GHF is excited to welcome Michelle Conde as the organization’s new Communications & Special Projects Manager. In this role, Michelle will manage GHF’S external communication channels (email, social media, earned media) and leverage social media for digital advocacy. She will also provide policy research support as needed and contribute to the organization’s policy analysis efforts.

Michelle is a graduate of Georgia State’s Andrew Young School of Public Policy, where she received her Master’s in Public Policy with a focus on nonprofit policy. She is a creative and highly motivated leader with familiarity in working with diverse communities and quickly finding resourceful solutions. Before joining GHF she served as a policy fellow at Voices for Georgia’s Children and as a volunteer at Hemophilia of Georgia for over a decade. She is also a founding member of Hemophilia of Georgia’s Advocacy Board where she participates in efforts to advocate and educate the public and legislators.

We are pleased that Michelle has joined our team! You can contact Michelle at mconde@healthyfuturega.org or 404-567-5016 x 3

Georgians for a Healthy Future’s eighth annual Health Care Unscrambled breakfast built on previous years’ successes with another standing room-only crowd. This year’s legislative panelists were:

Senator Elena Parent
Senator Renee Unterman
Representative Bob Trammell
Representative Mark Newton
Representative Sam Park

Each panelist provided updates on emerging health care trends impacting Georgia and took questions from the audience about what healthcare initiatives are likely to be taken up in the 2018 legislative session. Topics included Medicaid expansion, federal funding of PeachCare for Kids (CHIP), surprise out of network medical billing, access to mental health and substance use treatment services, network adequacy, hospital closures, scope of practice for non-physician providers, Certificate of Need reform, maternal and infant mortality, rural health care access, the Prescription Drug Monitoring Program (PDMP), federal health care reform, the opioid epidemic and homelessness.

Senator Unterman, Chairwoman of the Senate HHS Committee, led the conversation with updates of the findings and recommendations from the myriad study committees she chaired or established in the 2017 off-session including the Senate Study Committees on Homelessness, Georgians Barriers toAdequate Access to Healthcare, as well as her participation on Lt. Gov. Cagle’s Health Care Reform Task Force. New Minority Leader Bob Trammell, along with Representative Sam Park, announced their intention to introduce legislation to expand Medicaid in Georgia (which has now been filed as House Bill 669) and Rep. Mark Newton, an Augusta area ER physician and Senator Elena Parent, Deputy Whip in the Senate Minority Caucus both elaborated on the Medicaid expansion debate, mental health issues facing the state, the opioid epidemic and rural health care access.

This year’s key note speaker was Robin Rudowitz, Associate Director of the Kaiser Family Foundation’s Program on Medicaid and the Uninsured. Ms. Rudowitz provided some background information on the federal Medicaid program, as well as Georgia’s program specifically. She pointed out that children are the primary beneficiaries in Georgia’s Medicaid program followed by people with disabilities, pregnant women, and seniors respectively. Georgia’s Medicaid program does not cover adults making less than 138% of the federal poverty level (about $16,000 per year for an individual and $21,000 for a family of 3) because Georgia’s policymakers have thus far refused to extend health coverage to this population. There was an extended discussion by Ms. Rudowitz and audience members about the new flexibility offered by the U.S. Department of Health & Human Services to state Medicaid programs may impact children and other enrollees, as well as how it may change existing Medicaid expansion programs in other states, This information presented by Ms. Rudowitz and subsequent discussion are sure to inform the considerations around the future of Georgia’s Medicaid program. Ms. Rudowitz’s presentation can be accessed here.

To see photos, review materials, and get more information about this year’s Health Care Unscrambled event, please visit the event page.

The 2018 legislative session has begun

The Georgia General Assembly has convened at the state capitol for its annual 40-day legislative session. This year’s session is expected to be quick as legislators prepare for primary elections in May and this fall’s general election. While the legislature is only constitutionally required to pass a state budget, we expect that a number of critical consumer health care topics will be debated. GHF will be monitoring this activity and will keep you up-to-date with weekly legislative updates (like this one!), our legislation tracker, timely analysis of legislation, and more.

