Laura Colbert of the consumer advocacy group Georgians for a Healthy Future said Wednesday that “coverage under a waiver must be at least as affordable and comprehensive as under the ACA…
Blog (April 2019)
Month: April 2019
Yesterday was Sine Die at the Georgia General Assembly – the last day of the 2019 legislative session. This year’s session saw the approval of several bills that will surely impact consumers’ health and finances in positive ways if approved by the Governor. Efforts to address step therapy so patients have access to needed therapies and housing so that families can be assured of safe, healthy places to live have been multi-year efforts by consumer and family advocates. These bills now move to the Governor’s desk for his consideration and signature.
The impact of other bills is less certain. SB 106 may bring sweeping changes to Georgia’s health care landscape but the details have yet to be laid out. The passage of legislation is only the first step in a health reform process in which your voice and advocacy will be needed. (Learn more about the next steps and what to expect in our latest blog post and in the section below.)
Check out our summary of the more notable health bills of the 2019 session below and a full list of health care-related legislation at GHF’s legislative tracker.
SB 106, the Patients First Act, moved quickly through the Georgia General Assembly this session and was signed into law by Governor Kemp last week. As we have reported, the bill allows the state to pursue an 1115 waiver to make changes to Georgia’s Medicaid program that may include expanding coverage to more poor adults and a 1332 state innovation waiver to make changes to private insurance in the state.
Now that the bill is signed, what’s next? You are critical to ensuring that the waivers created from SB 106 lead Georgia to the healthy future that we all want. Your advocacy, stories, and input are necessary. Read our new blog so you know what to expect and how you can help ensure all Georgians have meaningful, affordable health coverage.
Step therapy legislation approved
HB 63, sponsored by Rep. Sharon Cooper, will require health insurance plans to establish step therapy protocols and outline a process for health care providers to request exceptions. Step therapy is a requirement by some insurers that patients try a series of lower-cost treatments before the insurer will cover the higher-cost treatment prescribed by a patient’s physician. The bill received final approval by the House on Tuesday
Call Governor Kemp at 404-656-1776 and ask that he sign HB 63.
Surprise billing legislation faced familiar roadblocks this year when provider groups and insurers could not come to agreement about payments for out-of-network care. There were late efforts to revive some or all of HB 84 and SB 56 but neither succeeded. (Both bills are covered in detail in our Februrary 11th legislative update.) We are grateful to Chairman Richard Smith and Chairman Hufstetler for their work on this important issue and hope to find a resolution for consumers in the next legislative session.
GHF, as part of the Healthy Housing Georgia coalition, supported HB 346. This bill will prohibit retaliation by a landlord against a tenant for complaining to Code Enforcement about unsafe or unhealthy housing conditions like the presence of mold, radon, rodents, insect infestations, or lead. If the Governor signs the bill into law, Georgia will join the ranks of forty-one other states that have already implemented similar legislation to protect tenants against retaliatory evictions. (For more details on the legislation, see our March 5th legislative update.)
Call Governor Kemp at 404-656-1776 and ask that he sign HB 346.
Sine Die Recap
HB 30: Amended FY 2019 Budget | SIGNED BY GOVERNOR
HB 30 makes adjustments to the state budget for the current fiscal year which runs through June 30, 2019. The “little budget” has passed both chambers of the General Assembly and been signed by the Governor. The amended budget went into effect on Tuesday, March 12th.
HB 31: FY 2020 Budget | PASSED
HB 31 is the budget document for the coming state fiscal year which will run from July 1, 2019 to June 30, 2020. The budget includes several new investments in behavioral health and mostly maintains funding for other health care programs and priorities. For more information on the health care highlights in the proposed FY 2020 budget, read the Community Health and Behavioral Health budget overviews from the Georgia Budget & Policy Institute.
HB 37: Expand Medicaid Now Act | DID NOT PASS
HB 37, sponsored by Rep. Bob Trammell, expands Medicaid in Georgia as envisioned by the Affordable Care Act by increasing Medicaid eligibility for adults up to 138% of the federal poverty guidelines (FPL). This is equivalent to $17,236 annually for an individual and $29,435 for a family of three.
