Consumer transparency bill introduced in the House

Rep. Richard Smith, Chair of the House Insurance Committee, introduced HB 678, legislation that requires health care providers and hospitals to provide consumers with information about their participation in a patient’s insurance network. The bill requires that a physician tell a patient if they are an in-network provider, and, if asked by the patient, provide an estimate of the total costs for their services. The legislation applies only to non-emergency care. While this bill is a first step towards addressing surprise out-of-network medical billing, we believe that, as written, it does not do enough to protect consumers. We recognize Rep. Smith’s commitment to shielding consumers from surprise medical bills, and we hope that this bill will prompt a robust conversation about solutions that address both network adequacy and surprise medical bills.

Join us for Cover Georgia Day!

Please join us at the state Capitol on Thursday, February 15 from 8:30 to 11:45 am for Cover Georgia Day! We will be asking our state legislators to put insurance cards in the pockets of low-income Georgians who cannot get affordable health coverage under current law. This is your opportunity to speak to your elected officials and let them know that you support closing Georgia’s coverage gap. RSVP here!

Can’t make it? Send an email to your state legislators to tell them to close Georgia’s coverage gap.

 Budget hearings continue at the Capitol

Last week, the General Assembly heard from Commissioners and other leaders regarding their budget requests for Fiscal Year 2019 (July 1, 2018 – June 30, 2019). While the Governor’s proposed budget is mostly status quo, there are a few items of interest for health advocates:

• The Department of Community Health has requested a 4% increase (for a total of $236 million) in funds for Medicaid to keep up with the population growth of Medicaid-eligible Georgians.
• The Department of Public Health (DPH) has requested $627,000 to support the Prescription Drug Monitoring Program (PDMP), which was moved from the Georgia Drug & Narcotics Agency to DPH per 2017 legislation.
• DPH has also requested $355,000 to support a new Office of Cardiac Care.
• The Department of Behavioral Health and Developmental Disabilities has requested a budget increase of $50 million. (See last week’s update for more details about DBHDD’s budget increase.)

Children’s Health Insurance Program finally funded

Federal funding for the Children’s Health Insurance Program (known as PeachCare for Kids in Georgia) expired at the end of September last year and remained unfunded for 114 days until yesterday evening when Congress passed a six-year extension for the program. PeachCare for Kids covers more than 130,000 Georgia children and, in combination with Medicaid, has been critical in driving our children’s uninsured rate down to 6.7%. The funding authorized by Congress will allow this critical health insurance program to continue to serve Georgia’s children for several more years. The future of funding for community health centers and Disproportionate Share Hospital (DSH) payments is still unclear.

Georgians for a Healthy Future released its 2018 policy priorities at this morning’s eighth annual Health Care Unscrambled legislative breakfast. These annual priorities outline the issues that GHF believes are most pressing for Georgia consumers and are best addressed by the state legislature. GHF will work to move all of these issues forward by engaging state policy makers, consumers, and coalition partners throughout the legislative session and the remainder of the year.

1. 1. Increase the number of Georgians with health insurance. Thousands of Georgians have signed up for low-cost coverage through the Health Insurance Marketplace. Because Georgia has not accepted federal funds to cover low-income Georgians though, approximately 300,000 people remain stuck in a coverage gap. These Georgians do not qualify for Medicaid under current rules and do not earn enough money to qualify for financial help through the Marketplace. Georgians for a Healthy Future supports closing this gap by opening up coverage through Medicaid to all Georgians with incomes up to 138 percent of the federal poverty level.
   2. Guarantee access to quality health care services for Medicaid and PeachCare beneficiaries. The Medicaid and PeachCare for Kids programs provide health insurance for many of our state’s most vulnerable citizens, including low-income children, seniors and people with disabilities, and some low-income parents. Enrollment in these programs is growing as uninsured families explore health insurance options and that their children meet the eligibility criteria. This presents an opportunity to reduce our state’s uninsured rate and improve access to care. Georgians for a Healthy Future will support policies that facilitate continuous coverage and enrollment for eligible Georgians, ensure robust provider networks, and improve health outcomes. Georgians for a Healthy Future will oppose changes to Medicaid that would shift financial risk and cost to states and result in program cuts that would harm many of our state’s most vulnerable citizens.
   3. Ensure access to care and financial protections for consumers purchasing private health insurance. Health insurance plans with the lowest premiums are often a first choice for consumers, but these plans are commonly more a affordable because of narrow provider networks. Although narrow networks can hold down the cost of health insurance and may provide adequate care, they can result in insufficient coverage for some conditions, inhibit continuity of care for some consumers, and lead to burdensome surprise medical bills if consumers unknowingly receive services from out-of-network providers. We encourage Georgia’s policymakers to address network adequacy and surprise out-of-network billing in tandem by developing a comprehensive network adequacy standard, based on the National Association of Insurance Commissioners’ (NAIC) model act released in the fall of 2015 and by passing legislation that protects consumers from surprise out-of-network billing by placing limits on allowable out-of-network charges, setting disclosure and transparency requirements for health care providers, and establishing a process to resolve billing disputes between patients, providers, and health care facilities.
   4. Set and enforce standards that provide for equitable coverage of mental health and substance use treatment services by health plans. The 2008 passage of the federal Mental Health Parity and Addiction Equity Act (Parity Act) required that health plans cover behavioral health services as they would physical health services. The Parity Act is only meaningful if health plans are implementing it well, consumers and providers understand how it works, and there is appropriate oversight. GHF supports legislation that sets standards and oversight procedures to ensure that Georgia consumers receive the coverage for mental health and substance use disorder benefits to which they are entitled by law and for which they have paid.
   5. Support partners in integrating health and equity in the policies across every sector to address social determinants of health that prevent equitable access to care and equitable health status. Factors outside the health system such as adequate housing, education, and economic opportunity impact the health of individuals, families, and communities. Left unaddressed, these and other complicating factors can inhibit the effectiveness of approaches that are strictly within the health system. Georgians for a Healthy Future supports policies that aim to advance health and health equity by addressing the social determinants of health.

