By Sarah Candler, MD/MPH Candidate 2013, Emory University and Rollins School of Public Health

JOIN US AT THE RALLY TO PROTECT THE AFFORDABLE CARE ACT

MONDAY, MARCH 26, 2PM

OUTSIDE THE GOLD DOME

FOR THE PAST TWO WEEKS WE HAVE BEEN COLLECTING SIGNATURES OF DOCTORS, ADVOCATES, AND HEALTH CARE CONSUMERS WHO SUPPORT AND WANT TO PROTECT THE AFFORDABLE CARE ACT.

ON MONDAY WE WILL BE RALLYING AT THE CAPITOL AND SPEAKING WITH SUPPORTERS AND THE MEDIA AND THEN DELIVERING OUR PETITION TO GOVERNOR NATHAN DEAL AND ATTORNEY GENERAL SAMUEL OLENS.   THE PETITION ILLUSTRATES THAT WE SUPPORT PROGRESS IN HEALTH CARE REFORM FOR THE THOUSANDS OF GEORGIANS WHO HAVE ALREADY BENEFITED FROM THE LAW AND FOR THOSE WHO HAVE YET TO SEE THE BENEFITS OF FUTURE PROVISIONS.

WE HOPE TO SEE YOU AT THE CAPITOL!

This is a coalition effort with Georgians for a Healthy Future, Doctors for America, HealthSTAT, Votehealthcare.org, and Know Your Care – Georgia

Sign the Petition in Support of the Affordable Care Act!

Now that Crossover Day (the 30th day of the 40 day Session and the day by which a bill must pass at least one chamber to remain viable for the Session) has passed, the 2012 Legislative Session enters its final stretch. The legislative calendar is now set through Day 37. Here is what health advocates are watching:

• HB 1166 would restore child-only health insurance policies to Georgia’s individual market. Georgians for a Healthy Future, along with a range of child health advocacy groups, is in strong support of this measure to provide this option for families who need coverage for their kids. The bill passed the House last week and passed through the Senate Insurance and Labor Committee this afternoon. It now heads to the Rules Committee.

• HB 879 would allow non-medical staff to be trained to assist students with diabetes in a school setting when a school nurse is not present. The legislation also allows children, who are able, to manage their own diabetes. This legislation passed the Georgia House of Representatives and will be before the Senate Health and Human Services committee tomorrow.

• SB 471 authorizes an alternative approval process for health insurance policies sold in Georgia and could place hard-fought consumer protections at risk. This bill passed the Senate last week and we will monitor it on the House side.

Several bills that consumer health advocates were supporting did not make the Crossover Day cut:

• HB 1159, sponsored by Representative Pruett, would have created a Joint Study Commission on Education for Parents with Newborn Children to determine how best to gather information, raise funds and create a comprehensive informational video.  The video would include but not be limited to information on the prevention of childhood obesity; how to prevent SIDS, shaken baby syndrome, and other forms of child abuse; how to prevent death and injury and additional information which would assist parents to raise safe and healthy children. HB 1159 passed through the House Health and Human Services Committee but did not make it out of the Rules Committee.

• SB 484 would help fight childhood obesity by encouraging – but not requiring – schools to open up and share their safe places for kids to play with responsible groups in their communities like churches, scouting troops, YMCAs and others. SB 484 passed the Senate Health and Human Services Committee but did not make it out of the Rules Committee.

• HB 801 and SB 418 were introduced by Representative Gardner and Senator Orrock, respectively, as companion bills to establish a health insurance exchange in Georgia. Neither bill received a hearing.

To read Georgia Health News’ Health Care Scorecard on Crossover Day, click here.
 

A shorter version of this commentary originally appeared on the op-ed page of the Atlanta-Journal Constitution on March 2nd, coauthored by Pat Willis of Voices for Georgia’s Children and Cindy Zeldin of Georgians for a Healthy Future (available here).

The Georgia Department of Community Health is in the midst of a process to redesign the state’s Medicaid and PeachCare for Kids programs. Together, these two programs cover more than 1.7 million low-income children, families, and disabled Georgians. As advocates for Georgia’s children and for Georgia’s health care consumers, we view this redesign process as an opportunity to strengthen these programs to ensure they provide access to the services that children and families need to live healthy and productive lives.

