Month: July 2020

A consumer health advocates guide to the 2020 elections: Georgia’s General Assembly

This year, no Georgian has been left untouched by the health or economic impacts of COVID-19. The global pandemic has spotlighted the importance of public policy decisions that prioritize the health and wellness of populations, the consequences of underfunding government agencies (like departments of public health) and other essential public infrastructure, and the disparate impact that public policies have had on Black Americans and other people of color.  National, state, and local leaders, many elected by the public, are responsible for the policy decisions made ahead of and in response to COVID-19, its economic fallout, and the movement for racial justice .

Ahead of Election Day on November 6, 2020, Georgians have the opportunity to learn more about these elected positions, the decision-making power each has, and how that may impact their health and the well-being of Georgians. This year, Georgians will cast their votes for the U.S. President, members of Congress,  state legislators, state supreme court judges, and other positions.  Voters’ decisions about the candidates in each race will have an unprecedented impact on consumers health issues in Georgia as we continue to battle through the current health crisis.

Georgia’s General Assembly
Pictures from the Georgia state capitol featuring GHF and health advocates

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, compromised 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. All of Georgia’s state legislative seats are on the ballot this fall.

Georgia’s state budget

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, housing, or transportation).  

All appropriations bills, which define how state money can be spent, must begin in the House. 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 all House members. As the House considers the budget, it hears from leaders of state agencies, lobbyists for various interest groups, advocates like GHF, and from members of the public about how the state should spend its budget for the next year.

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.

Due to the on-going coronavirus crisis, this year’s budget considerations by the General Assembly were influenced by falling state revenues. The General Assembly decided against finding new ways for Georgia to bring in money from increased tobacco taxes, taxes on insurance companies, and other revenue-generating ideas. Instead, the Georgia House and Senate passed a state budget that included $2.2 billion in budget cuts for the FY 2021 budget. The approved budget cuts  will have negative consequences for critical health care programs and social services. For example, a $91 million reduction in funds to the Department of Behavioral Health and Developmental Disabilities will make it more difficult for uninsured adults to find treatment for substance use disorders. The $8.2 million cut to the Department of Public Health will severely decrease programs that promote health care access in rural and underserved areas.

State laws

Members of the General Assembly may 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 maternal mortality. 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.

Two of the most impactful pieces of health-related legislation passed by the state legislature this year were HB 888, the Surprise Billing Consumer Protection Act, and HB 1114, postpartum Medicaid coverage. HB 888 will ban surprise billing in emergency situations and for non-emergency health services when a consumer is at an in-network hospital or other facility, beginning January 1, 2021. HB 1114 will allow new mothers to receive Medicaid coverage for six months after giving birth. (Previously, new moms were covered for only 60 days after giving birth.) Both of these bills will improve health and well-being of Georgians. Oppositely, in 2019, the Georgia General Assembly passed HB 481, which would have outlawed most abortions after 6 weeks of pregnancy. This law would have worsened Georgia’s maternal mortality crisis and was deemed illegal by a federal court.

This year’s election

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 COVID-19, 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. Be sure you know the candidates for Georgia’s Senate and House on your ballot and how they plan to act on the health issues that are important to you.


This blog is part of a series from Georgians for a Healthy Future to educate consumers about the impact of the 2020 election on timely consumer health issues. Please be on the lookout for more blogs in this series.

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


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Five Years in the Making: Consumer Advocates’ Role in Passing Comprehensive Surprise Billing Legislation

Quote from consumer about surprise billing and summary of blog

Today, Governor Kemp signed the Surprise Billing Consumer Protection Act into law! Georgians for a Healthy Future and our partners at Georgia Watch strongly supported this bipartisan bill to protect consumers from surprise out-of-network medical bills.

These exorbitant bills often burden patients with high amounts of medical debt. In fact, over half of debt collection actions contain medical debts, leading to bankruptcy for many consumers. Take George C. of Lilburn, for instance, who had his right foot amputated at an in-network hospital. Even after obtaining assurances from his insurer that the provider was in network, he still found himself stuck with costly medical bills. “I found out they used out-of-network providers when they assured me they would [not]. They would not dismiss the bills and I had no alternative but to file for bankruptcy,” said George, after receiving surprise medical bills totaling $60,000.

With the signing of the Surprise Billing Consumer Protection Act, the state has taken an important step toward protecting consumers from the nightmare scenario George experienced. Georgia is the 16th state to have adopted comprehensive protections against surprise medical bills, covering an estimated 2.5 million Georgia residents when the law goes into effect in 2021.

As a bonus, the legislation also allows Georgia to establish an all payer claims database (APCD), which is a powerful tool used by 19 other states. Georgia’s APCD will inform the surprise billing payment resolution process, but will also be used to help policymakers, stakeholders, and advocates develop better understandings of health care costs, use of services, population health trends, and disparities.

Thank you to all who followed the surprise billing debate and helped bring it across the finish line by contacting your legislators at each stage of the process!

This win was a long time in the making, and a very committed group of state leaders worked tirelessly on surprise medical bill protections for many years. That includes the bill sponsors, Sen. Chuck Hufstetler and Rep. Lee Hawkins, Chairman Richard Smith,  and the Governor and Lieutenant Governor and their staffs. Georgia Watch and Georgians for a Healthy Future (GHF) were fortunate to play meaningful roles as well.


