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Does a strong consumer voice make a difference in health policy outcomes? According to a Mathematica Policy Research evaluation of state-level consumer health advocacy projects supported by the Robert Wood Johnson Foundation (RWJF), yes! At Georgians for a Healthy Future, consumer engagement is woven into each of our initiatives to bring the needs – and voices – of Georgia health care consumers into the public policy process. Over the past two years, one of our top priorities has been maximizing health insurance enrollment and ensuring that, once enrolled, consumers can access the care they need. Our work in this area, along with that of similar efforts in seventeen other states, was recently evaluated by Mathematica. The evaluation focused on the activities and outcomes of the eighteen Consumer Voices for Coverage (CVC) projects funded by RWJF. Georgians for a Healthy Future was a CVC grantee in 2014-2016. Through this program, we focused on outreach, education, and enrollment in coverage and used this work to inform and strengthen our policy work. The CVC evaluation found that coalitions, such as the one led by GHF in Georgia, played a central role in successful outreach, allowed consumer advocates to work together to help maximize enrollment and retention, and helped identify policy issues needing attention. These coalitions worked to increase enrollment in health coverage programs by building alliances with diverse stakeholders, mobilizing and engaging consumers, identifying achievable policy options to address issues arising from consumer experiences, designing and implementing communication strategies, and securing resources to sustain these efforts. While the CVC program is winding down, Georgians for a Healthy Future’s work in this area will continue through our Georgia Enrollment Assistance Resource (GEAR) network and through our ongoing policy work around coverage, access to care, and health care value. As we continue this health policy and advocacy work, we will leverage the advocacy infrastructure and ability to translate consumer voices strengthened through CVC into concrete policy actions. To read the complete Mathematica evaluation, click here.

The weather is heating up and the official start of summer is just around the corner, but here at Georgians for a Healthy Future we’re already looking ahead to one of the hallmarks of fall: open enrollment! The fourth health insurance open enrollment period, known as OE4, will run from November 1, 2016 through January 31, 2017. Stay tuned for an announcement soon about our enrollment summit – an opportunity for Georgia assisters, advocates, and other enrollment stakeholders to reflect on OE3 and plan for OE4 – scheduled for this coming August.

 

Earlier this spring, new renewal policies and consumer shopping tools were announced (see a roundup of these changes from Georgetown University’s Center on Health Insurance Reforms) and health insurance plans released their initial rate filings (see Georgia Health News’s coverage here, including comments from GHF’s Executive Director Cindy Zeldin), giving us early insights into what we might expect in the upcoming open enrollment period. It’s important to keep in mind that initial rate filings provide important information to regulators, stakeholders, and consumer advocates but they aren’t a good predictor of what consumers will actually pay for health insurance this fall. That’s because proposed rates must first undergo scrutiny by regulators and don’t take into account consumer shopping behavior or the availability of premium tax credits.

 

While we’re busy preparing for OE4, we also know that health insurance enrollment does happen year-round (if you are engaged in enrollment activities this summer, please tweet about them using #enrollment365). Life changes like marriage, moving, or job loss can happen during any season, triggering special enrollment periods (SEPs). Awareness of SEPs is low, and assisters play an important role in helping consumers who qualify navigate the process. Despite low enrollment during SEPs, however, the Centers for Medicaid and Medicare Services (CMS) recently issued a new rule further tightening them. GHF is concerned these changes could dampen enrollment among qualified uninsured individuals. If you are an assister and are finding that qualified individuals are having difficulties enrolling in an SEP, please let us know.

 

Finally, if you or your organization helps consumers navigate the health coverage or health care landscape, please consider joining GEAR, the Georgia Enrollment Assistance Resource network. GHF formed GEAR last year to help members of Georgia’s enrollment community learn from each other, share consumer-facing educational materials, and stay apprised of best practices from around the country. Joining GEAR is free, and through it we provide networking and learning opportunities for individuals and organizations that assist health care consumers. And it helps GHF keep our finger on the pulse of what consumers and assisters are experiencing so we can be better advocates. Learn more here.

