programs in FY 2012 by 6, 8, and 10 percent, using the current FY 2011 budget as the baseline. Medicaid and PeachCare are not exempt from these cuts; however, because of Maintenance of Effort (MOE) requirements in the new federal health care law, states must maintain current eligibility standards for Medicaid and the Children’s Health Insurance Program (PeachCare). As a result, cuts will likely come from reimbursement rates to providers, which would negatively impact access to services for Medicaid and PeachCare beneficiaries. Significant cuts to public health programs were also proposed. To view the full presentation, click here. To learn more about the MOE requirements, click here.

Georgia Misses Opportunity to Protect Citizens Against Insurance Rate Hikes

The Affordable Care Act requires the Secretary of the Department of Health and Human Services (HHS), in conjunction with the States, to establish a process for the annual review of health insurance premiums to protect consumers from unreasonable, unjustified and/or excessive rate increases.  As part of process, the Federal government has made $46 million available to states to provide for grants to help them improve the health insurance rate review and reporting process between now and 2014.  In the first round of grant funding, Georgia passed on $1 million to help crack down on unreasonable health insurance rate hikes.  Georgia is just one of just five states who did not apply for the money. This is a missed opportunity to correct a situation that far too many Georgians face—being priced out of a plan when a disease or condition is diagnosed and costs sky-rocket.  Georgia is still able to apply for the second round of funding but it remains to be seen whether they will pursue this opportunity. For more information, click here.

Savannah Passes a Smoke-Free Ordinance

On Thursday, the Savannah City Council passed an ordinance supported by Mayor Johnson and Healthy Savannah to ban cigarette smoking in bars and other public spaces in Savannah, thereby reducing exposure to second-hand smoke and improving public health. The ordinance could serve as a model for the state. For more information, click here. To learn more about the work of Health Savannah, click here.

Local Doctors Build Advocacy Campaign in Georgia

Doctors for America (DFA) is a non-profit, grassroots, national organization of physicians and medical students who advocate for changes in the health care system to ensure affordable access to quality care for all.  Here in Georgia, confusion persists about the new health care law, and many doctors have come together to build a Georgia chapter of DFA to educate their patients and communities about the new law so that they can make appropriate, well-informed decisions regarding their care. If you are a physician and want to learn more about how you can get involved, please contact Gayathri Suresh for more information.

Special Council on Tax Reform and Fairness Continues its Work

On Wednesday, the 2010 Special Council’s four economists presented the principles of tax reform that will guide the council. These principles are:

• Growth enhancing
• Stability
• Clearness/simplicity
• Efficiency
• Equity/fairness
• Properly developed/transparency

This week the Council also held its first public hearing, or “fact finding session,” in Atlanta to gather comments from interested parties. Let the Council hear from you on the need to protect revenues for important services like public health, Medicaid, and PeachCare by submitting comments online (http://fiscalresearch.gsu.edu/taxcouncil/contribute.htm) or by attending one of the upcoming fact finding sessions in your community.

FACT FINDING SESSION SCHEDULE:  (All meetings from 4:00 PM to 7:00 PM)

To address the Council, submit a request by 5pm on the day prior to the hearing here.

August 30 – Augusta – Doubletree Hotel, Master’s Ballroom?2651 Perimeter Parkway?Augusta, GA 30909

August 31 – Savannah – Coastal Georgia Center, Auditorium?305 Fahm Street?Savannah, GA 31401

September 1 –Valdosta – Wiregrass Georgia Technical College, Brooks Hall Conference Center?4089 Val Tech Road?Valdosta, GA 31602

September 2 – Macon – Macon State College, Professional Sciences Conference Center, Banquet Hall?100 College Station Drive?Macon, GA 31206

September 7 –Rome – Forum Civic Center, Riverwalk Ballroom?Downtown Rome ?2 Government Plaza?Rome, Georgia 30162

September 9 –Gainesville – Gainesville State College, Gainesville Campus, Continuing Education, Business Division and Performing Arts Building, Auditorium?3820 Mundy Mill Road?Oakwood, GA  30566

The Affordable Care Act and You:

Health Reform Implications for Employers

Earlier this week, the Health Policy Center at Georgia State University released an analysis of the employer responsibility provisions of the new health care law and an interactive calculator for small businesses to estimate their eligibility for tax credits available through the new law to provide health insurance for their workers. The report is available here. The calculator can be accessed here.

