“The public comments are important because they become part of the legal record,” said Laura Colbert, who submitted a letter opposing the proposal on behalf of Georgians for a Healthy…
On November 4, 2019, Governor Brian Kemp released a draft plan that, if approved, would drastically undermine comprehensive coverage for the 417,000 consumers who now have comprehensive coverage through the marketplace. Federal law allows states to make changes to the Affordable Care Act (ACA) so long as a comparable number of Georgians have coverage that is at least as comprehensive and affordable as they would have under the ACA, and the changes do not increase the federal deficit. Even under the most forgiving interpretation of these guardrails, Governor Kemp’s proposal fails to meet the test.
Fortunately, there’s still time to fight back! The state is required to seek public comments on this plan and will be accepting comments until December 3, 2019. Comments can be submitted online at CoverGA.org, at in-person comment hearings. This is an opportunity for Georgians to tell state leaders how this plan will impact their health and finances, and the health and finances of their loved ones.
Instead of undermining the coverage that so many Georgians rely on, state leaders should focus on preserving critical consumer protections, strengthening comprehensive coverage, investing in outreach and enrollment to Georgia communities, and working to address the rising health care costs for low-and middle-income Georgians.
Disrupts coverage for more than 400,000 Georgians with a privatized marketplace
Governor Kemp’s proposal seeks to expand coverage to approximately 30,000 out of more than one million uninsured Georgians at the peril of those consumers currently enrolled in comprehensive coverage using a risky new program.
At the center of his plan, Governor Kemp aims to decentralize how consumers currently enroll in individual market coverage in favor of private web brokers and insurers. This means that consumers would no longer have an unbiased place to compare plan options and instead would be forced to rely on private entities who would have the incentive to enroll consumers in plans that offered the highest commission and not necessarily the plan that best fits their health needs.
Likely result: Georgia consumers will struggle to navigate numerous websites, translate the sales lingo of insurers, and disentangle conflicting information. For many, it may be harder to find in a plan that they feel good about.
Limits financial assistance, increasing out-of-pocket costs
Along with dismantling healthcare.gov, Governor Kemp plans to restructure financial assistance in a way that would raise premium costs for comprehensive coverage and likely cause many Georgians to lose coverage altogether. Under his plan, consumers could use financial assistance to purchase skimpier coverage, like short-term plans, that don’t have to meet the ACA’s minimum standards. Additionally, his plan doesn’t address whether or not cost-sharing reductions would be required, which currently help to lower deductibles and other out-of-pocket costs for certain low-income consumers. As a result, Georgia consumers should expect to pay more out-of-pocket to get the care they need.
To make matters worse, because financial help is based on premiums for comprehensive coverage that will likely become more expensive under this plan, providing financial help to all eligible Georgians will cost more than what is currently budgeted. This means that some consumers who currently receive (or are eligible for) financial help would lose this valuable benefit.
Likely result: Premiums for comprehensive coverage will rise. At the same time, fewer Georgians will receive financial help to purchase coverage. Georgians will pay more out-of-pocket when they need health care.
Weakens consumer protections
In order to allow private companies to run enrollment, the Governor’s plan seeks to eliminate crucial consumer protections. The protections that may be suspended include the requirement that insurance plans include enough doctors and hospitals so people can get care (called “network adequacy”); requirements about what information insurers must provide to consumers and how that information is presented; and mental health parity, which requires insurers to cover mental health services in a similar way as other health care. The Governor’s plan assumes these new skimpy plans will provide 90% of the benefits that comprehensive coverage under the ACA provides. There is no explanation or evidence to support this assumption.
Removing the requirement to cover the ten essential health benefits and mental health parity threatens access to critical services for many consumers with pre-existing conditions. For example, treatment and recovery services for people with substance use disorders would be threatened at a time when the state continues to struggle with opioid-related deaths and substance use disorders in general. These consumer protections enable people with mental illness and substance use disorders to obtain insurance that covers their conditions without bankrupting them. Without them, consumers will have to pay out-of-pocket for life-saving care, opening them up to thousands of dollars of medical debt.
Likely impact: Skimpy plans that do not offer basic health services like prescription drugs, maternity care, or mental health services will become commonplace. As a result, Georgians will have a harder time accessing needed care and will pay more out-of-pocket.
The bottom line is Governor Kemp’s plan is terrible for Georgians. Any rational analysis will find it doesn’t meet even the laxest requirements of federal law. Georgians should weigh in today to reject this plan!