HB 158: Improve Medicaid patient access to effective HIV treatment | DID NOT PASS*
HB 158, sponsored by Rep. Deborah Silcox, requires that Medicaid recipients have the same access to antiretroviral drugs used to treat HIV and AIDS as to those included in the formulary established for the Georgia AIDS Drug Assistance Program. This change would allow for increased continuity of care for people living with HIV/AIDS in Georgia. *Although HB 158 did not get a Senate vote, it received favorable comments in the Senate Health Committee, after passing the House unanimously. In recognition of the broad support of this effort, Georgia’s Medicaid agency has committed to the bill sponsor to implement the intent of the legislation.
HB 217: Needle exchange | PASSED
HB 217, sponsored by Rep. Houston Gaines, decriminalizes the act of working or volunteering for a syringe services program, a step towards legalizing the programs. Distributing clean hypodermic syringes and needles to people who use injection drugs (e.g. heroin) helps to prevent the spread of HIV and Hepatitis C, and does not increase the likelihood that people will newly take up injections drug use.
HB 290: PrEP pilot program | PASSED
HB 290, sponsored by Rep. Sharon Cooper, would establish a pilot program to provide preexposure prophylaxis (PrEP) drug assistance or services to persons at risk of being infected with HIV. PrEP is a medication taken by people who are HIV-negative to reduce their risk for infection. The pilot program would provide PrEP to people in counties identified by the Centers for Disease Control & Prevention as at risk of HIV outbreaks due to a high rate of opioid use and participants would receive regular HIV testing and related support services.
HB 83: Recess legislation | PASSED
HB 83, sponsored by Representative Demetrius Douglas, would require a daily 30-minute recess for all students in grades K-5 unless they have already had a physical education class or structured activity time in the day. This bill now sits in the Senate Rules committee and awaits a vote on the Senate floor. To learn more about the impact of recess on children’s physical and mental health, read this fact sheet from Voices for Georgia’s Children.
HB 321: Medicaid financing program | PASSED
HB 321, sponsored by Rep. Jodi Lott, would extend the sunset provision of the hospital provider fee for five years. The hospital payment program, which draws down additional federal funding, provides almost $1 billion annually to the state’s Medicaid budget. More information about HB 321 is available here.
HB 514: Georgia Mental Health Reform and Innovation Commission | PASSED
HB 514, sponsored by Rep. Kevin Tanner, would create the Georgia Mental Health Reform and Innovation Commission which would work to analyze and offer improvements to the state’s mental health system and run through at least June 30, 2020. Within the Commission, several subcommittees would be established to include Children and Adolescent Mental Health; Involuntary Commitment; Hospital and Short-Term Care Facilities; Mental Health Courts and Corrections; and Workforce and System Development.
SB 16: Interstate Medical Licensure Compact Act | PASSED
SB 16, sponsored by Sen. Kay Kirkpatrick, would allow Georgia to enter the “Interstate Medical Licensure Compact” which allows health care providers to more easily obtain licenses to practice in multiple states. It also provides Georgia’s Medical Board with easier access to investigative and disciplinary information about providers from other states, an important protective measure for Georgia patients.
HB 233: Pharmacy Anti-Steering and Transparency Act | PASSED
HB 233, sponsored by Rep. David Knight, would prohibit pharmacies from sharing patient data for commercial purposes and prohibit pharmacy benefit managers (PBMs) from steering patients to PBM-owned pharmacies. It also requires such pharmacies to file an annual disclosure statement of its affiliates. Pharmacy benefit managers are companies that manage the prescription drug benefit of your health plan.
SB 195: Prescription Drug Benefits Freedom of Information and Consumer Protection Act | DID NOT PASS
SB 195, sponsored by Senator Chuck Hufstetler, this bill would make it easier for consumers to know what prescription medications are covered by their health insurance plan and better understand the likely costs by requiring health insurers to conspicuously post on their website information about their drug formulary in a current and searchable format. A drug formulary is the list of prescription medicines that your health insurer agrees to pay for or partially pay for. SB 195 would also standardize and speed up the process for consumers and providers to request prior authorization for necessary prescription drugs.
HB 186: Certificate of Need Reform | PASSED
HB 186, sponsored by Rep. Ron Stephens, will create a new category for general cancer hospitals as part of an agreement with Cancer Treatment Centers of America that would allow more Georgia patients to be seen. This bill will also limit who can object to a provider’s Certificate of Need application for expanding hospital services. The change would limit objections to only come from health care facilities that provide similar services and are located within a thirty-five mile radius.