Several Health Reform Provisions To Take Effect on September 23rd:  Spotlight on the Dependent Care Provision

On September 23, 2010, the 6-month anniversary of the passage of the Affordable Care Act, several key reforms will go into effect. One of the most highly anticipated changes is the dependent care provision, which will allow young adults up to age 26 to remain on a parent’s health insurance plan.  Today, young adults aged 19 through 29 comprise about 13 million of the 47 million uninsured Americans.  Previously, young adults not enrolled in college full-time could not remain on their parents’ private health insurance plans as a dependent. However, because young adults just entering the workforce tend to have a more tenuous connection to the labor market (for example, as part-time, temporary, or low-wage hourly workers), they are less likely to have access to an employment-based health insurance plan. If they had been eligible for public programs like Medicaid and PeachCare as a child, they also generally lose eligibility for these programs when they reach age 19. To address this problem, the ACA requires private health plans to extend the age of coverage for dependents to 26, regardless of whether that young adult is enrolled in school.  While the provision takes effect on September 23, families who want to extend coverage to their children should consult their insurer and determine when their open enrollment period occurs.

On September 3, Young Invincibles, a group that works on health care issues for young adults, will unveil their Getting Covered campaign aimed at educating families about this new provision.  Their website, www.gettingcovered.org will go live that day and help educate the public about their rights under this provision.

Future issues of the Peach Pulse will highlight additional provisions taking effect on September 23^rd.

Implementation and the States: New Resources Available

Several elements of the new health care law will be implemented at the state level. To help states prepare, a range of resources have recently become available. The National Governors Association recently released a document identifying states that have passed legislation or issued Executive Orders to oversee and coordinate the process for health reform implementation. Highlighting eighteen states and the U.S. Virgin Islands, the document explains how many state legislatures and governors have begun setting up the infrastructure for implementing the new law. State implementation efforts, to date, include creating task forces or appointing officials responsible for moving forward with federal requirements.  Georgia has not yet set up such a structure. The table is available here.

The National Conference of State Legislatures also recently released a checklist for state legislatures that identifies state laws that may need to be amended to be in accordance with the new federal law. The checklist is available for download here.

Earlier this month, the Alliance for Health Reform held a briefing to outline key challenges and decision points for states as they embark on implementation. To read the event summary, transcript or to listen to the podcast, visit the Alliance for Health Reform website.

Additional resources to help guide state officials and advocates as they think through implementation include a recent report from the Robert Wood Johnson Foundation on harnessing federal resources for state goals, available here, and a guidebook from U.S. Pirg to help officials and advocates deliver on the promise of health reform, available here.

New Information on the Medicaid Expansion

The new health care law significantly expands the Medicaid program. Beginning in 2014, all Americans with household income up to 133 percent of the federal poverty level will be eligible for health insurance through Medicaid. Here in Georgia, this expansion is expected to considerably reduce the number of low-income uninsured Georgians. By 2019, between 645,000 and 900,000 could gain coverage through Medicaid. The Kaiser Family Foundation recently released two reports providing additional information about how this expansion will impact states. The first report provides state-by-state information on the number of people who will gain coverage through the program and the associated cost to states and is available here. The expansion will be entirely federally financed in the first two years, and will scale down to 90 percent federal/10 percent state in 2020 and thereafter. The second report describes several state Medicaid agencies’ efforts to prepare for health reform implementation while addressing challenges associated with the current economic downturn and is available here.

New Implementation Timeline Helps Explain the ACA

The Commonwealth Fund recently released an updated timeline for implementation of the Affordable Care Act.  Several provisions have recently taken effect, including the Pre-Existing Insurance Program (PCIP), the launch of the web portal and a requirement that no cost-sharing be applied to preventive services. However, most of the changes place between now and 2014. To view the timeline, visit the Commonwealth Fund’s website.