The first phase of the Department’s redesign effort, an assessment of the Medicaid landscape in Georgia and in selected states around the country conducted by an outside consulting firm, was recently made public. In addition to a lay of the land, the report featured three major redesign options, each of which would move Georgians with disabilities from fee-for-service into managed care arrangements. There are questions about how well managed care may work for populations with complex health needs such as Disabled Access Lifts, and the Department should work with advocates for these vulnerable Georgia citizens to ensure any redesign system does not disrupt or impede care for this fragile population.

At the same time, we must not lose sight of the children who are already enrolled in managed care through Medicaid and PeachCare for Kids.  Nearly a third of Georgia’s children are covered through these programs, and there are concrete steps that the Department can take now to bolster these programs for the future. We encourage the Department to adopt a best practices approach by focusing on three evidence-based themes as it redesigns these programs for children: first, coverage matters; second, ensuring access to care requires adequate network capacity and accountability; and third, ensuring quality of care requires system coordination.

Coverage matters. Numerous studies link continuous health insurance coverage to improved health outcomes. Georgia has made an intentional effort to cover more children in recent years: our uninsured rate for kids has steadily improved from 11 percent in 2008 to 9.8 percent in 2010. Still, about three-quarters of uninsured children in Georgia are eligible for Medicaid or PeachCare for Kids, and by leveraging new enhanced funding opportunities and program flexibilities at the federal level and by borrowing a page from successful initiatives in neighboring states like Alabama, which has reduced its uninsured rate for children to just six percent, we can get closer to the goal of providing health coverage to all of Georgia’s children. For example, Georgia could simplify the eligibility process for children by adopting a policy of 12 months continuous eligibility for kids (currently, some children fall through the cracks with a 6-month renewal policy). There are other administrative and technology system enhancements the Department can take to make it easier for kids to enroll and remain enrolled in coverage, and we encourage the Department to do so.

Ensuring Access to care requires adequate network capacity and accountability. Getting and keeping kids enrolled in Medicaid and PeachCare for Kids is critical, but it is only a first step to ensure that children have appropriate access to a well-coordinated and patient-centered medical home. Significant documented weaknesses in pediatric specialty networks exist in certain regions of the state. Georgia has two policy levers at its disposal to bring these networks up to standard: first, increase provider reimbursement rates for specialty care and second, monitor the contracts with the care management organizations to ensure compliance with policies to establish out-of-network arrangements. Where overall shortages in physician supply hinder access, the Department should work with the care management organizations to explore emerging solutions such as telemedicine, an approach that states like Texas have embraced with some success.

Ensuring quality of care requires system coordination. The Department of Community Health maintains strong quality standards, but performance measures show opportunities for improvement. For example, well-care visits and key screenings are below national averages, and less than half of Georgia’s children with behavioral health needs obtain the care they need. Promising care coordination practices in states like Texas, which uses an electronic health records system to share medical histories and ensure coordinated care for children in the state’s foster care system, and Rhode Island, which utilizes specially trained parent consultants, can inform Georgia’s efforts to develop a more coordinated system of care for children. The Department should also develop and enforce rigorous contracting standards to enhance quality.

We commend the Department of Community Health for its proactive efforts to modernize Medicaid and PeachCare for Kids and encourage best-practices based systems changes that incorporate these three themes. The health of Georgia’s children hangs in the balance.

In the on-going efforts to redesign Georgia’s Medicaid and PeachCare programs, the Department of Community Health (DCH)
is continuing to analyze and evaluate its options and has convened three taskforces to gather feedback from consumer advocates, providers and other stakeholders.  The latest taskforce, focused on children and families will hold its first meeting on March 9th.  GHF’s Outreach and Advocacy Director Amanda Ptashkin will be there to represent health care consumers who currently access these programs or who will gain access through the Medicaid expansion in 2014.  Part of the charge of this taskforce includes identifying:

• Program features identified in the Navigant report that are most/least appealing to meeting the needs of families and children;

• Current features of the program that should be maintained;

• Largest unmet need of the current program;

• Better medical management and coordination for children in foster care;

• Additional insights not identified in the report; and

• Identification of critical design features needed to protect the needs of children and families

If you or your organization have thoughts on the above charge, please email Amanda Ptashkin.  To learn more about the redesign process, visit www.healthyfuturega.org/issues/careforgeorgiaskids

The 2012 Legislative Session continues today as legislators meet for Day 27 of the 40-day Session. Crossover Day (Day 30), when a bill must pass at least one chamber to remain viable for the Session, will be March 7th. Here is what health care advocates are watching:

• The House and Senate have both passed versions of the Amended FY 2012 Budget (HB 741); since there are minor differences, HB 741 now heads to conference committee. Notably, the Senate version added $1.2 million in the Department of Public Health budget for the Children 1^st program to replace the loss of Supplemental TANF funds. This program provides screenings for newborns. Also in the Senate version, funds were added to the Department of Community Health budget to reflect projected need in Medicaid but there were also cuts to reflect the rounding down of co-payments to the nearest dollar. Meanwhile, work continues on the FY 2013 budget. Click here for the Georgia Budget & Policy Institute’s analyses of the implications for the state’s health care agencies on the governor’s proposed 2013 budget recommendations.

