In a 6-3 ruling the Supreme Court upheld tax credits in the Affordable Care Act. This is a big victory for Georgia health care consumers!

As an organization committed to making sure all Georgians have access to the health care they need, Georgians for a Healthy Future is celebrating today’s Supreme Court decision! This ruling is a big win and a big relief for the more than 400,000 newly enrolled Georgians who can keep their coverage and the access to care and financial peace of mind that comes with it.

“Today we celebrate an important victory for health care consumers, and we are relieved that hundreds of thousands of Georgians can keep their coverage,” said Cindy Zeldin, Georgians for a Healthy Future’s Executive Director. “But there is still work to do. Georgia has the second highest rate of uninsured in the country, and three-hundred thousand Georgians fall into a coverage gap that was created by Georgia’s decision not to expand Medicaid.”

Now that the outcome of King v. Burwell is clear, we must not forget these workers, parents, and veterans in our state who still lack access to quality, affordable health insurance. It’s time to close the coverage gap.

Tell your legislator that it’s time to close the coverage gap!

Sometime this month, the Supreme Court will rule on King v. Burwell, a case that could have major implications for Georgia health care consumers. The Court will rule on whether the ACA allows consumers to receive tax credits to help pay for health insurance in the 34 states including Georgia that use healthcare.gov, the federally facilitated marketplace.  Here in Georgia, nearly 9 in 10 Georgians who enrolled in coverage this year accessed tax credits that made that coverage affordable.  A ruling for the challenger in King v. Burwell would place coverage at risk for more than 400,000 Georgians. GHF is working to keep you informed and updated with all the latest on this case. Here’s what you need to know.

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GHF surveyed and interviewed enrollment assisters across the state to understand not only the “what,” but also the “why” behind the second open enrollment period.  The results of that research have led us to several policy recommendations to maximize health insurance enrollment and retention and to ensure that coverage translates to meaningful access to timely and appropriate medical services for Georgia health care consumers.

1. Close the coverage gap in Georgia. Approximately 300,000 Georgians fall into the coverage gap, meaning they do not qualify for Medicaid under existing income eligibility guidelines in Georgia but their income is still too low to qualify for financial assistance (tax credits) to purchase health insurance on the Marketplace. Eligibility for tax credits begins at 100 percent of the Federal Poverty Level, or $11,770 for an individual or $20,090 for a family of three in 2015, while Medicaid eligibility for most adults in Georgia cuts off at income much lower. Thirty states including DC have closed their coverage gaps thus far with promising results. We encourage Georgia policymakers to take this important step as well to ensure all Georgians have a pathway to coverage.
2. Set and enforce network adequacy and transparency standards. Many of the plans sold through the Health Insurance Marketplace are Health Maintenance Organization (HMO) plans that feature narrow provider networks. While these narrow networks can help keep premiums down, a trade-off many consumers may be willing to make, consumers do not currently have sufficient information to make this choice. There is no information available to consumers at the point of sale about whether a provider network is ultra narrow, narrow, or broad, and provider directories are routinely inaccurate. More transparency and oversight are needed to ensure that consumers have accurate and useful information to make these choices. It is also important that all provider networks allow for meaningful access to all covered benefits. To ensure this, we support putting in place and enforcing network adequacy standards.
3. Encourage public-private partnerships and remove unnecessary restrictions on consumer education and assistance. Many of the enrollment assisters we surveyed indicated that reducing barriers to partnering with state government organizations such as public colleges, universities, and health departments would lead to stronger and more effective partnerships. Specifically, many respondents indicated that improved coordination between enrollment assisters, the Marketplace, and the Georgia Department of Community Health (DCH) to better facilitate PeachCare for Kids and Medicaid enrollment would be helpful. The “Health Care Freedom Act,” passed in 2014 as part of HB 943, prohibits state and local governmental entities from operating a health insurance navigator program and places other limitations on governmental entities. This provision has been counterproductive, creating confusion around what educational and consumer assistance activities local entities can engage in as they work to serve their community members. We recommend lifting these restrictions.

From choosing a plan to using your plan, health insurance can be complicated and many Georgians lack the information they need to make informed decisions.  In GHF’s recent report Getting Georgia Covered: Best Practices Lessons Learned and Policy Recommendations from the Second Enrollment Period, we interviewed enrollment assisters across the state and found that more than two-thirds of our survey respondents identified low health insurance literacy as a barrier to enrollment. Many of the consumers that assisters worked with had never been insured before, so they did not know how to choose a primary care physician or pay their monthly premium. One of the assisters interviewed acknowledged they needed to educate consumers on how to use their health insurance, but that it was a challenge when scheduled with a large number of enrollment appointments, although there are lawyers and Massachusetts firms that are specialized in insurances policies so they can help you understand better how it works. Additionally, some assisters reported that consumers chose the lowest premium plan because they did not understand the concept of a high deductible. Sometimes consumers would return to the assister wanting to change plans once they had tried to use their coverage. As we move forward, Georgians for a Healthy Future will be focusing efforts on improving the health literacy of Georgians and ensuring they have the knowledge, information, and confidence they need to make informed decisions.

New health insurance opportunities created through the Affordable Care Act (ACA) have let to historic reductions in the nation’s uninsured rate.  The strong enrollment numbers in Georgia mean that more Georgia consumers can access the health care services they need and enjoy enhanced financial security for themselves and their families.