National News

President Signs FMAP Extension

On Tuesday, the U.S. House of Representatives passed and the President signed into law an extension of the enhanced federal Medicaid funding, known as FMAP. The additional $16 billion in Medicaid funding will bring approximately $230 billion to Georgia, staving off potential deep cuts to essential health care services. The federal legislation also contained an additional $10 billion in education funding for states. Both Georgia Senators voted against the enhanced FMAP extension. To find out how your House member voted, click here.  For those elected officials who voted in favor, please be sure to thank them for their support.

Healthy, Hunger-free Kids Act Unanimously Passes Senate

Last week, the U.S. Senate passed the Healthy, Hunger-Free Kids Act of 2010. The act requires the Secretary of Agriculture to establish national nutrition standards that would apply to all food sold on school campuses during the day, including food from vending machines. The new act will provide $4.5 billion to improve the National School Lunch Program, promote the health benefits of breastfeeding, and establish new national nutritional standards to help children eat healthier foods at school. With a childhood obesity rate of 31.7% in Georgia, this hits close to home. To learn more about the legislation, visit the Food Research and Action Center.

Senator Chambliss has helped to lead this effort through his work on the Senate Agriculture Committee and now the measure moves to the House where it is expected to pass.

What’s New in Georgia

Budget Revenue Estimates Show Case for Cautious Optimism

Last week, Gov. Perdue announced revenue collections for the state in July 2010 of $1.15 billion, which represents a 4.7% increase over last July’s numbers. According to the Georgia Budget and Policy Institute, revenues must grow by 4.3% each month to meet the Governor’s revenue estimates.  While the increase is cause for cautious optimism, a fuller picture of how actual FY 2011 revenue collections match up with FY 2011 revenue estimates won’t emerge until we have several months of data. If revenue collections fall short of revenue estimates, further budget cuts may be in store.

Kids Count Report

On July 27, the Annie E. Casey Foundation released its 21st Annual Kids Count Data Book.  This annual snapshot of America’s children, ranks states and provides county-level information on 10 measures of well-being.  Among the 50 states, Georgia remains ranked at 42 for overall child well-being, seeing no improvement over last year.  Here is a brief snapshot during one year in Georgia:

–       501,892 children live in poverty (nearly 1 in 5 children)

–       5,493 babies are born to girls ages 15-17 (15 each day)

–       14,014 babies are born low birth weight, less than 5.5 pounds (38 babies each day)

More information about Georgia and Kids Count data can be obtained from the Georgia Family Connection website.

Trauma Tag Fee Referendum

This November, Georgia voters will vote on a referendum to levy a $10 car tag fee dedicated to funding Georgia’s trauma care system. The tag fee, which would raise an estimated $80 million a year, would help the already existing 16 trauma hospitals in the state and be used to entice other hospitals to enhance their facilities to become trauma centers. Georgia’s trauma death rate is 20 percent higher than the national average and an estimated 700 Georgians die every year because they do not receive trauma care within the critical 60-minute window — the “golden hour” — immediately following injury. To read more about this issue, go to the Healthy Debate GA blog and read “Is it Worth $10 to Save a Life?”

Childhood Obesity in Georgia

A new report highlights the seriousness of the growing obesity epidemic in Georgia. In 2007, adult obesity prevalence in Georgia varied by county from 23.3% to 35.6%, with a statewide prevalence of 29%. Among children between the ages of 10 and 17, our state’s obesity and overweight rate is 31.7%.

The health consequences of rising obesity include: having risk factors associated with cardiovascular disease such as high blood pressure and high cholesterol; developing asthma, sleep apnea, and Type 2 diabetes.  There are many initiatives under way to combat this alarming trend, including efforts to get children physically active, increase the amount of quality physical education they receive in school as well as making sure they have nutritional options while there.  For example, see The First Lady’s Let’s Move campaign and legislation such as the Healthy, Hunger-Free Kids Act of 2010.

