Georgians for a Healthy Future is spearheading Cover Georgia, a new coalition in support of expanding Medicaid in our state to cover the uninsured.  As part of this on-going effort, we will explore what is at stake for Georgia families and consumers as policymakers weigh this option in the coming months.

In 2014, Georgia consumers with incomes between 100% and 400% of the federal poverty level (FPL), or roughly between $11,170 and $44,680 for an individual, will be eligible for tax credits to purchase health insurance through the new federally facilitated health insurance exchange. Adults with incomes below 100% FPL, however, will not be eligible for these tax credits. This is because the Affordable Care Act envisions individuals with incomes this low becoming eligible for Medicaid through an expansion of that program.

If Georgia fails to adopt this expansion, this would create a “coverage gap,” leaving many Georgians with no options for affordable health coverage. This infographic helps explain how this would play out for two Georgians: Jan would make too much money to be eligible for Medicaid but would not make enough to access tax credits to purchase affordable private health insurance (a typical health insurance policy would consume nearly her entire income).  Meanwhile, John would be able to purchase insurance in the exchange with a tax credit, making health insurance reasonable for his budget.  This is simply not fair. All Georgians should have a pathway to affordable health care coverage. To learn more about Cover Georgia and to join our efforts, click here.

Georgians for a Healthy Future’s Executive Director Cindy Zeldin was named a consumer representative to the National Association of Insurance Commissioners (NAIC) again for 2013. The program provides a structured way for health care consumer and patient advocates from around the country to provide input from the consumer perspective. Having representation from Georgia’s health advocacy community in this program helps to ensure the voices of health care consumers in Georgia are heard as important decisions about health insurance and consumer protections are made.

Through the NAIC, state insurance regulators establish standards and best practices, conduct peer review, and coordinate their regulatory oversight. The work of the NAIC is particularly timely and important this year because they are developing model rules and regulations for implementation of the private health insurance reforms associated with the Affordable Care Act. To that end, earlier this year the NAIC consumer representatives collaboratively released “Implementing the Affordable Care Act’s Insurance Reforms: Consumer Recommendations for Regulators and Lawmakers,” available for download here. To view the NAIC press release announcing the 2013 consumer representatives, click here.

Approximately 1.9 million Georgians are uninsured, among the highest in the nation. Our new interactive resource, Mapping Georgia’s Uninsured, visually displays detailed information on Georgia’s uninsured population by age, income, and region. Click on the shaded regions within each map to see the total number of uninsured by age and income, uninsured rate, and the number of Georgians who would be eligible for Medicaid within each region if Georgia policymakers chose to expand the program. This mapping resource is part of our Cover Georgia initiative to educate policymakers and the public about Georgia’s uninsured, the benefits of coverage, and the opportunity the Medicaid expansion presents for Georgia patients, consumers, providers, and the state’s economy. To view the interactive maps, click here.

We are excited to announce that Georgians for a Healthy Future is taking part in Georgia Gives Day, a 24-hour, statewide giving event organized by the Georgia Center for Nonprofits. On December 6^th, Georgia Gives Day encourages individuals to take a minute and realize how interwoven non-profits are in their lives and to feel inspired to give to their favorite non-profits through www.gagivesday.org.

At Georgians for a Healthy Future, we strive to provide a strong voice for Georgia consumers and communities on the health care issues and decisions that impact their lives. We hope you think we’re doing a good job! We would love your show of support on Georgia Gives Day.  How has GHF impacted you? Your work? Your interaction with the health care system? If we’ve had any impact on you, we hope you’ll consider supporting us so that we can continue to do this important work.  We are committed to working towards a day when all Georgians have access to quality, affordable health care and we need your help to do it.

For those “Super-GHF” fans (we think there are some of you out there), why not help us spread the word? Share our message with your friends and family. Post on Facebook and Twitter. Help us make the most out of Georgia Gives Day!

As part of the Affordable Care Act, beginning in 2014 all new individual and small group health insurance plans must cover a core set of health care services and items across ten broad categories including hospitalization, prescription drugs, maternity and newborn care, and preventive services, among others. This core set of services and items is known as Essential Health Benefits.