    

   To download GHF’s 2018 policy priorities, click here.

GHF is proud to welcome Zach Nikonovich-Kahn to our staff. Zach will serve as GHF’s Communications & Special Projects Manager. In this role, he will manage GHF’s external communications, utilize communications strategies to mobilize Georgians in support of GHF’s mission, and provide research & policy support.

Zach Nikonovich-Kahn is a communications and community engagement professional, specializing in the nonprofit sector. Prior to joining Georgians for a Healthy Future, Zach worked as the Public Policy Advocate for Families First, where he was responsible for leading the agency’s government affairs and advocacy initiatives.

Zach is an extremely proud Atlanta native, and he lives in Midtown. He currently serves on the BeltLine Affordable Housing Advisory Board, as well as the Atlanta BeltLine Young Leaders Council. Zach has also served on the board of the Midtown Neighbors Association, the Board of Ambassadors at the Georgia Museum of Contemporary Art, and the board of the Atlanta chapter of the New Leaders Council.

Zach graduated from the Honors College at the University of Georgia with a B.A. in History, and he has a Master’s degree from Cambridge University.

A subcommittee of the Georgia House of Representatives’ Insurance committee convened last Monday, November 13^th to evaluate the use, costs, and effectiveness of the state’s mandated insurance benefits. Before the Affordable Care Act’s ten essential health benefits, states required insurers to cover certain health care services in the health plans sold in and regulated by the state, and many of those benefit coverage mandates remain in effect today. (CMS has a list of Georgia’s coverage mandates.) Because benefit coverage mandates have a principally positive impact on consumers’ access to, cost of, and quality of health coverage, GHF’s Executive Director Laura Colbert testified at the committee hearing.

In her testimony, Laura focused on the benefits of coverage mandates to consumers:

• Protection from insufficient coverage— No one plans on getting in a car crash or being diagnosed with cancer. Even health care services we think of as planned are not; only half of U.S. pregnancies are planned. Coverage mandates help to guarantee that consumers have access to needed care and are financially protected even if they do not accurately predict their health care needs when they enroll in a plan.
• Increased access to care— Studies show that coverage mandates can result in increased use of the mandated health care services, especially those that are expensive. For example, methadone maintenance treatment, the most effective treatment for opioid addiction, costs about $5000 annually. Because most insurance plans are required to cover mental health and substance use services, consumers are able to better access these services. Without that financial help, consumers may forgo this critical service or others like it.
• Financial protection at minimal cost—The Affordable Care Act limits how much consumers have to pay out of pocket for health care each year through what is called an out-of-pocket maximum. This out-of-pocket maximum includes co-pays, deductibles, co-insurance, and any other out-of-pocket costs but does not include premium payments. The out of pocket maximum protections only apply to mandated services. Non-mandated services include adult dental and vision services, infertility treatments, in-home nursing, hospice care, and long-term care, and consumers are often left to pay for the full costs of these.
• Comparison shopping made easier—In the U.S., only about 12% of consumers have proficient health literacy skills, meaning that they are able to calculate their share of health insurance costs for a year. By standardizing insurance plans through coverage mandates, consumers are better able to compare plans based on a more limited number of factors like price and network breadth.