Philip is a 57 year old part-time roofer who resides in Fort Gaines, Georgia, a rural community in the southwest region of the state.
Philip suffered a knee injury along with a herniated disc in his back while repairing a roof. Because he is uninsured he has been repeatedly refused medical care because of his inability to pay. Despite making financial sacrifices to see several doctors and specialists, he has been unable to receive adequate help and get the treatment he needs. Philip says that if he had health coverage he would find the right specialist, get an MRI, and have his back fixed so he would no longer be in severe pain every day.
For the time being, Philip is able to see Dr. Karen Kinsell, the last practicing physician in Clay County. Dr. Kinsell is a volunteer physician who provides medical care to approximately 3,000 patients in a small office building that once served as a Tastee Freeze stand. Dr. Kinsell has advised Philip to stop roofing in order to ease the pain in his back but roofing is currently his family’s only income and Philip says there are no other viable job options for him in the area.
Philip believes access to health care is important and that significant changes need to be made so more people can access care. “Fix the issue, fix the problem, health insurance isn’t affordable for low-income people trying to work. Help us.”
Like Philip, 360,000 low-income Georgians, many of whom are uninsured, live in small towns and rural areas across the state. These areas have the most at stake in the debate over whether or not to close Georgia’s health insurance coverage gap. For rural Georgia residents like Philip, health coverage would open doors to the physicians and other health services that they need to stay employed or get back to work. For rural communities like Fort Gaines, more residents with health coverage could attract another primary care physician to the area.
Right now, Georgia’s policy makers are drafting two health care “waivers”. One of the waivers could be used to extend coverage to all low-income adults, including Philip and his southwest Georgia neighbors. Or state leaders could continue to ignore the needs of low-income, rural Georgians with a more limited plan.
The details of these waivers will be announced in the coming weeks and state leaders must offer online and in-person opportunities to hear public feedback. GHF will keep you up-to-date about what the waivers will mean for Georgians like you and Philip, and help you weigh in during the public comment periods!
Your story is powerful! Stories help to put a human face to health care issues in Georgia. When you share your story, you help others understand the issue, its impact on Georgia, and why it’s important.
Your health care story is valuable because the reader may be your neighbor, friend, someone in your congregation, or your legislator. It may inspire others to share their stories or to become advocates. It is an opportunity for individuals who receive Medicaid or fall into the coverage gap, their family members, their physicians and concerned Georgia citizens to show that there are real people with real needs who will be impacted by the health policy decisions made by Congress and Georgia’s state leaders.
Share your story here!
Since launching our Georgians in the Driver’s Seat initiative with The Arc Georgia, GHF staff have spoken with consumers around the state about their transportation needs as they relate to health. During one of those opportunities, GHF met Tannyetta and her four-month-old daughter Ayla at Atlanta’s CAPN Clinic.
Tanyetta enrolled in Medicaid while she was pregnant and both she and Ayla have Medicaid coverage now. In order to get back and forth from health appointments Tanyetta uses a free transportation service through Medicaid. This benefit, available to Medicaid-covered Georgians who do not have their own transportation, is called non-emergency medical transportation (NEMT). Transportation is provided in the form of pre-loaded public transit cards, van transport, rides with ride-share companies, and in other ways depending on the needs of the individual. Tanyetta does not have her own transportation but is able to get to medical appointments safely because of NEMT.
Much like Tanyetta, Georgians around the state are able to see health providers because they can use NEMT if they do not have another way to travel. For almost 400,000 Georgians each year, the service works well. However, there are times when it falls short of its promise. Patients and families are picked up late going to or from an appointment. In the worst cases, they are never picked up at all. People who use wheelchairs are picked up by vans that cannot accommodate their chairs. Parents who need to take one child to see the doctor are blocked from bringing their sibling, forcing them to find alternative and expensive childcare.
The people for
whom NEMT is breaking down are often those who need it the most: patients with
complex care needs. These riders are children and adults with physical and
intellectual disabilities, seniors who would otherwise have to live in nursing
homes, and people with multiple chronic conditions. Almost four
million NEMT rides are provided to Medicaid-covered Georgians each year. Riders
use an average of nine trips per year, demonstrating that those who use the
service visit the doctor frequently and rely heavily on NEMT to get them there.