The Georgia Department of Insurance will be holding hearings this summer on two key mergers that could impact the cost, quality, and coverage of health insurance that Georgia consumers are able to obtain.

Three of the nation’s biggest insurance companies (Aetna, Anthem, and Centene) are seeking mergers that would drastically change the health insurance market in Georgia and other states. What’s at stake for consumers is competition. Consumers benefit from competition, it encourages companies to offer lower prices, increase quality, and spur innovation. Currently in Georgia, the top four insurers control at least 75 percent of the market for individual, small group, and Medicare plans sold in the state. If the proposed Aetna-Human and Anthem-Cigna mergers go through then millions of Georgians can expect to see affordability, choice, and access greatly impacted.  But Georgia has the opportunity this summer to assess the merits of these mergers and, if approved, to guarantee that negative outcomes for our state’s consumers are mitigated.

State regulators have  power to approve mergers

Before the proposed Aetna-Humana and Anthem-Cigna mergers can go into effect in Georgia, both must be approved by the Georgia Office of Insurance and Safety Fire Commissioner (DOI). The DOI began reviewing the two proposed mergers in the summer of 2015. See initial findings for Aetna and Anthem here. After the review process is completed, a public commenting period, which includes a public hearing, will begin. During the public comment period this summer, consumer advocates have the opportunity to provide input and testimony in the public hearings where insurers will be questioned.  Following the public hearing, the Commissioner will issue a final decision to approve the mergers as is, approve with conditions, or disapprove.

How consumer advocates can get involved and have their voices heard

• Submit public comments and/or questions on how you believe mergers would affect consumers. Email mergercomments@oci.ga.gov or send by U.S. mail to Administrative Procedure Division, 2 Martin Luther King Jr., Drive, West Tower, Suite 1016, Atlanta, GA 30334
• Attend the hearing on the pending Aetna-Humana and Anthem-Cigna mergers. To receive meeting notifications, subscribe here
• Georgians for a Healthy Future plans to submit public comments and provide testimony. If you would like to learn more about our comments and sign onto them as a partner organization, contact Meredith Gonsahn at mgonsahn@healthyfuturega.org.

How to ensure that bigger means better for consumers

Georgians for a Healthy Future looks forward to participating in the public commenting process. Over the next month, we will release a policy brief on insurance mergers to help inform our partner organizations and submit public comments to Georgia’s DOI. We will put forth recommendations of merger approval conditions for premium stability, network adequacy, value-based coverage, consumer protections, and regulatory oversight. We recommend that Georgia’s DOI carefully consider whether or not to approve each merger and which remedies best address the expected concerns of and effects on consumers.

Once the mergers are approved they cannot be reversed. Therefore, we urge extreme caution in reviewing whether the mergers should be approved at all. If, at the end of the comment and review period, the DOI has a high degree of certainty that the mergers can benefit consumers, the DOI should set conditions for approval by which insurers should be held accountable to ensure consumers realize these benefits.

On May 13, the U.S. Department of Health and Human Services (HHS) issued a final rule implementing Section 1557 of the Affordable Care Act, an important milestone in the movement towards health equity. Section 1557 prohibits discrimination based on race, color, national origin, sex, age, or disability in all health programs and activities that receive federal financial assistance through HHS, are administered through HHS, or are established under Title 1 of the Affordable Care Act. As a result, most health insurance plans, facilities, programs, and providers are covered under this rule.

 

Notably, Brooksville chiropractic marks the first time that sex discrimination in health care is prohibited and also clarifies that gender identity and sex stereotyping are included in this definition. Because of these provisions, LGBT Georgians have protections from discrimination in health coverage and care. For specific information on the gender identity and sex stereotyping provisions of Section 1557, see Out2Enroll’s FAQ here. For Georgia-specific information about health insurance options for LGBT Georgians, check out the series of fact sheets that Georgians for a Healthy Future teamed up with Georgia Equality and The Health Initiative to release this past fall.