The benefits that health plans are currently required to cover vary by state. To ease the transition to essential health benefits in 2014, the U.S. Department of Health and Human Services (HHS) set out a process for each state to select a benchmark health insurance plan (which would include all benefits currently mandated in that state) that would then be supplemented to fill in any gaps and ensure health benefits across all ten categories are covered.

Last week, HHS issued a proposed rule outlining each state’s benchmark plan.  HHS is accepting public comment on all states’ proposed benchmark plans, including Georgia’s benchmark, until December 26th, 2012 (instructions for how to comment are included within the proposed rule). You can view the proposed benchmark plan for Georgia here. For additional information about the Essential Health Benefits process, see a recent Health Affairs article here. For additional information through a Georgia lens, see a recent Georgia Health News story on Essential Health Benefits here.

This afternoon, Governor Deal announced that Georgia would not move forward with a state-based health insurance exchange. Instead, Georgia will have, by default, a federally facilitated exchange. While a state-based exchange would have been more easily tailored for Georgia and could have been more responsive to the needs of Georgia’s health care consumers, a federally facilitated exchange will still provide information, decision tools, and access to tax credits to help consumers find and purchase meaningful and affordable health insurance.

As the federal exchange gets built out, it will be important that federal officials consider the needs of consumers in states like Georgia. To that end, earlier this week Georgians for a Healthy Future joined with consumer advocates in states across the country to submit a letter to the U.S. Department of Health and Human Services recommending that federal officials create a robust stakeholder planning process, ensure in-person consumer assistance programs meet consumers’ needs, and ensure that qualified health plans available on the exchange protect consumers and meet their needs. You can learn more about health insurance exchanges in Georgia by visiting Georgians for a Healthy Future’s health insurance exchange resource page here. We look forward to working with policymakers to ensure that the federally facilitated exchange is successful in Georgia and that consumers have better access to meaningful and comprehensive health coverage for themselves and their families.

Georgians for a Healthy Future is excited to announce that Jonathan Cohn of The New Republic will be the keynote speaker for our third annual Health Care Unscrambled policy breakfast on January 10, 2013! We hope you’ll join us for this important event that brings together health care consumer advocates, stakeholders, and policymakers for a look ahead to the biggest health policy issues facing Georgia in the coming year. Jonathan’s full bio is below.

Jonathan Cohn covers domestic policy and politics for The New Republic, with a particular emphasis on social welfare, labor, and health care. He is also the author of Sick: The Untold Story of America’s Health Care Crisis—and the People Who Pay the Price.

Jonathan has been recognized in the pages of the Washington Post as “one of the nation’s leading experts on health care policy” and in the New York Times as “one of the best health care writers out there.” An item from Time suggested he “may be the smartest, most well-sourced health care writer in the country.”

Jonathan has won the Sidney Hillman and Harry Chapin media awards. He has also been a finalist for the Robert F. Kennedy Book Award, the New York Public Library’s Helen Bernstein Book Award, and the Livingston Award for Young Journalists. Jonathan, who is presently a member of the National Academy of Social Insurance, has been a senior fellow with Demos, a media fellow with the Kaiser Family Foundation, and a Griffith Leadership fellow at the University of Michigan. He is a frequent public speaker and radio/television analyst.

Jonathan grew up in South Florida, where he became a devoted fan of the Miami Dolphins, and graduated from Harvard University, where he became a devoted fan of the Boston Red Sox. But his biggest devotion is to his wife and two children, with whom he lives in Ann Arbor, Michigan.

This week’s election results removed any uncertainty about the Affordable Care Act’s future: the health reform law is here to stay. Now it is time to do the hard work of ensuring that health reform meets its promise in Georgia and that health care consumers have access to meaningful and affordable coverage.

Over the past three days, several news stories have outlined the key next steps and decision points for Georgia policymakers on Medicaid and the private health insurance marketplace, and many of them turned to Georgians for a Healthy Future to explain the implications for Georgia health care consumers. All articles are linked below.