If you want more information on the consumer impacts of coverage mandates, check out the fact sheet we created summarizing GHF’s testimony.

One of GHF core organizational activities is consumer outreach and education. Over the past two weeks, GHF’s Outreach & Communications Coordinator Jamila Young participated in two conferences in Dublin and Albany, Georgia in an effort to reach consumers across the state, provide them with useful tools and resources, and hear about their experiences with health care and coverage. When you are experiencing IBS Symptoms like constipation, and diarrhea, contact IBSClinics.

On October 23 and 24^th, Jamila attended the Healthy Mothers Healthy Babies Coalition of Georgia (HMHB) conference in Dublin, GA. HMHB works to improve access to prenatal and preventive healthcare for women, children and families in Georgia through direct service, collaborative advocacy and community education. At this conference, Jamila talked with health care providers and consumers about the importance of Medicaid for pregnant women, children, and new moms. She was also afforded the opportunity to hear from Commissioner Frank Berry of the Georgia Department of Community Health (which oversees Georgia’s Medicaid program) about implementing community based work to advance health care in Georgia.

Last week, Jamila traveled to Albany, GA to attend the Southwest Georgia Project For Community Education’s (SWGA Project) second annual Food, Ag and Equity conference. At the conference, Jamila networked with rural farmers and consumers, and heard stories about their struggles obtaining health insurance, answered questions about Georgia’s Medicaid program, and provided much-anticipated information about the ACA’s current open enrollment period. Despite the conference’s focus on food and agriculture, several speakers spoke to the importance of healthy behaviors and utilizing preventative health care services to stay healthy. Georgians For A Healthy Future is excited to continue its work with the Southwest Georgia Project in 2018 as they work together to close Georgia’s coverage gap and expand Medicaid.

GHF is pleased to welcome Bianca Garcia as a Health Policy Intern. Bianca is a second year Master of Public Health student in health policy and management at the Rollins School of Public Health at Emory University. She earned a bachelor’s degree in biology from Purchase College in New York. Since then, Bianca has worked at different levels of our healthcare system—from clinical research associate training labs to clinics to health departments—which has equipped her with an intimate understanding of its strengths and weaknesses.

Bianca is interested in creating and promoting policy that improves access to care in disadvantaged communities. She is also interested in primary prevention initiatives that focus on education and economic prosperity.

As GHF’s Health Policy Intern, Bianca will be gathering data about Georgia’s Medicaid program and collecting recommendations from many of GHF’s partner organizations about how to improve Georgia’s Medicaid program. This information will be synthesized into a report and recommendations for state policymakers. During her time at GHF, Bianca hopes to learn more about communicating with legislators and how to effectively advocate for consumer interests.

With four open enrollment periods completed and a fifth one beginning in the coming weeks, the Health Insurance Marketplace has become established as the avenue for purchasing coverage for thousands of Georgians who do not have access to have insurance at work. The fourth open enrollment period differed from the first three in several important ways, and understanding these variations will be important in ensuring that the Marketplace continues to serve consumers who seek access to affordable comprehensive health insurance. This report examines the characteristics of the consumers enrolled in the Georgia Marketplace, compares open enrollment 4 to the previous three enrollment periods, and provides a preview for open enrollment 5.

Inside you’ll find:

– Key themes in consumer and assister experiences during the 2017 open enrollment period
– A look forward to open enrollment 5
– Policy opportunities to increase enrollment, ensure access to care, address affordability issues, and facilitate continued consumer education and supports

You can find the full report here. 

Earlier today, Senators McConnell, Graham, and Cassidy announced that the U.S. Senate would not vote on the chamber’s most recent attempt to dismantle Medicaid and the Affordable Care Act. We are pleased that, for the time being, millions of Georgians will be able to keep the coverage and protections that they have gained as a result of these programs.

As we look forward, we hope that Georgia’s members of Congress will consider the best interests of their constituents and work in a bipartisan fashion to make the ACA and health care better for all Georgians. The ACA was a significant step forward for health care consumers but we still have some distance to go before all Georgians have the quality, affordable health care they need to be healthy and contribute to the health of their communities. We need to work at the state and federal levels to build on the ACA’s progress by expanding coverage, lowering out-of-pocket costs, addressing health disparities, shoring up our rural health care system, and improving the quality of care.

We expect to see further threats to the rights and protections of health care consumers in the coming months and years. As an organization, GHF will remain vigilant and engaged, and we will continue to elevate the voice of consumers—your voice—to improve health care and coverage for all of us.