 

Discrimination against individuals with limited English Proficiency (LEP) is also prohibited in the health care programs and activities covered by the rule (defined under national origin). More than 1.3 million Georgians have LEP. In addition, the final rule requires effective communications with individuals with disabilities.

 

If you believe you have been discriminated against, you can file a complaint online with the Office for Civil Rights. If you are an enrollment assister looking for resources to educate the consumers you help about their protections under Section 1557, you can access FAQs and fact sheets from HHS here.

 

Rural Georgians experience health disparities on multiple dimensions: they are less likely to have job-based health insurance, may have to travel long distances to seek medical care, and experience higher rates of chronic health conditions than their suburban and urban counterparts. Compounding these challenges, several rural hospitals have closed their doors in recent years and others are at risk of closure.

While there are no easy answers to Georgia’s rural health crisis, an array of stakeholders including policymakers, the philanthropic community, health care providers, local community groups, and advocates have been exploring ways to strengthen our state’s rural health infrastructure.

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As part of its Two Georgias initiative, the Healthcare Georgia Foundation recently released its findings from a “listening tour” with health care providers and policy organizations in Georgia, including Georgians for a Healthy Future. The report offers a window into what practitioners and policy advocates are thinking about the direction of rural health care and the use of Hidrex for excessive sweating and how it can be improved. Check out the write-up to learn more about rural health and about how Georgians for a Healthy Future’s campaign to close the coverage gap in Georgia fits in.

You can stand with us by sharing this infographic with your social network. Use sample tweet: Our rural hospitals are hurting – but it does’t have to be that way. It’s time we accept federal #funding to #closethegap.

This morning, Governor Deal signed SB 302 into law! GHF strongly supported this bipartisan bill to improve the accuracy and usability of provider directories throughout the 2016 Legislative Session. Provider directories play a critical role in informing patients and consumers about which doctors are in their plan, yet they are notoriously error-ridden. SB 302 is an important step towards making provider directories the accurate and functional tool that consumers need to make the best health care decisions for themselves and their families.

Thank you to all who followed this issue throughout the Legislative Session and helped bring it across the finish line by contacting your legislators at each stage of the process!

Georgia’s proactive move is being noticed by national health policy organizations. Families USA’s Private Insurance Director Claire McAndrew’s blog post, How States Are Improving Consumers’ Access to In-Network Health Care Providers, prominently features the bill and GHF’s role in its passage. Another national organization, Community Catalyst, featured GHF’s Executive Director Cindy Zeldin as a guest blogger on the topic. This post, Protecting Health Care Consumers in the Peach State, provides an in-depth look at the policy process and next steps. Here in Georgia, the bill’s progress was covered by Georgia Health News back in March.

During this process, we created a series of resources to educate advocates, stakeholders, and policymakers.

Issue Brief: Improving Provider Directory Accuracy and Usability

Fact Sheet: Network Error, Secret shopper survey finds more than 1 in 5 health care providers inaccurately listed as “in-network”

Fact sheet: What’s Wrong with Georgia’s Provider Directories?

Video: Julie Silas on Why Provider Directory Accuracy is Important

Video: How Georgia Can Ensure Network Adequacy

  

Georgians for a Healthy Future staff attended the Connections 2016 conference hosted by the Healthcare Georgia Foundation on March 29^th and 30^th. The conference, held every other year, is an opportunity to network and learn from Georgia’s health and public health practitioners, professionals, advocates, and experts.

This year’s conference theme was partnerships, and in keeping with that theme, GHF was invited to present on how we use coalition building and mobilization as a strategy for policy change at the state level. Cindy shared how our history created an organizational environment that fosters and supports the development of strategic partnerships and coalitions. Laura added to that with an overview of GHF’s five coalitions, a coalition case study, and a review of some selected best practices in coalition development and management. You can see their presentation here.

