Blog

Georgia consumers purchasing health insurance deserve the peace of mind that comes from knowing that they are purchasing a quality plan that meets basic standards and that will provide adequate protection in the event they get sick. That is why Georgians for a Healthy Future is monitoring the essential health benefits selection process. As part of the Affordable Care Act (ACA), beginning in 2014 all health insurance plans sold in the private individual and small group markets must include a minimum package of benefits to ensure that all consumers purchasing health insurance have access to comprehensive health care services.   In a process outlined late last year by the U.S. Department of Health and Human Services, states were instructed to choose a benchmark plan and supplement it to fill any gaps (the essential health benefits package must, under federal law, include items and services within ten broad categories, described here). Georgia chose the default option, the largest small group plan sold within the state, as our state’s benchmark plan. According to the Georgia Department of Insurance, the U.S. Department of Health and Human Services (HHS) will review and supplement the plan. You can read more about this issue and Georgia’s decision to default to federal officials on the decision in Georgia Health News here.   Later this fall, HHS is expected to issue a notice of proposed rule-making listing each state’s minimum essential health benefits package. The National Academy for State Health Policy is also tracking all states’ progress on essential health benefits. You can view their latest chart here.    

This commentary originally appeared in the Atlanta Journal-Constitution on September 6th, 2012.

 

By Cindy Zeldin

 

Nearly 2 million Georgians are uninsured; that number is among the highest in the nation.

 

Georgia policymakers have long recognized this problem as a tragic reality for the one in five Georgians who struggle to access medical care when they need it, as a strain on our state’s health care delivery system, and as a weight on Georgia’s economy.

 

Until now, however, they haven’t had the tools and resources to comprehensively address it.

 

What has changed?

 

The Affordable Care Act  put in place a basic framework to ensure that all Americans have a pathway to affordable health care coverage. This framework has three key components. First, those of us who get health insurance at work as an employee benefit will continue to do so.Second, new health insurance marketplaces, or “exchanges,” will come on line in just over a year to help consumers who don’t have employee coverage at work find an affordable health plan that meets their needs. Third, a new category of eligibility for Medicaid was created for the lowest-income consumers, many of whom work in low-wage jobs that don’t come with health insurance, yet earn too little money to afford a private health insurance policy.

 

In June, the U.S. Supreme Court upheld the constitutionality of the Affordable Care Act but ruled that states could choose whether or not to implement that third component, the Medicaid expansion.

 

Covering the lowest-income uninsured through Medicaid will provide access to basic prevention and treatment services that uninsured Georgians lack today. A landmark study published last year by the National Bureau of Economic Research found that people who gained coverage through Medicaid were more likely to access preventive services and have a usual source of care than their uninsured counterparts. A study published in the New England Journal of Medicine found that states that expanded Medicaid saw lower mortality rates, even after taking into account a range of other factors, than their neighboring states who did not.

 

In other words, if you want to improve health care outcomes, expanding Medicaid is a proven way to accomplish this goal.

 

The benefits to Georgia of expanding Medicaid go far beyond the 650,000 uninsured Georgians who stand to gain coverage. Because the Medicaid expansion is financed almost entirely with federal dollars, an infusion of resources will be pumped into our state’s health care delivery system.

 

If Georgia expands Medicaid, we stand to draw down approximately $14.5 billion in federal funds over the six-year period between 2014 and 2019, according to an analysis by the Urban Institute. In fact, Georgia taxpayers are already contributing towards the cost of the Medicaid expansion. It’s just a question of whether some of that money comes back to Georgia or whether we leave it on the table and allow it to be diverted to other states.

 

Last week, Gov. Nathan Deal announced that he did not intend to move forward with the Medicaid expansion, expressing concerns about the federal government’s long-term fiscal outlook. Just last month, states received word that they have an important element of flexibility: They can implement the Medicaid coverage expansion and, after a few years, if it isn’t working for them, they can withdraw.