The State Budget

On Thursday, Governor Deal addressed the General Assembly in his annual State of the State address and, per tradition, used the opportunity to introduce his proposed budget. The Governor minimally mentioned health care in his address, only highlighting the Commission on Children’s Mental Health. The inclusion of $20.6 million to fund the Commission’s recommendations made up the most significant health care-related change in the Governor’s proposed budget. This money will go to fund behavioral health crisis services ($10.4 million), a school-based mental health initiative called Project Apex ($4.3 million), supported employment and education ($3 million), suicide prevention ($1.1 million), provider training and telehealth ($1 million), and opioid abuse prevention ($790,000). The budget will now go to the House for its consideration before passing to the Senate.

HB 669: Medicaid Expansion

New House Minority Leader (and Health Care Unscrambled panelist) Bob Trammell introduced HB 669 requiring Georgia to authorize state dollars to drawn down additional federal dollars to expand Medicaid. Closing Georgia’s coverage gap by expanding Medicaid (or through a tailored Georgia-specific 1115 Medicaid waiver) would be the most significant step Georgia’s law makers can take to strengthen the state’s weakening rural health care system, address the opioid and substance use epidemic, and provide all Georgians with an insurance card regardless of income. Contact your legislators and let them know that you support closing Georgia’s coverage gap and they should too. Save the date. February 15th is Cover Georgia Day at the Capitol. Make plans to attend! Stay tuned for an official event announcement and RSVP link soon.

The Legislative Calendar

The schedule for the first eleven days of the 2018 legislative session was set on Monday, January 8. The General Assembly has already worked four days of the constitutionally capped 40-day session (January 8 through January 11). Tuesday, January 16 and Wednesday, January 17 are slated for budget hearings, and the next seven legislative days are as follows:

• January 18: Legislative Day 5
• January 19: Legislative Day 6
• January 22: Legislative Day 7
• January 23: Legislative Day 8
• January 24: Legislative Day 9
• January 25: Legislative Day 10
• January 29: Legislative Day 11

Earlier this week, GHF provided a summary of the recommendations from several Senate study committees and how their findings may affect the health care system and consumers in the state. The Georgia House of Representatives also convened study committees to examine issues directly related to health care, and two of these committees recently released their final recommendations.

The House Study Committee on Georgians’ Barriers to Access to Adequate Health Care (HR 240) examined a broad array of health care issues with a focus on the burden of chronic disease in Georgia. The committee, chaired by Representative Sharon Cooper, issued an exhaustive final report that included several legislative recommendations that could impact consumers. The most pertinent recommendations include:

Increasing access to immunizations: Allow schools to require the second dose of the meningitis vaccination in 12^th grade; require hospitals and nursing homes to offer shingles and flu vaccinations; allocate an additional $1 million to the Department of Public Health for additional staff and screenings for the viral hepatitis program; require the Department of Juvenile Justice to check vaccination records and offer vaccinations for juveniles in their care.

Improving testing and treatment for HIV/AIDS: Rewrite state laws to focus criminalization on intention to transmit HIV, as opposed to knowledge of HIV infection; ensure access to HIV treatment regimens for sexual assault victims; increase funding to the Department of Public Health to expand their ability to test for HIV; encourage state-funded health care programs such as Medicaid to expand their outreach for HIV testing.

Facilitating continued enrollment in Medicaid: Engender a policy shift that would allow for the suspension of Medicaid benefits, as opposed to outright termination, for people entering incarceration in the state.

Addressing respiratory diseases: Build upon the existing state asthma plan, which expires in 2018, to include a broader scope of chronic respiratory diseases; expand the screening process for people at risk of COPD to help confirm additional diagnoses.

Expanding access to mental health services: Expand funding for the Department of Behavioral Health and Development Disability’s community service boards; allocate funding for psychiatric residents who specialize in mental health treatment; encourage the use of e-prescriptions for opioid medications in an effort to curb opioid abuse.

You can read the full committee report here.

The House Rural Development Council (HR 389) closely examined a variety of issues that impact rural communities in Georgia and a recurring theme across the state was a need for increased access to quality health care. After 18 meetings in all parts of rural Georgia, the council released several recommendations that could have a significant impact on rural health care consumers.