When NEMT falls short for these riders, the consequences can be serious, so it
is imperative the system works well all of the time.
In order to improve Georgia’s NEMT services (so that they work all of the time, every time!), we need to hear from the people who use it. You can help! Fill out this rider survey, if you use transportation services to get to health appointments. If you are a caregiver or otherwise help people arrange for NEMT rides, we want to hear from you too.
If you do not fit into one of those categories, share the survey with someone who does! Ask your patients, your social media network, and others to fill out the survey if they have used Medicaid’s transportation services. The survey is available at this link and is open through December 09, 2019: https://www.surveymonkey.com/r/MedicaidTransport.
Have a story about transportation and health that you want to share? Tell us about it! We’ll get in touch with you soon to learn more.
Sherry is 77 years old and lives independently in Murray County in north Georgia. She gets up five days a week at 5 am and prepares for her day, which begins with a bus ride to the RossWoods Adult Day Center. Medicaid and Medicare make it possible to spend her weekdays at RossWoods where she engages in arts and crafts and social activities designed to keep her brain and body healthy. She also receives information about her medications and doctor’s appointments. Sherry is one of over half a million seniors and people with disabilities in Georgia who depend on Medicaid and Medicare to live and function in their communities.
Sherry has several health conditions including high blood pressure, a blood clot in her heart, chronic obstructive pulmonary disorder, a pacemaker, and arthritis in one of her legs. On top of all that, she recently fell and broke her wrist, causing nerve damage. Thanks to Medicaid, Sherry is able to afford the medications she needs to live a functional and healthy life. She would not have the financial means to pay the standard $30–$50 copay for each of her seven medications but Medicaid means she pays just $1.20 per medication instead.
To get to the pharmacy for her medications, doctors’ appointments and RossWoods, a type of Medicaid called the Community Care Services Program (CCSP) waiver provides Sherry with transportation. CCSP waivers provide “community-based social, health and support services to eligible consumers as an alternative to placement in a nursing home.” When asked about her Medicaid coverage, Sherry said: “I couldn’t make it if I didn’t have [Medicaid]. There would be no way.”
For 168,000 seniors like Sherry who typically live on low, fixed incomes, Medicaid makes the difference and helps to pay the costs of their Medicare coverage. For some, it provides additional health benefits not covered through Medicare. For others, Medicaid allows them to age with dignity in their communities by covering needed home and living adaptations like chair lifts, wheelchair ramps, or engaging day programs with trained staff.
In our first blog on Project Aware, we provided an overview of the dynamic and innovative youth mental health initiative that is making a difference in the lives of school-aged youth in Georgia. One of the four goals of Georgia’s Project AWARE is to “train educators, first responders, parents and youth group leaders to respond to mental health needs of youth by providing free training in Youth Mental Health First Aid (YMHFA).” In this blog we’ll get to know Youth Mental Health First Aid.
Youth Mental Health First Aid is a public education program which “teaches individuals how to help an adolescent in crisis or experiencing a mental health challenge.” Through an eight-hour course, participants learn the risk factors and warning signs of adolescent mental health issues. Attendees learn how to identify, understand, and provide early intervention for mental health challenges such as anxiety, depression, eating disorders, and substance use disorders. Those who take the course develop skills to support youth using a five-step action plan:
- Assess for risk of suicide or harm
- Listen nonjudgmentally
- Give reassurance and information
- Encourage appropriate professional help
- Encourage self-help and other support strategies
Youth Mental Health First Aid training was first designed by Mental Health First Aid USA in collaboration with experts at the National Technical Assistance Center for Children’s Mental Health at the Georgetown University Center for Child and Human Development.
Georgia currently has three Project AWARE sites: Griffin-Spalding County School System, Muscogee County School District and Newton County Schools. Through Project AWARE, the Georgia Department of Education (GaDOE) provides training in Youth Mental Health First Aid to teachers and other school staff and work with schools to develop innovative ways to connect youth and families to community-based mental health services. Georgia State University’s Center for Leadership in Disability and the Center for Research on School Safety, School Climate and Classroom Management provide the training and evaluation for Georgia Project AWARE at these three schools systems.
You can learn more about Project AWARE and the Impact of Youth Mental Health First Aid here:
Georgians for a Healthy Future and Georgia Women (and Those Who Stand With Us) co-hosted Health Care Salon: Georgia’s Patients First Act in Macon on Friday July 23rd. This community event brought together Macon residents to learn about Medicaid and Georgia’s new Patients First Act and develop health advocacy skills that can be used to build a healthier community.