Georgia expected to spar over Medicaid expansion in election aftermath

The Augusta Chronicle  | November 8, 2012

Big healthcare decisions loom for state in election’s wake

Atlanta Journal-Constitution  | November 7, 2012

Deal: No state exchange likely under Obamacare

11 Alive News  | November 8, 2012

Deal suggests Ga. unlikely to run health exchange

Columbus Ledger-Enquirer  | November 7, 2012

Health care law lives — and Ga. faces big choices

Georgia Health News  | November 7, 2012

Perhaps the biggest issue for Georgia’s policymakers to consider in the coming months is the Medicaid expansion. Leveraging the resources on the table to expand Medicaid will improve access to care, strengthen our state’s health care delivery system, and bolster Georgia’s economy. If your organization would like to join the Cover Georgia coalition in support of expanding Medicaid, email Georgians for a Healthy Future’s Outreach and Advocacy Director Amanda Ptashkin.

Georgians for a Healthy Future is a proud partner in the Specialty Tiers Coalition of Georgia, a group of consumer and patient advocates committed to ensuring affordable access to medications for patients with rare, chronic conditions. Earlier this month, the coalition hosted an educational forum at Emory University in Atlanta to raise awareness among policymakers and consumers about the growing trend of specialty tiers and the related risks to patients and consumers.

According to RheumatoidArthritis.org, specialty drugs are typically breakthrough prescription drugs that are used to treat complex, chronic health conditions such as cancer, multiple sclerosis, rheumatoid arthritis, hemophilia, and HIV/AIDS (remember the odds of contracting hiv). Traditionally, insurance plans cover prescription drugs on a 3-tiered drug formulary (Tier One: generic drugs; a typical co-pay is around $10; Tier Two: preferred brand name drugs; a typical co-pay is around $30; Tier Three: non-preferred brand drugs; a typical co-pay is around $50) These drugs can also have a second effect on you, in this center people get treated when they become addicted to any drugs and substances.
. Specialty tiers, also known as Tier IV, V, or VI, add an additional structure for specialty medications — cost sharing known as “co-insurance” — where the patient pays 20-35% of the cost of the medication, rather than a fixed, predictable co-payment.  Unfortunately, there is no limit on what a beneficiary may be required to pay for therapies relegated to specialty tiers.

The trend towards specialty tiers shifts costs to patients and places needed treatment out of reach for too many patients who are paying health insurance premiums to get the medical care they need, some need this special serums for your eyes and they are not receiving it.  Specialty tiers can result in drug costs well into the thousands of dollars per month for patients, increasing the likelihood that patients will go without needed treatment. In fact, a recent study found that one in four patients with an out-of-pocket prescription cost of $500 or more failed to fill their prescriptions. This indicates patients with insurance are having to choose between needed medications and everyday living expenses.

The Specialty Tiers Coalition will be active in the upcoming 2013 Legislative Session to grow awareness about this issue, and advocate for patient protections. Georgians for a Healthy Future and the coalition are currently serving as a community partner to the Health Legislation & Advocacy course at Georgia State University’s College of Law. Through this partnership, law students are providing research assistance and helping craft potential legislation to ensure adequate patient protections.

To read coverage of the October 10^th forum at Emory University, click here and here. To download a fact sheet on this issue from a coalition leader, Advocates for Responsible Care, click here.

Earlier this year, Governor Deal signed into law House Bill 1166 to restore child-only health insurance plans to the Georgia marketplace. The legislation was sponsored by Representative Atwood and supported by a broad coalition of consumer health advocates, health care industry stakeholders, and legislators, including Georgians for a Healthy Future. The law goes into effect on January 1, 2013, and will make standalone insurance policies for children available through an open enrollment period in January or in the event of a qualifying event throughout the year. The Georgia Department of Insurance is currently preparing the draft regulation, after which there will be a public comment period with the final regulation expected in December.

Several states around the country have taken similar action to make these plans available for children, and earlier this month the Commonwealth Fund issued a report examining legislative and regulatory efforts around the country during 2010 and 2011 and found that, in states that had taken action during those years, child-only coverage is now available in nearly all of those states. Since Georgia’s legislation was passed in 2012 and has not yet gone into effect it was not included in the analysis; however, the authors interviewed officials and advocates in Georgia and noted that legislation had been signed into law in 2012. Kaiser Health News also reported on the story last week. That article is available here. The study is available here.