One of the most noteworthy recommendations encouraged the Department of Community Health to apply for an 1115 Medicaid waiver that would allow participating hospitals and community providers to form a closed network in order to provide care to a set number of uninsured community residents. This waiver would allow Georgia to pull down additional federal funds to provide health care to some of the state’s uninsured population and to test out new ways to deliver high quality care at a lower cost. Unfortunately this idea falls far short of expanding Medicaid, which would provide health coverage to low-income, uninsured Georgians statewide and is the most significant step our state could take in improving access to care for rural Georgians. (Note: the council report refers to this capitated, value-based delivery model as a “block grant,” but this waiver would differ from a block grant in some nuanced, but important ways.)

Like the Senate Study Committee on Barriers to Georgians’ Access to Adequate Healthcare, the council heard a significant amount of testimony on the dearth of practicing medical professionals in rural counties and, as a result, their final recommendations mirror those of the Senate committee. They suggest expanding the scope of practice for mid-level practitioners to allow them to perform certain medial services not currently allowed and implementing a preceptor tax credit program to incentivize medical practitioners to train future healthcare professionals in rural areas.

Finally, the council recommended establishing a Rural Center for Health Care Innovation and Sustainability, which will be responsible for promoting a curriculum of best practices for rural health care. The center will also be used to provide mandatory training for the executive leadership and boards of rural hospitals.

You can read the full committee report here.

As always, you count on GHF to keep you up-to-date on how these recommendations may turn into legislative action when the General Assembly convenes in January. Stay tuned!

As the year winds to an end, the General Assembly’s 2017 study committees have largely completed their work and are releasing final reports, complete with notable findings and recommendations for the legislature to consider when it convenes in January. GHF monitored the activities of several Senate study committees this year as they considered changes to Georgia’s health care system that may impact consumers. (We will issue a blog later this week to provide an overview of similar House committees.)

The Senate Study Committee on Barriers to Georgians’ Access to Adequate Healthcare (SR 188) chaired by Senator Renee Unterman focused heavily on provider shortages that impact Georgians’ ability to receive health care when and where they need it. These shortages are felt most heavily in rural areas of the state, including the 79 counties that have no practicing OB/GYN physicians, 63 counties with no pediatric physicians, and 9 counties with no practicing physicians at all. In its final report, the committee issued several specific recommendations to remedy the provider shortages and increase access to care. Most prominently, the committee recommended expanding the scope of practice for Advance Practice Registered Nurses (APRNs) in areas of the state with the worst health outcomes and largest provider shortages. The committee noted that Georgia has among the strictest practice environments for APRNs and expanding the scope of practice for these nurses would allow rural Georgians to access quality care despite a lack of physicians. The committee also recommended expanding the practice of telemedicine in the state by training more telemedicine presenters, loosening restrictive rules, and providing more funding to telemedicine initiatives. Lastly, the committee addressed the rash of rural hospital closures around the state, suggesting that the closures could be prevented by providing more specific training for hospital board members on healthcare finance and supporting ongoing education for hospital board members and executive staff. You can read the committee’s full report here.

Senator Unterman also chaired the Senate Study Committee on Homelessness (SR 352). The committee examined the integral link between mental health and housing stability, and discussed housing status as a social determinant of behavioral health. The committee recommended that the Department of Community Health identify ways in which the state could use Medicaid funds to support people who are at risk of becoming homeless, and they recommended increased funding to expand the Georgia Housing Voucher and Bridge Program to ensure that more people who live with behavioral health conditions are connected with supportive housing programs. During the committee’s proceedings, several health care providers testified about the health care needs of people experiencing homelessness, including the need to have health insurance coverage. The committee did not issue a recommendation about how to better provide health care services for the homeless population; however, data shows that expanding Medicaid would be a meaningful and significant step to ensuring access to care and treatment for this group of Georgians. You can read the committee’s full report here.

Finally, GHF has also been following the work of Lt. Governor Casey Cagle’s Health Care Reform Task Force, which has met throughout the year at locations across the state. The task force has held meetings about the best practices to combat the opioid crisis and treat addiction, expanding access to health care in rural areas, and strengthening preventative care across the state. The task force convened for their final meeting in October, and they will issue their formal recommendations to the state legislature in January.

It is unclear which of these recommendations will be acted on by the General Assembly during the 2018 legislative session. However, you can count on GHF to keep you updated on any resultant legislation and any other legislative decisions that will impact Georgia’s health care consumers.

I am a graduate student in the Public Health program at Georgia State University. As a part of my coursework, I completed a semester-long practicum with Georgians for a Healthy Future as the Legislative Health Policy Intern.