Georgia’s Medicaid program insures half of Georgia’s children, and covers some low-income people with disabilities, seniors, and pregnant women. More than thirty thousand (30,949) Bibb County residents, about 20% of the county’s population, are covered by Medicaid. Participants heard from Alyssa Green, GHF’s Outreach & Education Manager, who shared powerful testimonials from several Medicaid-covered Georgians to demonstrate the real benefits of coverage.
Alyssa also introduced Macon-ites to the Patients First Act, a new state law which could make seismic changes to health coverage in the state using two kinds of health care waivers. Participants received information about 1115 and 1332 waivers, Georgia’s expected timeline for developing the waivers, and why the waivers’ required public comment periods are so important. The four expected public comment periods are the public’s opportunities to help shape and influence the future of health care in Georgia.
At the event, attendees were able to practice ways that they can advocate for the health care issues that matter most to them, like signing up for GHF’s new Georgia Health Action Network (GHAN) program. GHAN is a volunteer-led program that supports grassroots health advocates to work alongside GHF to promote quality, affordable, accessible health care and healthier communities.
If you were unable to attend this event, be on the look-out for similar community events coming soon or contact Alyssa (firstname.lastname@example.org or 404-567-5016, ext. 2) to schedule one in your community. You can also contact Alyssa learn more about the Georgia Health Action Network.
In March 2019, Georgia lawmakers approved SB 106, the Patients First Act. The new law allows Georgia to use two kinds of health care waivers to make changes to health coverage in the state. These waiver plans could affect you, your friends, family, neighbors, and Georgians all across the state and the way you access and pay for health care.
(Waivers allow a state to set aside or “waive” certain requirements imposed by the federal government and try new models of providing health coverage and care.)
The state has hired Deloitte as a consultant to work with state leaders to develop the waiver plans. Georgia’s decision-makers have proposed an aggressive timeline and aim to finalize the waiver plans by the end of 2019.
Two types of waiver plans
Two types of plans are being developed by state leaders: an 1115 waiver and a 1332 waiver. An 1115 waiver allows Georgia to make changes to the state’s Medicaid program. Medicaid is the state’s health insurance program that covers kids, some low-income parents, seniors, and people with disabilities, and pregnant women. SB 106 limits the 1115 waiver to cover people making up to the poverty line (about $12,000 a year for an individual or $26,000 for a family of four). Medicaid expansion, which GHF has advocated for, would extend public coverage to people with incomes just above the poverty line (138% of the federal poverty line.) A successful way to use an 1115 waiver would be to cover everyone under the poverty line and exclude barriers to coverage such as burdensome paperwork requirements, confusing cost-sharing, or counterproductive lock-out periods.
A 1332 waiver allows the state to make changes to private insurance and the health insurance marketplace. About 450,000 Georgians buy their health coverage through the marketplace. Most of these Georgians receive federal tax credits to cover some or all of their premium costs. (Another 827,600 of Georgians are eligible for private coverage and financial help to buy it but have not yet enrolled.) A successful way to use a 1332 waiver is to establish a “reinsurance program” to reduce premium costs. This waiver should also ensure all plans continue to cover the essential health benefits (like prescription drugs) and maintain protections for people with preexisting conditions.
You can weigh in!
Now is the time to ensure that Georgia gets a plan that will provide comprehensive coverage to as many people as possible. Thousands of Georgians across the state could gain health care coverage through the Patients First proposals. While positive intentions have been expressed by Georgia’s elected officials about the forthcoming waivers, none has yet committed to ensuring all Georgians have a pathway to comprehensive, affordable coverage.
For every 1115 and 1332 waiver that the state wants to pursue, Georgia’s policymakers must seek input from the public. Because there are required state and federal public comment periods for each waiver proposal, there will be at least four public comment periods (a state and federal period for an 1115 waiver and a state and federal period for a 1332 waiver). These are your chances to help shape and influence health care in Georgia!
GHF and our Cover Georgia partners will let you know when the public comment periods begin and end and we will provide an easy way for you to have your say. Make a plan to submit comments during every public comment period so that state leaders know how their ideas will impact you and your family! Your story can help make a difference for thousands of Georgians and can support positive changes in health care coverage.