New health insurance opportunities created through the Affordable Care Act (ACA ) have led to historic reductions in the nation’s uninsured rate. Here in Georgia, more than half a million consumers signed up for health insurance during the open enrollment period that ended this past February, known as OE 2.

These strong enrollment numbers mean that more Georgia consumers can access the health care services they need and enjoy enhanced financial security for themselves and their families. The reduction in our state’s uninsured rate, although smaller than that of the nation as a whole, also has positive implications for the vitality of local health care systems and communities throughout Georgia.

Too many Georgians, however, remain uninsured, either because

• they are unaware that there are coverage options that can meet their needs and budget
• face cultural, linguistic, financial, or other barriers to coverage; or
• fall into the “coverage gap” that was created when Georgia declined to expand Medicaid as authorized under the ACA

The goals of this report are

• to explain the role of in-person assistance on enrollment outcomes and consumers’ experiences
• to explore best practices that helped achieve robust enrollment in Georgia
• to identify any common challenges or barriers to enrollment that Georgia consumers faced during OE2
• to highlight promising strategies and approaches to reach the remaining uninsured who qualify for affordable health insurance
• to put forth policy recommendations that can help facilitate a positive experience for health care consumers, both for those who are newly enrolled and for those who remain uninsured.

You can download and read the report below.

[embeddoc url=”https://healthyfutprod.wpengine.com/wp-content/uploads/2015/12/Getting-Georgia-Covered-Cover.pdf”]

While Georgia has made little progress on closing its coverage gap, the subject is a hot topic elsewhere.

• Montana has closed its coverage gap! As the 29^th state to close the gap, Montana will provide 70,000 Montanans with quality, affordable health care coverage.  The state is currently working with CMS to gain approval for its expansion proposal.
• Face Off in Florida–The debate over closing the coverage gap is as hot as sunburnt skin after spring break! Floridians have seen a sudden and unexpected adjournment of the legislative session, a stand-off with HHS over the low-income pool (LIP), and their governor file suit against the federal government.  The debate is far from over as the legislature plans to reconvene in June to complete their legislative responsibilities.
• Policy makers in both Alaska and Louisiana are discussing if and how to close their coverage gaps.  While their legislators debate whether or not to close the coverage gap during a special session, polls show that Alaskans are hugely in favor of the policy.  In Louisiana, Gov. Jindal remains opposed to the idea of closing his state’s coverage gap, but legislators are discussing their options.

While Montana closes its gap and other states think through their options, more and more studies are revealing that closing the coverage gap is good for states! It saves money in state budgets and facilitates job growth, especially in the health care sector.  Families USA summarized the new data in a recent blog post.

You’re Invited!

May 13, 2015 from 11:30 to 2:00

Georgia Railroad Freight Depot; Blue Room

Sign up here!

More than half a million Georgians signed up for health insurance during the open enrollment period that ended this past February (OE2). These strong enrollment numbers mean that more Georgians have access to the health care services they need and the peace of mind that comes from knowing that they are covered. What drove this success story for health care consumers in Georgia? Please join us for a conversation with representatives of the organizations most active in OE2 to learn lessons about their strategies, successes, and challenges that you can apply to your work. After their presentations, you will have the opportunity to ask your most pressing questions about health coverage in Georgia.  Lunch will be provided.

Panelists

Enroll America: Danté McKay, Georgia State Director

GHF: Whitney Griggs, Consumer Education Specialist

InsureGA: Sarah Sessoms, Executive Director

SEEDCO:  Lisa Stein, Vice President Work and Family Supports

US Dept. of Health & Human Services: Dr. Pamela Roshell, Region 4 Director

While this is a free event, please RSVP so we can order enough food.

How much of the state budget went to health, and where was that money allocated?

Which health care-related bills passed, and what do they mean for my family and my community?

For the bills that didn’t pass, are they dead?

What study committees should I be paying attention to throughout the summer and fall?

For a complete understanding of what happened this legislative session, don’t miss our webinar.  Lobbyist Andy Lord and Community Outreach Manager Laura Colbert will walk you through what you need to know and answer any questions you may have.

Don’t worry – you can still sign up!

Date:Thursday, April 9

Time:12:00 – 1:00 EDT

Pranaya Rana joined Georgians for a Healthy Future this week as our new Navigator! In this role, Pranaya will work with consumers to help them enroll in health insurance through the Marketplace.  Pranaya is a former Lieutenant from the Nepalese Army Elite Forces. He has served as a U.N. Peacekeeper in post-earthquake Haiti and as a Refugee Resettlement Program Officer in Connecticut before he came to Kennesaw State University, Georgia to pursue his Ph.D. in International Conflict Management in 2012.   He has been working as a certified Healthcare Navigator in Metro Atlanta since the first open enrollment began in 2013. He recently completed his 6 months long Navigator’s term at Georgia Watch before joining Georgians For a Healthy Future.  He specializes in refugees and international communities and has served a wide variety of international communities enroll into affordable healthcare using a community specific service model developed through continued outreach, education and  needs assessment. He is Fluent in Nepali and Hindi besides English, and, speaks Urdu and intermediate French. If you’d like to contact Pranaya, he can be reached by email or by phone at 404-567-5016.