Here in Georgia, there are several groups and organizations committed to fighting the alarming obesity trends.  The Center Helping Obesity In Children End Successfully (CHOICES) helps prevent obesity and eliminate the overweight epidemic in children by enabling them to make better choices as it relates to food and lifestyle.  To learn more about ways they are making a difference, visit their website.  Youth Becoming Healthy (YBH), based in Albany, GA, was created in order to reduce the burden of childhood obesity in the community. This program was created in memory of CEO Pamela Green-Jackson’s brother Bernard Green, who died in February 2004 from the effects of obesity-related illnesses. YBH has facilities in six middle schools and one elementary school in Albany and provides free fitness and nutrition education to about 350 students a year.  To learn more, visit their website.  Also, check out the Policy Leadership for Active Youth (PLAY) and their Childhood Obesity section. PLAY is a collaborative effort between universities, state agencies, professional associations, and not-for-profit organizations in Georgia.  The initiative is led by the Institute of Public Health at Georgia State University, with support from Healthcare Georgia Foundation. You can visit their website here.

County-by-County Data on Health Insurance Now Available

The Census Bureau recently released county-by-county data on health insurance. This information is useful in determining gaps in access and affordability across the state and will help guide decision makers’ efforts to address these disparities in the future.

Last month, Small Area Health Insurance Estimates (SAHIE) released 2007 estimates of health insurance coverage by age, sex, race, Hispanic origin, and income categories at the state-level and by age, sex, and income categories at the county-level.  The data indicates that Echols County, Georgia has the highest percent of uninsured at 37.6 percent, while Telfair County has the lowest at 12.4.  Additionally, looking at all demographics, in sheer numbers, Gwinnett County has the highest number of uninsured with 163,870, representing 22.2 percent of the population there.  To learn more about the breakdown in each county as well as how Georgia compares to the rest of the country, visit the SAHIE website.

The Affordable Care Act and You

New Resources Available for States to Build Health Insurance Exchanges

On July 29, the Department of Health and Human Services (HHS) announced the availability of up to $1 million in grants per state to help states begin work to establish health insurance exchanges. Under the Affordable Care Act (ACA), the Exchanges are to be operational by 2014 and will provide eligible consumers and businesses with a “one-stop shop” where they can compare and purchase health insurance.  This round of funding will give states resources to conduct initial research and planning for the exchange. Each state has the option to establish and operate its own Exchange or partner with another state or states to operate a regional Exchange. If a state decides not to create an Exchange for its residents, HHS will establish one on their behalf.

HHS also issued a request for comment asking states, consumer advocates, employers, insurers, and other interested stakeholders to provide input as HHS develops the rules and standards Exchanges should be required to meet. Comments are due by October 4, 2010.  To read the complete request for comment, visit http://www.healthcare.gov/center/regulations.

The Impact of Community Health Centers

This week, the Department of Health and Human Services (HHS) announced the availability of up to $250 million in grants for New Access Points for the delivery of primary health care services for underserved and vulnerable populations under the Health Center Program. Organizations eligible to compete include public or nonprofit private entities, including tribal, faith-based and community-based organizations who meet health center funding requirements.

Once fully implemented, the ACA will result in an additional 32 million Americans with health insurance coverage, with about half of these individuals likely to be covered through an expansion of the Medicaid program. Policymakers identified community health centers as ideal locations to provide this additional care and included an additional $9.5 billion in operating expenses for these centers.  The $250 million in grants are just the start of the investment in community health centers across the country.

According to state-by-state data recently released by The Center for American Progress, the total projected economic activity of community health centers by 2015 in Georgia will be $663 million–$412 million of which will be as a result of health care reform.  In terms of job growth, community health centers expect to see 5,696 employees there with 3,541 of those jobs attributable to efforts undertaken by the ACA.  These community health centers serve vulnerable populations, regardless of their ability to pay and will continue to provide a much needed service to communities across Georgia.  In 2008, 275,743 patients were seen because of these institutions and with the availability of new funding, more patients will have greater access and more communities will be served.  To view the interactive map, visit http://www.americanprogress.org/issues/2010/08/chc_econ_impact_map.html.

Partner Up! For Public Health Campaign Now Underway

On July 14th, a public awareness and advocacy campaign was launched to educate policymakers and the public about the vital role that our state’s public health system plays in prevention, food safety, halting the spread of infectious disease, and other key aspects of population health. After nearly a decade of funding cuts, Georgia’s per capita spending on public health is about four cents a day, among the lowest in the nation. Georgians for a Healthy Future is one of thirty organizations represented on the campaign’s advisory board. To learn more and to get involved, visit www.togetherwecandobetter.com.