Sean “Saifa” Wall is an Atlanta-based intersex justice activist. He is currently enrolled in a health plan with Ambetter through the Affordable Care Act’s health insurance marketplace (also called healthcare.gov).
As an activist, Saifa’s income is generated exclusively through contractual work, which means that his employers do not provide health benefits. He talks to people about issues that affect the intersex community. He also serves as a public health researcher that consults with racial justice and domestic violence organizations.
Saifa enrolled in coverage in 2016 with the help of a GHF health insurance navigator after being uninsured for over two years. (He was also able to purchase dental coverage.) Saifa pays a premium of $63 per month after a $500 tax credit helped to lower his costs. His coverage allows him access to hormone therapy and behavioral health services, among other essential health benefits. He loves his medical provider and receives high quality treatment as an intersex person who is hormone dependent.
Saifa was recently diagnosed with osteopenia, which means his bones aren’t as dense as they need to be to prevent breaks and other injuries. Saifa will need comprehensive medical care as he works to build bone mass; much or all of that care will be covered by the comprehensive insurance plan he purchased through the ACA.
Like Saifa, 450,000 Georgians rely on the ACA marketplace to access comprehensive, affordable health coverage. Many more Georgians are eligible for marketplace coverage but remain uninsured for a variety of reasons.
Georgia’s new law, called the Patients First Act or SB 106, may bring changes to private health insurance in the state but Georgia leaders have not yet spelled out what changes they plan to seek. An effective way to use their new flexibility would be to maintain the protections and financial help that Georgia consumers enjoy while building a “reinsurance program” to bring down premiums for everyone. (This approach has been successfully tried in seven other states.) If premiums fall or remain steady, this could attract more Georgians to the marketplace and get more people covered.
When Saifa was asked what he would tell legislators about having health coverage, he replied: “As an intersex activist, I believe health care is a human right.” While this belief isn’t yet reflected in Georgia’s state health laws, the ACA allows consumers like Saifa to take advantage of comprehensive, affordable coverage options and protections from discrimination in the health system, among many other advances.
Georgians for a Healthy Future regularly hosts graduate students who work with GHF staff to support the organization’s current projects and issue advocacy campaigns. The students learn about critical consumer health issues and develop skills that they can use to become effective health advocates throughout their careers.
Tyla Adams joins Georgians for a Healthy Future this summer as the Health Education & Advocacy Intern. In this role, she is responsible for supporting the Georgia Voices for Medicaid project by assessing the learning needs of community members, health advocates, people living with disabilities and those existing at the intersections of these identities, updating the curriculum accordingly, and creating any needed learning aids. She will also assist with community outreach efforts that aim to help consumers access health services, inform them on the current state of Medicaid expansion and any other relevant health policy issues.
While attending East Carolina University, Tyla studied abroad in New Zealand and Australia where she realized her passion for health education and access to quality health care. She graduated with her bachelor’s degree in public health studies and a minor in human development and family science. She is currently in her second year studying behavioral sciences and health education in the Master of Public Health program at Rollins School of Public Health at Emory University.
After graduation, Tyla hopes to work to decrease generational disparities due to controllable risk factors (like nutrition and access to quality health care) and to foster health equity in black communities. Her public health interests include maternal and child health, adolescent health, the social determinants of health and minority women’s health.
In late 2018, Georgians for a Healthy Future was awarded a General Operating Support grant from the Community Foundation for Greater Atlanta. The Foundation works to connect the passions of philanthropists with the purposes of nonprofits. Awards were given through a highly competitive process and we are excited about this partnership as we continue to work to ensure quality, affordable health care for all Georgians.
GHF was one of twenty-nine nonprofits to have received this highly competitive General Operating support grant from the Community Foundation for Greater Atlanta. Seven nonprofits, including GHF, were awarded grants to support well-being and “ensure a healthy region where all residents have access to quality health care and nutritious food.”
With the support of the Community Foundation for Greater Atlanta, GHF continues to offer Georgians the tools and information they need to become effective health advocates for themselves and their communities, inject the consumer perspective into health care stories in the media, and convene partner groups in coalition to strengthen our collective ability to advocate for the needs of Georgians across the state. We are ecstatic to have been among the select organizations who share our vision and drive to improve the lives of the people of Georgia. We look forward to continuing our work as the voice for Georgia health care consumers with the support of the Community Foundation for Greater Atlanta.
Read the Foundation’s December 2018 press release.