In my academic program, I have spent extensive time learning about health policy, the legislative process, and the healthcare landscape in the United States. While covering those topics in a classroom setting was informative, seeing the legislative process first hand was invaluable. During my time with Georgians for a Healthy Future, I had the privilege of experiencing the legislative process by visiting the Capitol for committee and advocacy meetings, tracking legislation, and meeting policy makers and advocates.

Some of what I learned in the classroom applied to my work at GHF, but I found that there are some things you can only learn through experience. I was surprised by the length of time that legislators spend discussing some bills. Minutia in bill language could be debated for a whole two-hour meeting, while some key details might be voted on within minutes. I often felt a rollercoaster of emotions as a passionate hearing drew my sympathy for a given issue, while opposition pushed back on the bill. Spending time in committee hearings solidified my understanding that health policy often lies in gray areas, despite initially appearing to be black and white.

In my time at Georgians for a Healthy Future, I have learned a great deal about the organization and working in advocacy. Something that surprised me about GHF is the great value of the small things they do, such as encouraging constituents to call their legislators, sharing facts and resources with partner organizations, and talking to consumers. Their efforts often go unseen by the general public but have significant implications for the citizens of Georgia. I have seen the fruits of their labors, and it excites me to know there is an organization working so hard to protect and give a voice to our most vulnerable Georgians. Their partner organizations are equally inspiring in working to better the health of people in the state.

look forward to taking my GHF experience and knowledge with me into the public health field. I have gained a greater understanding of health policy and how bills get passed. I have learned the importance of advocacy and that every person can have a voice. I have learned that there are so many deeply passionate, caring, and hard-working individuals working towards health equity in Georgia. I have learned that the road to policy is often long, but the payoff is worth the time and effort. I will take these lessons with me as I move into my career, and work towards the goal of creating a healthier state and nation for everyone.

-Hayley Hamilton

MPH Candidate 2017

Georgia State University

Georgians for a Healthy Future’s Executive Director Cindy Zeldin attended the Spring Meeting of the National Association of Insurance Commissioners (NAIC) in her role as a consumer representative to the NAIC. At the meeting, a group of health-focused consumer representatives presented an overview of a new report authored by a diverse group of patient and consumer advocates highlighting the need to ensure that any changes to the health care system do no harm to consumers, minimize market disruption, and maintain common-sense consumer protections. The report, The Need for Continued Consumer Protections and Stability in State Insurance Markets in a Climate of Federal Uncertainty, conveys the perspective of consumer advocates on the need for continued access to high-quality health insurance products—regardless of whether and how changes are made at the federal level—and the likely impact that some proposed Affordable Care Act replacement policies will have on consumers and state insurance markets. The report discusses:

• What consumers want when it comes to private health insurance;

• The progress that has been made in reducing the uninsured rate since 2010 and the risks of full or partial repeal of the Affordable Care Act;

• Key principles—such as insuring the same number of consumers with the same quality of coverage and minimizing market disruption—that we urge policymakers to apply when considering further changes to the market; and

• Concerns about the impact of potential changes on consumers and state markets, with an emphasis on high-risk pools, continuous coverage requirements, high-deductible health insurance products, association health plans, the sale of insurance across state lines, the loss of essential health benefits protections, and the need for continued nondiscrimination protections.

An overview of the report was provided to state insurance commissioners during the NAIC/Consumer Liaison Committee meeting on Monday, April 10th during the National Association of Insurance Commissioners (NAIC) Spring 2017 National Meeting in Denver, Colorado. The authors of the report serve as appointed consumer representatives to the NAIC and members come from national organizations such as the American Cancer Society Cancer Action Network, the American Heart Association, Consumers Union, and the National Alliance on Mental Illness; state-based advocacy organizations such as the Colorado Consumer Health Initiative, Georgians for a Healthy Future, and the North Carolina Justice Center; and academic centers such as Georgetown University and Washington & Lee School of Law.

The full report is available here.

Surprise billing legislation passed by committee 

SB 8 was heard by the House Insurance committee this morning and passed unanimously. Among other transparency and notification requirements, this version of the surprise billing legislation requires that providers and hospitals must provide consumers with information about the plans in which they participate, and that upon the request of consumers, providers give an estimated cost of non-emergency services before they are provided. Insurers must inform consumers whether a provider scheduled to deliver a service is in-network, and if not, an estimation of how much the insurer will pay for the services, among other notification requirements. SB 8 will now go to the House Rules committee.

