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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

 

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.

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.

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.