Nationwide transgender individuals face significant barriers to accessing health care because of their gender identity; however, little is known about the experiences of the estimated 55,000 transgender individuals in Georgia as they interact with the health care system. Understanding the health care needs, access barriers, and discrimination experiences of transgender individuals in Georgia can inform the work of advocates, stakeholders, and policymakers to reach the shared goal of ensuring health equity for all Georgians, especially transgender Georgians.

To inform the public about these barriers to care, Georgians for a Healthy Future, Georgia Equality, and The Health Initiative are releasing a policy brief, Voices for Equity: How the experiences of transgender Georgians can inform the implementation of nondiscrimination provisions in the Affordable Care Act.

Voices for Equity: How the experiences of transgender Georgians can inform the implementation of the ACA’s nondiscrimination provisions

The passage of the Patient Protection and Affordable Care Act (ACA) was notable not only for increasing access to health insurance coverage for millions of Americans but also for its broad non-discrimination provisions. Section 1557 of the ACA prohibits discrimination on the basis of race, color, national origin, sex, age, or disability in many health programs and activities.  The final rule determined that discrimination on the basis of gender identity and sex stereotyping are equally prohibited under Section 1557, and as a result, lesbian, gay, bisexual, transgender, and queer (LGBTQ) Georgians have protections from discrimination in health coverage and care for the first time. To better understand the challenges that transgender Georgians may face when accessing health care, GHF, GE, and THI collected data and information from transgender Georgians that provided compelling narrative of barriers that transgender individuals routinely face when seeking health care and utilizing their health insurance.

The goals of this policy brief are:

• describe the protections for transgender individuals under Section 1557 of the Affordable Care Act.
• discuss the results from a series of transgender focus groups and survey of the LGBTQ community in Georgia, and the 2015 U.S. Transgender Survey to understand transgender individuals’ experiences in health care.
• recommend actions that health care providers, policy makers, and advocates can take to support improved health care access and equity for transgender Georgians.

Download the brief here.

Resources for LGBT consumers

Thanks to Section 1557 of the Affordable Care Act, LGBT Georgians have protections from discrimination in health coverage and care for the first time. If you believe you have been discriminated against, it is important to file a 1557 complaint with the Office of Civil Rights in the Department of Health and Human Services. GHF and our partners can help you with that! Visit GHF’s LGBT Health Equity page for more information and help to file your complaint.

Members of Congress, who have spent much of August in their home districts while on recess, will reconvene in Washington, D.C. this week with an ambitious agenda and looming deadlines. After July’s failure of the Senate’s health care legislation, health care remains a top agenda item for many members and we expect to see activity that could have big impacts on consumers in Georgia. Group Benefits Broker will offer health plans to anybody who needs it.

During the August recess, the chairman and vice-chair of the Senate’s Health, Education, Labor, and Pensions (HELP) committee scheduled bi-partisan hearings for September 6^th & 7^th on the stabilization of the Affordable Care Act’s Marketplace. The HELP committee, including Georgia’s own Senator Isakson, will hear testimony from Governors and Insurance Commissioners from a variety of states with a primary focus on private insurance topics. These hearings are an important step in helping to stabilize and strengthen the ACA Marketplaces and we expect to see suggested proposals that include guaranteed funding of cost-sharing reduction payments to insurers, funding for a reinsurance program, strong enforcement of the individual mandate, and others.

Also on Congress’s agenda for September is the reauthorization of the Children’s Health Insurance Program (CHIP), the federal program that funds 100% of Georgia’s PeachCare for Kids insurance program. CHIP covers more than 230,000 Georgia children and has been critical in driving our children’s uninsured rate down to 6.7%. CHIP expires on September 30, 2017 and must be reauthorized by Congress to continue. CHIP enjoys wide bipartisan support in Congress so it is expected to pass, but there is some danger Medicaid cuts or program changes like work requirements and premiums will be attached.

Lastly, the House of Representatives will continue its work on the FY2018 federal budget. The current House budget plan calls for a cut of $1.5 trillion from Medicaid and the Affordable Care Act from 2018-2027, mirroring many of the devastating cuts from the House-passed American Health Care Act. On top of these cuts are proposals for fundamental changes to Medicaid such as a work requirement that would cut the program by another $110 billion. Like all of the leading health care proposals put forth by Congress this year, these cuts to Medicaid would debilitate the program, shift substantial costs to states, and leave 2 million Georgians without the access to health care on which they currently rely. The budget has already passed the House Budget committee and will be taken up by the full House in the coming weeks.

Congress’s work in September could have significant impacts—both positive and negative—on consumers in Georgia and it is vital that they hear from you on these issues. As your elected officials reconvene in Washington, we ask that you to visit this site for more information: oinkmoney.com