The race to be Georgia’s Insurance Commissioner is one of the most overlooked statewide races on the ballot this November, despite the position’s impact on the health and finances of almost all Georgians.

Georgia’s Office of Insurance and Safety Fire Commissioner (commonly referred to as the Department of Insurance or DOI) is headed by Georgia’s Insurance Commissioner. The Department oversees health, auto, long-term care, and other insurance products that can be regulated by the state. For Georgians who have individual or small-group insurance (about 2.6 million Georgians), the Insurance Commissioner has a direct impact on their insurance rates, their ability to access needed health services, and the extent to which their coverage is transparent and fair.

Georgia’s Insurance Commissioner is a constitutional officer in Georgia and is elected by Georgia voters for a four-year term. The Commissioner and the Department are tasked with regulating insurance companies and licensing insurance agents operating in Georgia and overseeing state fire safety initiatives, in addition to other non-health-related duties.

Because the Insurance Commissioner is primarily responsible for overseeing private health insurance in Georgia, they are key to how the Affordable Care Act and its consumer protections are implemented in the state. For example, the ACA requires that insurance companies justify any premium rate increases of more than 10% through a process called “rate review”. The Commissioner and Department staff determine how strong and transparent to make Georgia’s rate review process, and in doing so, determine how accountable insurers must be as they ask consumers for more dollars out of their household budgets.

The Commissioner and DOI are also responsible for ensuring that health plans do not design their benefits so that they discriminate against certain types of consumers. For example, if a health plan only covers one type of HIV medication and only at the highest cost-sharing level of the plan, the Commissioner could instruct his department to examine whether the plan’s design constitutes discrimination against people living with HIV. Similarly, health plans are required to cover mental health and substance use treatment services at the same level as they cover physical health services. If the Commissioner is lax in overseeing the enforcement of these laws, consumers could be financially blocked from receiving the health services that they need.

The Commissioner and his office also license insurance agents selling health insurance plans and other consumer products, as well as Georgia’s health insurance navigators. The position of “navigator” was created and funded through the Affordable Care Act in order to provide free, local, unbiased assistance for consumer enrolling into health coverage through the Marketplace. Currently, Georgia’s navigators have to meet unnecessarily burdensome licensing requirements and pay a large fee in order to be licensed by the state, something that Georgia’s next Insurance Commissioner has the power to address.

The Department of Insurance is further charged with protecting Georgia citizens from insurance fraud, mediating disputes between consumers and insurance companies, and assisting consumers with questions. The Georgia Department of Insurance has historically been under-resourced and, as a result, has struggled to carry out these tasks in a robust way. Georgia’s next Commissioner will be integral in advocating for the budget and resources needed to assist and support Georgia consumers across all insurance products.

Georgia’s next Insurance Commissioner will have a significant role in shaping the state’s health care landscape over the next four years or more. Whether and how the state addresses issues like access to care, health care affordability, the opioid crisis, and the sustainability of the rural health care system may be decided by voters at the ballot box this November.

This blog is part of a series from Georgians for a Healthy Future to educate consumers about the impact of the 2018 election on timely consumer health issues. Please check out our previous blogs in the series:

• Eight questions for health care voters to ask Georgia candidates
• Governor blog
• General Assembly Blog

*Georgians for a Healthy Future is a non-partisan, 501(c)3 organization. We do not endorse or support any candidates or political party.

Early voting is underway ahead of the upcoming November 6th Election Day. Georgians across the state are heading to the polls to cast their votes for Governor, Insurance Commissioner, state legislators and other elected positions, and voters’ decisions about the candidates in each race will have a critical impact on consumers health issues in Georgia.

All of Georgia’s state legislative seats are on the ballot this fall and a record number of seats are being competitively contested. The resulting changes in the General Assembly could have a big impact on the future of health and health care for Georgia consumers.

Georgia’s General Assembly is made up of two chambers: the House of Representatives and the Senate. Georgia has one of the largest state legislatures in the nation with a total of 236 members, made up of 56 Senators and 180 Representatives. Every Georgia resident has one Georgia Senator and one Georgia House member, both of whom are up for re-election every two years.

Constitutionally, the General Assembly is only responsible for proposing and passing an annual state budget; however, during the body’s annual 40-day session, legislators also propose, debate, and pass laws for the state of Georgia, including those that regulate health care, health coverage, or that impact health through another sector (like education or transportation).  