• HB 1166, sponsored by Representative Atwood, would restore child-only health insurance policies to Georgia’s individual market. Georgians for a Healthy Future, along with a range of child health advocacy groups, is in strong support of this measure to provide this option for families who need coverage for their kids. The bill is expected to be before the House Insurance Committee on Wednesday. You can learn more about this issue by downloading our fact sheet.

• HB 801 and SB 418 were introduced by Representative Gardner and Senator Orrock, respectively, as companion bills to establish a health insurance exchange in Georgia. While leadership in the House and Senate have indicated that there will not be movement on an exchange this year, please thank Representative Gardner and Senator Orrock for their leadership on this important issue. You can learn more about how a Georgia exchange could work by downloading our issue brief here. All information from the Governor’s Health Insurance Exchange Advisory Committee, which met throughout the second half of 2011 to develop recommendations on this issue, is available here.

• HB 1159, sponsored by Representative Pruett, is known as the New Parent Information Bill and would create a Joint Study Commission on Education for Parents with Newborn Children to determine how best to gather information, raise funds and create a comprehensive informational video.  The video would include but not be limited to information on the prevention of childhood obesity; how to prevent SIDS, shaken baby syndrome, and other forms of child abuse; how to prevent death and injury and additional information which would assist parents to raise safe and healthy children. The bill is expected to be before the House Health and Human Services Committee this week.

Don’t forget to download our Consumer Health Advocate’s Guide to the 2012 Georgia Legislative Session to help you navigate the Capitol! A limited number of hard copy guides are available. Please contact us if you’d like a copy.

Members of the Bump It Up a Buck coalition (including Georgians for a Healthy Future) are working together to maintain the momentum needed to secure an increase in the consumption tax on cigarettes by $1.  Experts say the measure would reduce smoking levels in the state, improve the health of all Georgians and conservatively generate more than $340 million in new tax revenue for the state each year. If you are a beginner make sure to check out our glass bongs for sale section first to get a good impression of everything available on the market today. Are your more of a clumsy smoker? As part of our efforts to increase awareness of the issue, members of the coalition will participate in the first celebration of national Kick Butts Day to be held in Atlanta since 2008. The event will be held on Wednesday, March 21, 2012, and will include a rally on the steps of the Capitol and online activities as well. Georgia currently has the 48th lowest per pack tax in the nation at only 37 cents (national average: $1.46). You can show your support for the initiative by joining the hundreds who Like the idea at http://www.facebook.com/BumpItUpaBuck.

A new survey shows that consumers aren’t satisfied with the level of customer service they receive from their health insurance plans. In fact, the industry ranked the lowest of any industry measured in this survey. Additionally, other studies have found that consumers often find health insurance jargon confusing, which makes it challenging for consumers to select a policy that best meets their needs, to know what is covered and what isn’t, and to understand their rights as consumers if disputes arise. While overshadowed by some of the other major reforms included in the law, the Affordable Care Act contains some exciting reforms for consumers in this area, including making available access to clear, plain language information about their insurance plans. The U.S. Department of Health and Human Services issued final regulations on February 9^th requiring an easy-to-understand Summary of Benefits and Coverage and a uniform glossary of terms. These new tools will be available to consumers on September 23, 2012. More information is available here and here.

Georgia lags other states in progress towards establishing a health insurance exchange as authorized by the Affordable Care Act (ACA), despite the fact that Georgia stands to experience one of the largest drops in the uninsured as a result of the ACA reforms, according to an analysis by the Urban Institute. At our Health Care Unscrambled breakfast in January, a panel of Georgia policymakers discussed prospects for a health insurance exchange and indicated that exchange legislation would not move through the General Assembly in 2012. Nevertheless, Representative Pat Gardner has introduced HB 801 to establish a Georgia health insurance marketplace, or exchange. Please thank Representative Gardner for taking a stand on this important issue! For recent news articles on health insurance exchanges and Georgia, click here and here.