Public Health Commission Begins its Work

The first meeting of the Public Health Commission was held on Monday, July 12th. As part of the legislation that reorganized the Department of Human Resources, a Public Health Commission was created to examine whether the interests of the state are best served with the Division of Public Health being a part of the Department of Community Health, an attached agency, a completely separate agency or a part of some other organization. The Georgia Public Health Association is monitoring the meetings and providing ongoing information about the Commission’s progress on its website. More information about the Commission and its members is also available on the Department of Community Health’s website. The Commission will meet once a month and meetings are open to the public. The next meeting is scheduled for August 9th at 8:30am. The Commission’s report is due December 1, 2010.

What’s New in Georgia:

Budget Crisis Continues: Senators Still Need to Hear from Advocates

Governor Perdue has ordered Georgia agencies, with the exception of K-12 schools, to cut their budgets by another 4 percent starting in August. Georgia had been relying on Congress to pass an extension of the enhanced matching funds for Medicaid that the state was receiving as part of the American Recovery and Reinvestment Act, known as FMAP, when the Legislature and the Governor approved the FY 2011 budget. Those enhanced funds would have brought in about $375 million to the state. Without the enhanced FMAP, Georgia may have to make cuts to essential health care services for our most vulnerable families or cut reimbursement rates to providers, potentially limiting access to care and further harming our state’s fragile economy.

Please call Senator Isakson at (202) 224-3643 and Senator Chambliss at (202) 224-3521 and urge them to support an extension of the enhanced FMAP.

Special Tax Council Takes Aim at Changing Tax System

The first meeting of the Special Council on Tax Reform and Fairness was held on Wednesday, July 28th. The Council was created by the Georgia Legislature to study the tax system and provide recommendations to the General Assembly in January 2011.  The council will consider information from economists and from the public, according to remarks made at the initial meeting yesterday.  The work of the council provides an opportunity for consumers and advocates to weigh in. As an alliance member of 2020 Georgia, Georgians for a Healthy Future supports a balanced approach to state budget and revenue solutions that can meet the short and long-term needs of our state and its people, including vital health services for Georgians. Information about the council can be found here.

The Battle for a Smokefree Savannah Heats Up!

The Savannah City Council has begun public discussion on the Healthy Savannah proposal to make all workplaces and places open to the public smoke-free. Council members plan two public meetings before the introduction and first reading on August 12. The proposed ordinance seeks to eliminate problematic exceptions in state law, and includes:
•    All workplaces
•    Outdoor eating areas in restaurants
•    All Bars and Restaurants
•    Long-term care facilities
•    Private and semi-private rooms in health care facilities
•    International airports
•    Convention facilities
•    Private clubs
•    Retail tobacco stores
•    Distances 15 to 20 feet from the entrance to any public building

The measure is supported by many health organizations under the umbrella of Healthy Savannah. Healthy Savannah is a great example of a community based health program. They address a myriad of issues that are barriers to a healthy lifestyle.  The Mayor of Savannah, Otis Johnson, has endorsed the ordinance, saying it is an important step in protecting those who, like him, have heart conditions or other health risks aggravated by exposure to secondhand smoke.

If you know advocates in Savannah who would lend their support, please encourage them to contact the American Lung Association at jdeen@lungga.org.

The Affordable Care Act and You:

84% of Small Businesses in Georgia Eligible for New Health Care Tax Credits

Beginning this year, as part of the new health care law, small businesses that employ 25 or fewer workers, have average wages of less than $50,000, and contribute at least 50 percent of each employee’s health insurance premium are eligible for a tax credit to help with the cost of employee health insurance premiums. The tax credits are worth up to 35 percent of the employer’s cost for employee coverage, and the amount of the tax credit depends on firm size and average wage, with the smallest, lowest-wage firms receive the largest tax credits.

In Georgia, more than 120,000 small businesses–or 84 percent of all small businesses operating in our state–are eligible for the tax credit in 2010, according to a study released last week by Families USA and the Small Business Majority. Further, about 37,500 small businesses in Georgia qualify for the full 35 percent tax credit. A tax credit calculator is available here, and detailed FAQs about how the tax credit works are available here. Read the full report here.