The beginning of the debate

The Georgia General Assembly’s consideration of surprise billing protections stretches back to 2015 when legislators began to look at the inter-related issues of network adequacy and surprise out-of-network medical billing (called surprise billing or balance billing). Following the 2015 legislative session, the Georgia Senate convened the Consumer and Provider Protection Act study committee to look at these issues and to which GHF’s then Executive Director was appointed.

Picture of a speaker at a podium

To buttress the work of the committee and highlight the importance of addressing both surprise billing and network adequacy for consumers, Georgia Watch and GHF held the Getting What You Pay For policy forum in February 2016. As a result of the study committee’s work, the policy forum, and powerful advocacy by Georgia Watch and GHF, the 2016 legislative session saw the successful passage of SB 302, which required health insurers to maintain accurate lists (called “provider directories”) of in-network medical providers.

While the state legislature did not have the appetite to take on surprise billing in all of its complexities in 2016, Georgia Watch and GHF knew this important consumer issue had the attention of policymakers.


Stalemate

We did not want to lose the momentum for surprise billing protections. Using the time between the 2016 legislative session and the start of the 2017 session, Georgia Watch and GHF worked closely with legislative leaders to inform their thinking on the issue and to craft legislation. Unfortunately, the legislative options put forward by state leaders in the 2017 session failed because of disagreements between insurers and providers about how to resolve payment disputes.

Dedicated leadership by legislators and continued partnership with consumer advocates could not overcome the entrenched disagreements between doctors and hospitals, and health insurance companies over the costs of care. This dynamic continued through the 2018 and 2019 legislative sessions, leaving consumers vulnerable to expensive, unfair medical bills through no fault of their own.


“If you want to go fast, go alone. If you want to go far, go together.”

Recognizing the on-going stalemate, Georgia Watch and GHF thought carefully about how to overcome this impasse. After studying surprise billing successes in other states, we agreed that success would require a united front from legislative leaders with a Georgia-specific solution.

Georgia Watch and GHF approached Sen. Hufstetler, Chairman Smith, and Rep. Hawkins about pursuing a “united front” strategy in the summer of 2019, and as a result of the trusting relationships we had built with them over many years, they agreed to participate and guide the process. Through GHF’s relationships at Georgetown University’s Center on Health Insurance Reform, we were able to bring in national experts on surprise billing who shared the latest information on state and federal proposals and discussed how other states tackled major issues, both of which helped bring a few fresh ideas to the table. Sen. Hufstetler and Reps. Smith and Hawkins—as eager as we were to break the stalemate—used that information and input from Georgian Watch and Georgians for a Healthy Future to develop a solution that works for Georgia but that was informed by efforts in other states.

This bi-cameral strategy attracted the support of Gov. Kemp and Lt. Gov. Duncan, both of whom had already expressed interest in passing surprise billing protections. When HB 888 and SB 359 were introduced in January, state leaders showed courage and commitment by sticking with the approach they had collectively developed, even over the objections of some stakeholders.

As the bill moved through the General Assembly, more state legislators, hospitals, and provider groups lent their support to the legislation. Moving this bill across the finish line involved negotiation among multiple parties, support from our partners in the patient and consumer advocacy community, storytelling from consumers who had experienced surprise bills, and a reliance on the trusted relationships that Georgia Watch and GHF had with state leaders.

Our efforts now move to the Georgia Department of Insurance (DOI) and the Office of Health Strategy & Coordination (OHSC). DOI will write the rules that guide the implementation of surprise billing protections which will take effect on January 1, 2021. The OHSC will develop funding for and lead the creation of Georgia’s all payer claims database.


It is rare for a state to go from no protections to comprehensive protections in one fell swoop, especially with the near unanimous support we saw in the Georgia General Assembly. Georgia Watch and GHF believe that this success demonstrates the incredible impact of long-term, sustained consumer advocacy at the Georgia Capitol and in other spaces where decisions are made. This kind of advocacy takes staff time, focus, expertise, and resources, all of which are provided by individual donors and philanthropic funders like you.

Our organizations work for you but we cannot do our work without you! Please support our consumer advocacy efforts with a donation today. Thank you!

Consider a donation to our partners at Georgia Watch too!


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GHF welcomes new Story Collection Coordinator

GHF is excited to welcome Lois Hairston as the organization’s new Story Collection Coordinator. In this role, Lois will work to collect, develop, and share the stories of Georgia individuals and families as part of GHF’s Close the Gap initiative.

Lois is a graduate of Old Dominion in Virginia, where this past year, she served as the Communication and Membership Chair for the University’s Black Alumni Chapter. Her professional background includes experience with marketing agencies in Virginia and the District of Columbia, where she managed direct marketing campaigns for clients such as the Democratic Governors Association and the HealthWell Foundation. Recently, in her role as Communications Manager for Youth Entrepreneurs, Lois managed the creation of branded content and acted as the public relations liaison for the national nonprofit.

When Lois first moved to Atlanta in 2016, she took a position with Spelman College leading fundraising campaigns for faculty, students, and young alumnae. She was also nominated and served as Vice President of the Spelman Staff Council Board. Before joining GHF, Lois was an independent contractor in the disciplines of photography, graphic design, and media production.

Purposeful, driven, and creative, Lois’s mantra is to get better every day, even if only by a little!

We are pleased that Lois has joined our team! You can contact Lois at lhairston@healthyfuturega.org or 404-567-5016 x 4.


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GHF In The News

Jul 17, 2020
Kemp Signs Maternal Mortality, Surprise Billing Legislation Into Law
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