WHAT HAPPENED LAST WEEK

Senate passed the FY2018 budget

Last week, the Senate approved the FY 2018 budget. The budgets approved by the Senate and House differ slightly, so a conference committee will be appointed to meet and work out the differences. You can check the Differences Report for specifics on the variance between the House and Senate budgets, and we will provide a brief overview of the final version once the conference committee finishes its work.

Insurance coverage for children’s hearing aids passed

SB 206 was approved by the House of Representatives today, and will require private health insurance plans to cover hearing aids for children under 19 years old. The legislation stipulates that the costs cannot exceed $3000 per hearing aid and that the plans cover replacement hearing aids every four years or when the hearing aid fails before that time. Medicaid already covers hearing aids for children who qualify for coverage.

Pharmacy Patients Fair Practices Act passed by both chambers

Both HB 276 and SB 103 were approved by the Senate and House respectively last week and will get sent to the Governor for his signature. This legislation (which we previously covered here) will regulate practices of pharmacy benefit managers so as to allow consumers access to their pharmacy of choice, provide the opportunity for home delivery of medications, and prevent consumers from over-paying for prescriptions. It is really important to find a pharmacy that you can trust, I suggest to check Canadian pharmacies which have been very reliable for me.

Legislation to synchronize multiple medications passed

SB 200 will make it easier for people to synchronize their prescriptions so that they can pick up multiple prescriptions at the same time. The bill requires that insurance plans pro-rate medication co-pays for partial prescription fills so that the schedules for medications can be synced if requested by a patient. Under current law, a person may have to pay a full co-pay even if a pharmacist is providing only a part of their 30-day medication in order to synchronize multiple prescriptions. SB 200 passed the House Insurance committee last week and was approved unanimously by the House this morning.

Senate Health Reform Task Force held first public meeting 

The Senate Health Reform Task Force was established by Lt. Gov. Cagle to study how federal health reform efforts would impact Georgia. The task force held its first public meeting on Friday and heard from two federal health policy professionals, Joseph Antos and Jim Frogue. Together, they provided a brief overview of the proposed American Health Care Act, some analysis of how the bill would impact Georgia, and suggestions for legislators to consider. The message from both presenters is that the AHCA is “not favorable” for Georgia because of the way the proposal cuts and caps Medicaid which would lock in Georgia’s pattern of low per capita Medicaid spending.

We agree that this proposal is “not favorable” for Georgia. Despite the harm it would do to our state, the bill seems headed for a vote in the House of Representatives. Call your Congressman today to tell him that this bill hurts Georgia!

As the health care debate ramped up in Washington, February’s Congressional recess presented opportunities for Georgia’s health care advocates to voice their concerns about plans to repeal and replace the Affordable Care Act. GHF participated in two events that highlighted the progress that has been made in Georgia under the ACA and the need to build on its successes rather than repeal it. 

The week began with a rally as the Save My Care bus tour stopped at Liberty Plaza across from the Georgia Capitol.  House Minority Leader Stacy Abrams energized the crowed and spoke of the importance of health care for every Georgian. GHF’s Executive Director Cindy Zeldin reminded the audience that because of the ACA the uninsured rate in the US is lower than it has ever been before and that new consumer protections provided to Georgians with pre-existing conditions, LGBT Georgians, and low-income families helped to narrow disparities in health care access. Georgia consumers Jan and Vicki shared their stories of how the ACA has helped them access the health care they needed when they needed it. You can watch the full rally here.

On Saturday, GHF marched at the Atlanta March for Healthcare organized by the Georgia Alliance for Social Justice. Marchers traveled down Peachtree Street from Midtown to downtown’s Woodruff Park where a rally was held. Along with partner organizations active on health care issues, Cindy reminded those at the rally of how much progress had resulted from the ACA and how interconnected health care is to other social justice issues like racial, gender, and economic equality.

GHF will continue to work to #ProtectOurCare as Congress attempts to pass the American Health Care Act, a proposal that attempts to cut and cap Medicaid and increase costs for low-income families and older Georgians. We hope you’ll join us to rally, march, call, and organize for affordable, accessible, high quality health care for all Georgians.