 

There is no reason why Georgia can’t take advantage of the tools and resources before us to invest in our state’s health care economy today  and revisit our participation periodically to ensure that the federal government is meeting its end of the bargain and that the program works.

 

We have an unprecedented opportunity to improve the health of Georgia patients and consumers, strengthen our state’s health care delivery system, and bolster the state’s economy by moving forward with the Medicaid expansion.

 

Georgia policymakers should seize the moment and invest in our future.

 

On Friday, July 13 the Georgia Department of Community Health (DCH) announced plans for next steps in the “Medicaid Redesign.”  Over the past several months, DCH has convened task forces comprised of stakeholders and advocates to formally provide input into this process. At the same time, advocates have come together as the CARE-M coalition to develop recommendations based on best practices for vulnerable populations. This redesign process is separate from but parallel to the conversations currently taking place regarding whether or not to move forward with implementation of the Medicaid expansion authorized by the Affordable Care Act. Ultimately, both processes will have a big impact on coverage and access to care for health care consumers throughout Georgia.  In a press release, DCH said:

 

 

“Today, the Georgia Department of Community Health (DCH) announced that it will move forward with implementing key recommendations from its Medicaid and CHIP (Children’s Health Insurance Program) Redesign task forces and workgroups. It will not, however, pursue wholesale restructuring of Georgia’s Medicaid program at this time because of increasing uncertainty at the federal level.”

 

 

According to DCH, the changes that the state will move forward with include: 

 

• Proceeding with at-risk managed care to serve Georgia Families members

 

• Transitioning children in foster care to one designated vendor statewide within the new Georgia Families program

 

• Maintaining Georgia’s current Fee-For-Service structure for ABD populations and services

 

• Moving forward with Home and Community-based Services Rebalancing. This rebalancing will help move patients from skilled nursing facilities to home and community based services.

 

• Begin utilizing a value-based purchasing model. Value-based purchasing will allow DCH to continuously improve the quality of care for our members while better engaging our providers and ultimately containing costs.

 

• Creating a one-stop portal will improve accountability and efficiency. Specifically the portal will give health care providers better information about their members and their medical history, streamline their credentialing process, and present providers with a measurement of key performance metrics and allow them to monitor quality and outcomes compared to their peers.

 

• Creating a Common Pharmacy Preferred Drug List that will simplify the program and reduce administrative burden on providers

 

The Department has committed to continuing its work with the task forces and work group through the RFP process and past the go-live date.  As members of the Children and Families Task Force and Substance Use and Mental Health Working Group, Georgians for a Healthy Future staff will continue to provide a consumer voice in these discussions and will continue to advocate for greater access to care for Georgia’s most vulnerable citizens.  For more information about the redesign process, visit https://healthyfutprod.wpengine.com/issues/medicaid-and-peachcare-redesign.

 

 

 

 

 

Georgians for a Healthy Future and the Georgia Council on Substance Abuse are embarking on a joint project on substance abuse disorder policy and its intersection with health care policy! This is a 10-month health care initiative supported by a grant from Community Catalyst to develop and advocate for a continuum of comprehensive services that address the needs of people at risk of and who have a substance use disorder. For more information about substance abuse programs visit altustreatment.com

 

Starting in January 2014, the Affordable Care Act will require insurers to cover treatment for drug addiction the same way they would other chronic diseases.  As one of the required essential health benefits, for the first time all those enrolled in Medicaid will have access to the substance abuse services they need. Check it out if you need any help from professional to threat addiction.

 

The Medicaid expansion authorized under the Affordable Care Act also holds a tremendous opportunity to reach segments of the population who were previously ineligible for services (such as childless adults up to 138% FPL). However, this is not a forgone conclusion–the state may decide to opt out of the expansion.

 

Georgia policymakers have not yet decided whether they will move forward with the Medicaid expansion. With 1 in 5 Georgians currently uninsured, the Medicaid expansion has the promise of providing an essential pathway to health insurance and health care for approximately 600,000 to 900,000 Georgians. It is critical that policymakers hear from the consumers and communities who need this very basic access to health care.