Non-Profit Hospitals and Their Roles in Communities

Until recently, neither federal nor state governments clearly laid out expectations for hospitals around charity care and the requirements for maintaining their non-profit status. As a consequence, it has been hard for patients to understand what services are available to them when they need care they cannot afford. The Affordable Care Act (ACA) clarifies the role of non-profit hospitals and their committment to the communities they serve. For more information on the specific provisions of the ACA, see the fact sheet created by national nonprofit organization Community Catalyst:  Non-Profit Hospitals: Providing Essential Benefits to Local Communities.

The IRS issued a call for comments on these provisions, asking for input on the need for additional guidance to non-profit hospitals on how to fulfill the new requirements. Consumer advocates weighed in with many recommendations that included: 1) Setting standards for financial assistance policies that guarantee effective notification practices, fair and transparent application procedures, and eligibility criteria that reflect the needs of the hospital’s community; 2) Protecting consumers from harmful debt collection practices; 3) Clarifying what hospitals can charge their patients for care; and 4) Clarifying that hospitals must consult with consumer advocates and members of the communities they serve when conducting community needs assessments.

During the month of August, Georgia’s Congressional Delegation will be home for back in the state for their August Recess.  So that the final rule ensures that you can depend on nonprofit hospitals to deliver the care you need on fair
terms, at an affordable price that is accessible to all, please contact your Congressman to make sure they are playing a leadership role to make health care more affordable for all Georgians.  To stay updated on this issue, visit the Georgia Watch website.

New Rules Regarding Preventive Services Unveiled Last Week

Last week, the Department of Health and Human Services issued new rules relating to preventive care services. Under the new regulations, new health plans beginning on or after September 23, 2010, must cover preventive services that have proven evidence-based health benefits, and these plans may no longer charge a patient a co-payment, coinsurance or deductible for these services when they are delivered by a network provider. Services that will now be covered include: blood pressure, diabetes, and cholesterol tests; many cancer screenings; routine vaccinations; pre-natal care; and regular wellness visits for infants and children. For more detailed information about these new provisions, visit the HHS web portal to learn more.

FMAP and the Looming Budget Crisis in Georgia

The economy is still in a fragile state and all across the country states are struggling to balance budgets and still provide for their citizens.  Here in Georgia, it is no different.  Governor Purdue’s FY 2011 budget was balanced in large part based on the assumption of a continuation of enhanced FMAP for an additional six months.  Provisions were enacted through last year’s Recovery Act to enhance the Federal match dollars to protect state Medicaid programs at a time of crisis.  The crisis was two-fold, for individual families and as fiscal relief to states.  The enhanced FMAP was used to help keep state budgets afloat and to maintain vital health services to children and families at a point where much assistance was needed.  To date, no FMAP extension has been approved by Congress which places our state in a dangerous position.  Without an extension of the enhanced FMAP through the end of our 2011 State Fiscal Year, Georgia is short at least $375 million dollars.

Advocates must make their voices heard to get the FMAP extension passed very soon.  Take Action Today!  Call Senator Isakson and Senator Chambliss and urge them to support their constituents in Georgia and to extend the enhanced FMAP.  Their support will maintain our state’s commitment to providing coverage and health service access to vulnerable Georgians through Medicaid.

Update on the Babies Born Healthy Program

Effective June 7th, the Department of Community Health ceased operations of the Babies Born Healthy Program, which provides prenatal care to women who are at or below 250 percent of the federal poverty level, ineligible for Medicaid, and otherwise uninsured or underinsured. The Department of Community Health recently released a letter explaining this decision, which is available for download here, and an FAQ on the decision, available for download here. Since the program has closed, Healthy Mothers, Healthy Babies Coalition of Georgia, which operates a Powerline program to connect women in need of services with those health care services, is working to locate low-cost prenatal resources across the state of Georgia. If you are aware of low-cost prenatal services in your community, Healthy Mothers, Healthy Babies would like to be able to share that information with the women who call the Powerline. Please contact Pam Gaston, Executive Director of Healthy Mothers, Healthy Babies, with this information.

