Laura Colbert of the consumer group Georgians for a Healthy Future said that with medical underwriting, “Georgians who apply for coverage through this plan or others like it may be…
Blog (November 2017)
A subcommittee of the Georgia House of Representatives’ Insurance committee convened last Monday, November 13th to evaluate the use, costs, and effectiveness of the state’s mandated insurance benefits. Before the Affordable Care Act’s ten essential health benefits, states required insurers to cover certain health care services in the health plans sold in and regulated by the state, and many of those benefit coverage mandates remain in effect today. (CMS has a list of Georgia’s coverage mandates.) Because benefit coverage mandates have a principally positive impact on consumers’ access to, cost of, and quality of health coverage, GHF’s Executive Director Laura Colbert testified at the committee hearing.
In her testimony, Laura focused on the benefits of coverage mandates to consumers:
- Protection from insufficient coverage— No one plans on getting in a car crash or being diagnosed with cancer. Even health care services we think of as planned are not; only half of U.S. pregnancies are planned. Coverage mandates help to guarantee that consumers have access to needed care and are financially protected even if they do not accurately predict their health care needs when they enroll in a plan.
- Increased access to care— Studies show that coverage mandates can result in increased use of the mandated health care services, especially those that are expensive. For example, methadone maintenance treatment, the most effective treatment for opioid addiction, costs about $5000 annually. Because most insurance plans are required to cover mental health and substance use services, consumers are able to better access these services. Without that financial help, consumers may forgo this critical service or others like it.
- Financial protection at minimal cost—The Affordable Care Act limits how much consumers have to pay out of pocket for health care each year through what is called an out-of-pocket maximum. This out-of-pocket maximum includes co-pays, deductibles, co-insurance, and any other out-of-pocket costs but does not include premium payments. The out of pocket maximum protections only apply to mandated services. Non-mandated services include adult dental and vision services, infertility treatments, in-home nursing, hospice care, and long-term care, and consumers are often left to pay for the full costs of these.
- Comparison shopping made easier—In the U.S., only about 12% of consumers have proficient health literacy skills, meaning that they are able to calculate their share of health insurance costs for a year. By standardizing insurance plans through coverage mandates, consumers are better able to compare plans based on a more limited number of factors like price and network breadth.
If you want more information on the consumer impacts of coverage mandates, check out the fact sheet we created summarizing GHF’s testimony.
One of GHF core organizational activities is consumer outreach and education. Over the past two weeks, GHF’s Outreach & Communications Coordinator Jamila Young participated in two conferences in Dublin and Albany, Georgia in an effort to reach consumers across the state, provide them with useful tools and resources, and hear about their experiences with health care and coverage. When you are experiencing IBS Symptoms like constipation, and diarrhea, contact IBSClinics.
On October 23 and 24th, Jamila attended the Healthy Mothers Healthy Babies Coalition of Georgia (HMHB) conference in Dublin, GA. HMHB works to improve access to prenatal and preventive healthcare for women, children and families in Georgia through direct service, collaborative advocacy and community education. At this conference, Jamila talked with health care providers and consumers about the importance of Medicaid for pregnant women, children, and new moms. She was also afforded the opportunity to hear from Commissioner Frank Berry of the Georgia Department of Community Health (which oversees Georgia’s Medicaid program) about implementing community based work to advance health care in Georgia.
Last week, Jamila traveled to Albany, GA to attend the Southwest Georgia Project For Community Education’s (SWGA Project) second annual Food, Ag and Equity conference. At the conference, Jamila networked with rural farmers and consumers, and heard stories about their struggles obtaining health insurance, answered questions about Georgia’s Medicaid program, and provided much-anticipated information about the ACA’s current open enrollment period. Despite the conference’s focus on food and agriculture, several speakers spoke to the importance of healthy behaviors and utilizing preventative health care services to stay healthy. Georgians For A Healthy Future is excited to continue its work with the Southwest Georgia Project in 2018 as they work together to close Georgia’s coverage gap and expand Medicaid.