All appropriations bills, which designate how state funds are to be spent, must originate in the House. Health care is the state’s second largest expenditure and made up almost 20% of this year’s annual budget. Each year, after the Governor proposes a state budget, the legislative leaders of the House turn the proposed budget into a bill for consideration by the House’s appropriations committee and then by the full chamber. When the House has approved the budget, the budget goes through the same process in the Senate. Once approved by both chambers, any differences are worked out in a conference committee, before sending the budget back to the Governor to be approved or vetoed.

The decisions made during the General Assembly’s budget considerations can have a big impact on health care and coverage for Georgians. For example, the General Assembly has over the last three years approved pay increases for primary care and OB-GYN doctors and dentists treating Medicaid patients, which improves access to care for the almost 2 million Georgians who rely on Medicaid for health coverage.

Members of the General Assembly may also propose laws to address issues of concern for their constituents. These issues can range from surprise out-of-network medical billing to the opioid crisis to Medicaid expansion to Georgia’s health insurance Marketplace. Many legislators receive ideas for legislation from concerns and complaints brought to them by their constituents (an important reason to get to know your legislators!).

Each year, hundreds of bills are proposed and only a fraction successfully pass both chambers. Health-related bills typically pass through the Health & Human Services and Insurance Committees in each chamber. Legislators can consider bills until Sine Die, the 40th and last day of the legislative session. When approved by both chambers, successful legislation goes to the Governor for approval or veto.

One of the most impactful pieces of health-related legislation passed by the state legislature in recent years is HB 990 (2014), which requires the General Assembly to approve any expansion of Medicaid. This bill effectively revoked the Governor’s ability to act independently to close Georgia’s coverage gap, making it more difficult to expand health coverage to low-income adults in Georgia. 

Georgia’s General Assembly will have many new faces after the upcoming election, each of whom will play a role in shaping the state’s health care landscape over the next two years or more. Whether and how the state addresses issues like access to care, health care affordability, the opioid crisis, and the sustainability of the rural health care system may be decided by voters at the ballot box this November.

This blog is part of a series from Georgians for a Healthy Future to educate consumers about the impact of the 2018 election on timely consumer health issues. Please check out our previous blogs in the series:

• Eight questions for health care voters to ask Georgia candidates
• A consumer health advocates guide to the 2018 elections: Georgia’s Governor

*Georgians for a Healthy Future is a non-partisan, 501(c)3 organization. We do not endorse or support any candidates or political party.

Pricilla Epps is a 54-year-old former security guard who lives in Blakely, GA, a rural community in the southwest region of the state.

Two days after having a sudden stroke, Priscilla lost her job because she was unable to work her scheduled shifts as she recovered that week. Priscilla’s health insurance was provided by her employer, so she lost her health insurance coverage when she lost her job, leaving her on the hook for all of the hospital costs that accumulated as she received care for her stroke. After a two-day stay, Priscilla was told she would have to leave the hospital due to her inability to pay for the costs of in-patient care.

Experiencing dizziness, difficult walking, discomfort in her limbs, and frequent forgetfulness, Priscilla went to see Dr. Kinsell, the only available physician in Clay County, where she still receives the limited follow-up care she can afford. She is still unable to go back to work or live on her own, so Priscilla has been living with her daughter for the time being.

Like Priscilla, 360,000 low-income Georgians, many of whom are uninsured, live in small towns and rural areas across the state. These areas have the most at stake in the debate over whether or not to close the health care coverage gap. According to a new report from Georgetown University’s Center for Children and Families and the University of North Carolina’s Rural Health Project, Medicaid expansions in other states have cut the uninsured rate in rural areas by half, while Georgia has seen a much smaller decline from 43 percent to 38 percent among the same population.

For rural Georgia residents like Priscilla, health coverage would open doors to the physicians and services that they need to stay employed or get back to work. For rural communities like Blakely, more residents with health coverage could make the difference between keeping or losing the few remaining primary care physicians in the area.

Your story is powerful! Stories help to put a human face to health care issues in Georgia. When you share your story, you help others understand the issue, its impact on Georgia, and why it’s important.

Your health care story is valuable because the reader may be your neighbor, friend, someone in your congregation, or your legislator. It may inspire others to share their stories or to become advocates. It is an opportunity for individuals who receive Medicaid or fall into the coverage gap, their family members, their physicians and concerned Georgia citizens to show that there are real people with real needs who will be impacted by the health policy decisions made by Congress and Georgia’s state leaders.

Share your story here!