WHAT’S NEW IN GEORGIA

New Report on Metro Atlanta Hospitals

Only about half of metropolitan Atlanta’s hospitals comply with state regulations to advertise the availability of financial assistance, according to a report released in June by Georgia Watch. These findings are the result of an 18-month study through the organization’s Metropolitan Atlanta Hospital Accountability Project, or HAP, which focuses on financial aid programs for low-income, uninsured and underinsured patients at general hospitals in the 21-county metro area. For this project, Georgia Watch representatives visited all hospitals studied to see if signage was posted advertising the availability of free or reduced cost care, and if financial assistance policies were made available to the public. In addition, the HAP team surveyed 900 low-income, uninsured, or underinsured individuals about their financial experiences at area hospitals. Using publicly-available information, HAP compared and contrasted hospitals throughout the metro area in regards to their offerings for these vulnerable populations, and analyzed the specific barriers and challenges these populations face. You can read the report at GeorgiaWatch.org.

New Poll Reveals Cancer Patients Struggle to Afford Health Care and Pay Bills in Tough Economic Times

A new American Cancer Society Cancer Action Network(ACS CAN) poll of families affected by cancer shows that cancer patients, survivors and their families continue to struggle to afford health care and pay for other basic needs such as food and heat in the troubled economy. The findings suggest the need to implement the Affordable Care Act so that it benefits people with cancer.

The poll finds that nearly half of cancer patients and survivors under age 65 have had difficulty paying for health care costs such as health insurance premiums, co-pays and prescription drugs in the past two years. One-third of those currently in active treatment have had to delay some type of health care in the past year.  To learn more about the poll, take a look at the ACS Press Release and the Lake-Bellweather Poll Report.

The Commish: The Race for Insurance Commission is On

Georgia’s Insurance Commissioner is responsible for regulating insurers and enforcing consumer protections in health insurance. As many features of the new health care law begin to take effect, the Insurance Commissioner will have new watchdog and enforcement responsibilities over health insurance.  On June 25, the Atlanta Press Club hosted several candidate debates in advance of the July 20th primary elections, one of which was between candidates for the office of Insurance Commissioner. Georgia Public Broadcasting has the video on its website now of the Republican primary debate. There was no debate in the Democratic primary because that race is uncontested. There were several questions about health insurance regulation and the new health care law. The video is available here.

THE AFFORDABLE CARE ACT AND YOU

The Pre-Existing Conditions Insurance Plan and Web Portal are Live!

An important reform of the 2010 Patient Protection and Affordable Care Act takes effect July 1 when Georgians who have been without health coverage for at least six months and who have been denied coverage because of pre-existing health conditions will be given access to affordable, quality coverage. They will receive it through a new Pre-existing Condition Insurance Plan (PCIP) created by the U.S. Department of Health and Human Services (HHS).To find the new coverage available in Georgia and information about the complete range of health coverage options available for consumers by ZIP code through a website set up by HHS, see http://www.healthcare.gov

The HHS Web site and other information about the new program will be available on July 1.  The new website is the first to provide consumers and small businesses with information about private insurance, Medicaid, the Children’s Health Insurance Program, Medicare, and other coverage options in one place. Federal officials are emphasizing that the PCIP is not the long-term solution to the insurance industry’s practice of denying coverage based on pre-existing conditions; instead, it will serve as a bridge to 2014, when the reform law bans denials of coverage based on pre-existing conditions.

State-Level Implementation and Insurance Regulation:  New Resources from the NAIC

Over the next several years, state Insurance Commissioners will play an important role in implementing the new federal health care law. The National Association of Insurance Commissioners, comprised of health insurance regulators across the 50 states, is charged with several standard-setting and consultative responsibilities and now has a special section on its website dedicated to state insurance regulation and the Patient Protection and Affordable Care Act (PPACA). Among other things, the site includes information about potential funding opportunities for states through PPACA, a glossary of health care terms, and information about the new high-risk pools, now known as the Pre-Existing Condition Insurance Plan (PCIP).

New Reports and Resources

A  new series of issue briefs released by the Robert Wood Johnson Foundation walks through the effect on state governments, children, young adults, seniors, health outcomes, and premiums. The series is available for download here. The Georgetown Center for Children and Families also released a new report outlining key decisions for states in the implementation of the new law. That report is available for download here. For Georgia-specific information, the Health Policy Center at Georgia State University has a fact sheet on the implications of health reform in Georgia, which is available for download here.