As a result of the two-day conference, GHF staff came away with new contacts to partner with in the future and new ideas about what partnership might look like. The conference also provided the opportunity to network with existing partners, learn about their emerging work, and identify ways to collaborate moving forward.

If you would like to partner with GHF or join any of our five coalitions, contact Laura Colbert, Director of Outreach and Partnerships, at lcolbert@healthyfuturega.org.

• The Access to Care and Equity (ACE) coalition focuses on ensuring that coverage translates to access to care and has been working most recently on the issue of network adequacy
• The Cover Georgia coalition advocates for closing Georgia’s coverage gap that leaves 300,000 Georgians without a coverage option
• The Georgia Enrollment Assister Resource (GEAR) Network connects people and organizations working to help consumers enroll in coverage
• The Health Advocates coalition is open to health advocates representing non-profit organizations who want to coordinate efforts with other advocates

• The Preventing Youth Substance Use Disorders coalition works together to raise awareness about and advocate for a public health approach to preventing addiction

GHF is excited to welcome Sarah Dobra to our team! In her role she will provide development, planning and evaluation, and editorial support to ensure that we’re functioning well across programs and projects. Prior to joining GHF, Sarah was the Disparities Manager and Cancer Care Delivery Research Program Coordinator at a community cancer center in Savannah, Georgia. In this position Sarah successfully leveraged community partners to support cancer prevention and screening activities to address cancer disparities as part of a larger community network. Sarah obtained her law and Master’s in Public Health degrees at Tulane University and holds a BA from the University of Oregon. Sarah can be reached at sdobra@healthyfuturega.org – please join us in welcoming her!

Georgians for a Healthy Future teamed up with the US Department of Health and Human Services Region IV and Enroll America to bring enrollment assisters together to learn what went well, what could be improved upon, and what groups were planning for the next open enrollment period starting this coming fall. We had great participation from all the partners in attendance — stay tuned for some materials highlighting key themes from the discussion in the coming weeks! If you are an enrollment assister or work on health insurance enrollment in Georgia, please join our GEAR network to access helpful materials and engage with your colleagues!

Dear Friends,

Since our founding in 2008, Georgians for a Healthy Future has worked tirelessly to provide a strong voice for health care consumers in the policy sphere. One of the most important ways we advocate on behalf of consumers is by engaging with state policymakers to bring important health care challenges and barriers to light and work collaboratively to address them. While this is a year-round endeavor, the 40-day Legislative Session is when the rubber really meets the road.

This year, improving provider directories was our top legislative priority. Over the past three years, we have heard time and again that these directories, intended to inform patients and consumers about which doctors are in their plan, were error-ridden. A secret shopper survey we conducted earlier this year confirmed this: one in five health care providers listed in the directories we reviewed weren’t even in the network, and three-quarters of directory listings contained at least one error. This was unacceptable. Consumers need and deserve an accurate and functional tool that can help them make the best health care choices for themselves and their families.

Throughout the Legislative Session, we have asked you to contact your legislators in support of SB 302, legislation to improve the accuracy and usability of provider directories. Last night at 11:23pm, SB 302 cleared its final hurdle by receiving a favorable Senate “agree” vote to the modest changes made to the bill in the House of Representatives! This means the legislation has successfully passed the General Assembly and now heads to the Governor for his signature.

Please take a moment to thank Senator P.K. Martin, SB 302’s sponsor and champion, and to contact Governor Deal to let him know you support the bill.

I also hope that you will continue to engage with Georgians for a Healthy Future. We deeply value your support, whether it be as avolunteer, community partner, or donor. And while we’ll be taking a breather this weekend to celebrate this legislative victory, we also remain vigilant. There are still too many Georgians who can’t access the care they need, and our work to get Georgians covered, ensure access to care, enhance value for consumers, and build a healthier Georgia continues.

Thank you,

Cindy Zeldin