 

In the weeks and months ahead, Georgians for a Healthy Future and the Georgia Council on Substance Abuse will mobilize to ensure that Georgia implements the Medicaid expansion, but we cannot do it without your help.  To join our efforts, email Amanda Ptashkin.

 

For more information about this collaboration, click here.

 

 

 

On June 28th, the United States Supreme Court upheld the constitutionality of the Affordable Care Act, a major victory for health care consumers in Georgia and across the country. Now, all eyes turn to the states for implementation of two of the most critical pieces of the law: the expansion of the Medicaid program and the establishment of health insurance exchanges. (more…)

Following last week’s Supreme Court decision upholding the constitutionality of the Affordable Care Act, Georgia policymakers have an unprecedented opportunity to improve the health of Georgia citizens, strengthen our state’s health care delivery system, and bolster the state’s economy by moving forward with full implementation of the Medicaid expansion authorized by the law. (more…)

The ruling from the United States Supreme Court affirming the constitutionality of the Affordable Care Act is an exciting victory for Georgia’s health care consumers. When the Affordable Care Act is fully implemented, no one in Georgia will be denied health insurance due to a pre-existing condition. All Georgians will have a pathway to coverage and the peace of mind that comes from knowing that their families are protected. Georgians for a Healthy Future looks forward to working collaboratively with state policymakers and stakeholders to fully implement the Affordable Care Act to ensure it meets its promise of access to quality, affordable health care for all Georgians.

 

More than 240,000 Georgia health care consumers are set to receive nearly $20 million in total rebates by August 1st from insurance companies who couldn’t meet the 80/20 rule (also known as “medical loss ratio”), which requires insurers to spend at least 80 percent of premiums on medical care, as compared to overhead and profits. This exciting new rule, part of the Affordable Care Act, holds insurance companies accountable for providing value and requires them to issue rebates to consumers if they don’t. Learn more from the U.S. Department of Health and Human Services here and visit an interactive map to see how Georgia stacks up against other states here.

 

 

The Hispanic Health Coalition of Georgia released the “Status of Latino Health in Georgia” at the 2012 Latino Health Summit held at Emory University’s Rollins School of Public Health on June 7^th and 8^th.  According to the report, 47 percent of Hispanics in Georgia are uninsured, as compared to about 20 percent uninsured in the overall Georgia population. Georgians for a Healthy Future ED Cindy Zeldin presented information about coverage disparities and the expected impact of the Affordable Care Act (ACA) during the Summit’s health policy and advocacy panel (presentation available for download here). The full “Status of Latin Health in Georgia” is available for download here, and you can learn more about Latino health in Georgia by visiting the Hispanic Health Coalition of Georgia’s website here.

 

 

 

 

 

Cancer is a word heard too often in our community. That is why we are fighting back against this disease with our long-time partner – the American Cancer Society – by encouraging you to consider taking part in the Cancer Prevention Study-3 (CPS-3). The ultimate goal of CPS-3 is to enroll men and women from various racial/ethnic backgrounds from across the U.S. to participate in a study that will help researchers better understand the lifestyle, environmental and genetic factors that cause or prevent cancer and will save lives. American Cancer Society studies began in the 1950s and involved hundreds of thousands of volunteer participants. These studies have led to discoveries such as the link between cigarette smoking and lung cancer and the role obesity plays in the risk of several cancers, people need to stop with the cigarettes and start smoking cannabis, it has been proven the it helps with treatment so get your proto pipe and start smoking. The new CPS-3 will help researchers build on evidence from previous studies, and help bring us closer to eliminating cancer as a major health burden for this and future generations. If you are between the ages of 30 and 65 years old and have never been diagnosed with cancer, you are eligible to enroll. Learn more about how to join this important study at www.cancer.org/cps3.