HB 197: Establishment of Strategic Integrated Data System | PASSED
HB 197, sponsored by Rep. Katie Dempsey, will establish the Strategic Integrated Data System through the Office of Planning and Budget. The data system would capture de-identified information about the physical and mental health and social services beign provided to Georgians across the state. The goal of the system is to provide a central source of date about state services that can be used by state agencies, lawmakers, and researchers to make programs more effective and cost-efficient.
HB 323: Regulation and licensure of pharmacy benefits managers | PASSED
HB 323, sponsored by Rep. David Knight, will provide a good first step in drug transparency from pharmacy benefits managers (PBMs.) PBMs will have to report how much they receive in rebates from pharmaceutical manufacturers to the Department of Insurance and how much of those savings are being passed on to customers, although the information are not required to be reported to the legislature or the public.
GHF has you covered
GHF has been monitoring legislative activity on a number of critical consumer health care topics. Along with our weekly legislative updates and timely analysis of bills, we have the tools you need to stay in touch with health policy under the Gold Dome.
- Sign up for the Georgia Health Action Network (GHAN) to receive action alerts that let you know when there are opportunities for advocacy and action
- Track health-related legislation
- Updated for 2019: GHF’s annual Consumer Health Advocate’s Guide. (Contact Michelle Conde at email@example.com for a printed copy.)
Last week Georgia’s Governor signed SB 106, legislation that allows the state to pursue an 1115 waiver to make changes to Georgia’s Medicaid program that could include expanding coverage up to more poor adults and a 1332 state innovation waiver to make changes to private insurance in the state. (We have covered the bill extensively in our weekly legislative emails and blog, and at CoverGA.org.) The Governor’s signature is only the beginning of a process that could bring sizable changes to Georgia’s health care landscape.
Now that the bill has been signed, what are the next steps?
The waivers that will result from SB 106 are only the vehicles to a possible future where all Georgians have access to affordable, quality health care, but they don’t provide a road map or the gas to get us there.
Your advocacy and input are necessary to provide the power and directions to that future.
For every 1115 and 1332 waiver that the state wants to pursue, Georgia’s policymakers must seek input from the public. There are required state and federal public comment periods for each waiver proposal and those are your opportunities to directly weigh in! Because waivers allow states to “waive” some consumer protections and provisions of federal law, it is essential that you speak up to let Georgia know how its ideas may impact you and your family.
Georgia’s timeline for crafting its waivers is still unclear (and likely still developing) but there is a specific process the state must follow. Here is what to expect from the 1115 waiver process and how you can help to shape what it looks like along the way.
While GHF will engage with Georgia’s decision makers to advocate for consumer-centered, evidence-based waiver proposals, there is a limit to what we can do without you. It is your stories, advocacy, and comments that will guide Georgia to the healthy future we all want.
In the above graphic there are ways that you can help us at every turn. In the time periods represented by white circles, you can share your health care and coverage stories with us and our Cover Georgia partners. We want to hear from you if you are uninsured and in the coverage gap, if you have an individual or family health plan through the ACA Marketplace, if you are covered by Medicaid, and any other story you think will help us understand how to best represent your interests.
The public comment periods (yellow circles) are your time to take direct action. You can directly impact Georgia’s health care reform proposals by telling the state how their ideas may impact you and your family. (Don’t worry! We’ll make it easy for you to understand the proposed waivers and will provide clear instructions so that submitting comments is easy!)
In states like Kentucky and Arkansas, thousands of comments from people just like you have fended off onerous waiver ideas that would have kept people from enrolling or staying covered. In Tennessee and Alabama, almost 14,000 individuals across both states said that their states’ proposed ideas would damage their ability to live physically, mentally, and financially healthy lives. You can do the same.
Expect at least four public comment periods (two for an 1115 waiver and two for a 1332 waiver) and plan to submit comments every time. As we head into the next phase of our work to ensure all Georgians have access to meaningful, affordable health insurance, we are counting on you!
Stay tuned and stay active!
Share your health insurance story with us now. Your experience will inform our advocacy ahead of the public comment periods.
Stay in touch! Sign up to receive email updates and look for your opportunities to act!
Read up on health care waivers with these resources: