Next in Health Care: Network Adequacy Explained

 When consumers enroll in a health insurance plan, they gain access to a network of medical providers. Insurance companies contract with a range of providers, including both primary care and specialty physicians, to deliver health care services included within the plan’s benefit package. This network of providers must be adequate to ensure that consumers enrolled in the plan have reasonable access to all covered benefits. This is what is meant by network adequacy.  More specifically, to be considered adequate, a network must provide adequate numbers, types, and geographic distribution of providers; must ensure that access to care is timely; and must include essential community providers that serve predominantly low-income, medically underserved individuals. Additionally, accurate information about providers must be made available to consumers.

Network adequacy has become a hot topic over the past several months because many consumers who enrolled in new health plans through the Health Insurance Marketplace found that their plan came with a narrow network of providers. Provider directories weren’t always accurate or up-to-date, and consumers expressed a fair amount of confusion over which providers were in their plan’s network.

At the same time, the National Association of Insurance Commissioners (NAIC), which develops model laws and rules that states often adopt, has been working to update its network adequacy model law. Stakeholders ranging from insurers to medical providers to patient and consumer advocates are weighing in on this process, making network adequacy a hot topic in the policy arena too. Georgians for a Healthy Future has been monitoring this process through the participation of our executive director as one of the consumer representatives to the NAIC. Earlier this summer, the consumer representatives submitted comments to the NAIC focusing on developing a stronger standard and better oversight of network adequacy, an end to “balance billing” by out-of-network providers in in-network facilities, and greater transparency of provider networks.

Georgians for a Healthy Future will continue to monitor this process and will advocate at all levels, in conjunction with state and national partners, to ensure consumers have meaningful access to care.

If you are an individual consumer enrolled in a commercial health plan and the provider directory you were given was incorrect or if you have concerns about your ability to access covered services under your plan, please contact the Georgia Office of Insurance & Fire Safety, Consumer Services Division by calling (800) 656-2298 or use the Consumer Complaint Portal at www.oci.ga.gov/ConsumerService. Please also consider sharing your story with Georgians for a Healthy Future so we can get a better picture of what is happening in our state.

For more information on network adequacy, please see the following reports and resources:

From Georgetown Center on Health Insurance Reforms: Reforming State Regulation of Provider Networks: Efforts at the NAIC to Re-Draft a Model State Law

From Robert Wood Johnson Foundation and Georgetown University Health Policy Institute: ACA Implications for State Network Adequacy Standards

From Families USA: Network Adequacy and Health Equity: Improving Private Health Insurance Networks for Communities of Color

Connecting Georgians to Coverage

The ACA and people living with HIV/AIDS: what you need to know

The Affordable Care Act (ACA) makes health insurance more affordable, more accessible, more understandable, and more complete for all Georgians. Health care and health insurance are especially important to people living with HIV/AIDS (PLWHA) so that they can stay healthy and well.  PLWHA often have very specific needs and questions regarding their health coverage and care options.  To answer them, Georgians for a Healthy Future and Georgia Equality have created a fact sheet that breaks down the biggest concerns and decisions for PLWHA.  The fact sheet details new rights and protections under the ACA, walks through important questions to ask prior to choosing a health plan, and provides contacts for further assistance.

This fact sheet was made to be shared! You can view and download this new fact sheet on the GHF website. If you would like hard copies to distribute to your members, clients, or community partners, please contact Laura Colbert, GHF’s Community Outreach Manager at lcobert@healthyfuturega.org.

Georgia Gives Day

Georgians for a Healthy Future works hard every day to bring about our vision of a day when all Georgians have access to the health care services they need to lead productive lives and contribute to the health of their communities. Whether we’re enrolling people in health insurance, advocating on behalf of health care consumers at the state capitol, working to address substance use among young adults, or convening a coalition to expand Medicaid, we are focused on you and your health.

November 14^th is Georgia Gives Day.  This is a day for Georgians across the state to express their support for the non-profit organizations that enrich our lives.  We hope that you will put November 14^th on your calendar and take a few minutes out of your day to support Georgians for a Healthy Future by making a small contribution.  Look for alerts leading up to the day and please follow us on Facebook and Twitter as we celebrate and work toward our vision of a healthy Georgia.

Stories that Cause Change: How you can make a difference!

The public discussion around the Affordable Care Act is often about its politics. What the pundits miss is that each person’s experiences-whether it is the elation, relief, and sense of security that come with enrolling in health insurance for the first time or the frustration that comes from finding out you fall into the coverage gap–is important.  Whatever your story, we want you to share it with us!

Volunteer!  Throughout open enrollment we will be talking to consumers throughout the state.  You can help us in this important effort by attending an event in your neighborhood and talking to consumers.  We will prepare you with supplies and materials, a how-to guide, and more.  If you would like to help out, please email our outreach manager, Laura Colbert.

Share your story and encourage others to do the same. If you or someone you know has successfully enrolled in a health insurance plan through the marketplace, tell us about it.  If you fall in the coverage gap, let us know.  If you are able to access care that you couldn’t afford before, we want to hear about it.  Tell us your story by contacting our communications coordinator, Anna Cullen.

Together we can make a change.

Medicaid Minute: Uncompensated Care Cost

Last week, HHS released a report highlighting one way Georgia can help our hospitals and reduce uncompensated care costs: closing the coverage gap by expanding Medicaid.  In states that have expanded, uninsured/self-pay admissions as well as uninsured/self-pay emergency visits have fallen.  Those same states have seen hospital admissions for patients with Medicaid increase.  In short, they have more paying customers.  And Georgia is getting left out.  The report shows a $5.7 billion savings to hospitals in uncompensated care because of the Affordable Care Act.  $4.2 billion (74%) of those savings will be to states that have expanded.  Just one more reason why closing the coverage gap is the best option for Georgia’s economy and Georgia’s people!

Covering Kids: Health Insurance for the Whole Family 

New from GHF!

All kids need reliable access to quality health care.  Children need to see the doctor even when they are healthy:  shots for school, well-child visits, and dental care are all important for kids to grow up healthy and strong.  Their parents need coverage too to stay on track with regular screenings and preventive care, to access the health care system if they become sick, and to experience the financial peace of mind that comes with being covered. 

Thanks to new health insurance options available through the Marketplace, the uninsured rate among parents is dropping. Still, too many of Georgia’s low-income parents fall into what has become known as the “coverage gap,” meaning they don’t earn enough to qualify for subsidized private insurance and they earn too much to qualify for Medicaid because Georgia has so far declined to join the 27 states (and counting!) who have expanded Medicaid.

In an effort to provide accurate information to parents about the coverage options for themselves and their children, GHF has created a set of fact sheets about health insurance coverage for kids and parents in Georgia.  These fact sheets are intended to be a resource for individual consumers and for organizations who represent or provide services for Georgia families.  

Affordable Health Care for Your Children and For Uninsured Parents help parents understand the coverage options for themselves and their children. If you work with low- to moderate-income families through a charity care clinic, at a school or church, or in a community-based organization, you may want to provide these resources to the families you serve. 

Covering Kids paints a picture for policy makers and the media who want to better understand children’s health care coverage in Georgia.  If you work with policy makers or want to talk to your legislators about health care coverage for kids, this fact sheet will be a helpful resource.  

A fourth fact sheet serves as a reference for those who need to know the income limits for the Medicaid and PeachCare programs.

You can view and download these new fact sheets on the GHF website. If you would like hard copies to distribute to your members, clients, or community partners, please contact Laura Colbert, GHF’s Community Outreach Manager.

Connecting Georgians to Converage: GHF’s Navigator Program Will Again Assist During Open Enrollment!

Last week, the U.S. Department of Health and Human Services (HHS) awarded health insurance navigator grants to 90 organizations in states with federally facilitated or partnership marketplaces. Health insurance navigators help consumers understand and compare health insurance options, enroll in coverage, determine eligibility for tax credits, and utilize new coverage once enrolled. Georgians for a Healthy Future is excited to announce that, for the second year in a row, we are part of a consortium of 12 nonprofit organizations, led by the national nonprofit organization Seedco, which received one of two grants for Georgia!

With the next open enrollment period just 58 days away, we are already getting ready. In the coming weeks Georgians for a Healthy Future will bring on a full-time health insurance navigator who will work closely with consortium partners to provide outreach, education, and enrollment assistance to Georgia individuals and families. More than 300,000 Georgia consumers signed up for coverage during last year’s open enrollment period, but hundreds of thousands more who are eligible for affordable coverage remain uninsured. Reaching these uninsured Georgians will require targeted outreach strategies and new partnerships with local community-based organizations throughout the state. Additionally, consumers who enrolled during the last open enrollment period will need assistance navigating re-enrollment and may have questions about how to understand and use their new coverage. Health insurance navigators played a critical role during the first open enrollment period and are poised to assist consumers again this fall, when the second open enrollment period begins.

Georgians for a Healthy Future is honored to participate in these efforts.

Click here to see a full list of organizations that have received funding through Seedco.

Stories That Cause Change: How You Can Make a Difference!

Did you recently sign up for health insurance for the first time? Were you locked out of the market before because you had a pre-existing condition? Was insurance too pricey for you in the past and did you finally find an affordable plan that meets your needs? Or maybe you tried to enroll in coverage and found out that you fell in the “coverage gap” and can’t gain eligibility for Medicaid until Georgia policymakers move forward with Medicaid expansion? Or perhaps you enrolled in coverage but have had difficulty accessing an in-network provider nearby? Whatever your health care story is, we want you to share it with us!

The public discussion around the Affordable Care Act is often about its politics. What the pundits miss is that each person’s experiences-whether it is the elation, relief, and sense of security that come with enrolling in health insurance for the first time or the frustration that comes from finding out you fall into the coverage gap–is important. Georgians for a Healthy Future believes that telling those stories is a powerful tool that can help bring about a better policy environment for health care consumers in Georgia. Over the next several months, GHF, along with other organizations within the Cover Georgia coalition, will collect these stories and share them across the state.

To do this, we need your help in two important ways:

1. Volunteer!  Throughout open enrollment we will be talking to consumers throughout the state.  You can help us in this important effort by attending an event in your neighborhood and talking to consumers.  We will prepare you with supplies and materials, a how-to guide, and more.  If you would like to help out, please email our outreach manager, Laura Colbert.
2. Share your story and encourage others to do the same. If you or someone you know has successfully enrolled in a health insurance plan through the marketplace, tell us about it.  If you fall in the coverage gap, let us know.  If you are able to access care that you couldn’t afford before, we want to hear about it.  Tell us your story by contacting our communications coordinator, Anna Cullen.

Together we can make a change.

Medicaid Minute

Every day that Georgia does not close the coverage gap and expand Medicaid, federal dollars are lost.  To show just how much we are really losing, Pro Georgia has created a Georgia Medicaid Counter to track the dollars lost in real time.  Below is the code it embed it on your website.  Please use and share!

<script type=”text/javascript” src=”http://progeorgia.org/wp-content/uploads/2014/01/counter.js”></script>

New from GHF: ACA and the LGBT Community

• What health care rights and protections do legally married same-sex couples have in states like Georgia that don’t currently recognize same-sex marriage?
• Can health insurance navigators help consumers find LGBT-friendly plans? (Hint – yes they can!)
• How can a consumer file a complaint if they experience discrimination?
• What new health care rights and protections do transgender individuals have?

The Affordable Care Act makes health insurance and health care more understandable, more accessible, more affordable, and more comprehensive for Georgians, no matter their gender identity.  Georgians for a Healthy Future and Georgia Equality have teamed up to develop  a new set of LGBT specific fact sheets to answer some of these challenging questions that LGBT individuals and families face as they seek out, enroll in, and use their health coverage.

These fact sheets are intended to be a resource for individual consumers and for organizations who represent or provide services tailored to LGBT Georgians. You can view and download these new fact sheets here. If you would like hard copies to distribute to your members, clients, or community partners, please contact Laura Colbert, Georgians for a Healthy Future’s Community Outreach Manager.

Health Insurance Options For Georgia’s LGBT Community

Transgender Health Care

Love and Marriage: Health Insurance Rights for LGBT families

There is one day left for the 20,900 Georgians who received letters from the Federally Facilitated Marketplace (FFM) asking for citizenship verification.  Georgians who haven’t responded by September 5th will see their health care coverage end on September 30th.  Consumers whose coverage is canceled may be required to pay back some or all of the tax credits they received.

If you or someone you know has received this letter, please visit LocalHelp.HealthCare.gov and type in your zip code.  This will take you a list of organizations with health care Navigators – licensed professionals who can walk you through what needs to be done and how to get it done by the deadline. Click here assistance.

For up to the second information on this time sensitive issue, follow the twitter hashtags #BySept5 #StayCovered #Asegurate

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SBIRT, GCSA, and NRM: Acronyms You Should Know

More than 300,000 Georgians have enrolled in health insurance since last October, when new coverage opportunities became available through the Health Insurance Marketplace. These big coverage gains present an opportunity to raise awareness about the importance of prevention, both among consumers and policymakers.  We are already seeing the lifesaving impact that services like cancer screening, blood pressure checks, and mammograms are having.  One screening tool not broadly talked about is Screening, Brief Intervention, and Referral to Treatment (SBIRT).  SBIRT is a cost-effective way to identify individuals who are at risk of developing a substance use disorder and can often prevent the development of addiction or refer those in need to treatment.  Studies have shown every $1 invested in SBIRT yields $4 in savings. This important set of preventive tools should be available to all Georgians, particularly to our state’s youth.

This important set of preventive tools should be available to all Georgians, particularly to our state’s youth. The rise in heroin use among Georgia adolescents has gained widespread attention in recent months, but the problems goes beyond just heroin. By the time a student reaches ninth grade, 1 in 5 will display signs of alcohol use, a rate which rises to 2 in 5 by the twelfth grade. Approximately 20 percent of twelfth-graders are also engaging in drug use. We know that drug and alcohol use that starts in adolescence all too often becomes a lifelong habit. In fact, 90% of adults with a substance use disorder began using alcohol and/or drugs before the age of 18 and half under the age of 15.  With an increased awareness and use of SBIRT, we can work together to prevent drug and substance use disorders among Georgia’s youth and help them lead healthier and more productive lives.  To raise awareness about substance use disorders among Georgia’s youth as a public health challenge that can be addressed through prevention, Georgians for a Healthy Future and the Georgia Council on Substance Abuse (GCSA) have teamed up to raise awareness of and advocate for widespread use of SBIRT.

The GHF/GCSA campaign starts now, taking advantage of the spotlight already on the issue during the month of September: National Recovery Month.  Throughout the month, GCSA will participate in more than 20 events statewide to rally support, increase awareness, and connect people to the care they need.  See if there’s an event in your area!  The theme for this year’s Recovery Month is “Join the Voices for Recovery: Speak Up, Reach Out,” and we hope you will follow suit by speaking up and reaching out to those around you.  This is a crucial health issue that touches so many lives – join GHF and GCSA’s commitment to SBIRT and dedicated youth screening and early intervention efforts.  Stay posted for more information about SBIRT and recovery throughout the month!

For more information about teen substance abuse, please visit http://www.drugfree.org/.  If a teen if your life is struggling with addiction, please call the Substance Abuse and Mental Health Services Administration hotline number (800) 662-HELP or (800) 662-4357 or the Georgia Crisis and Access Line 0 1.800.715.4225 or www.mygcal.com .

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Washington Update: Funding for PeachCare to Expire in 2015!

THE GOOD NEWS:  Thanks to the Affordable Care Act, in October of 2015 the federal match rate for PeachCare for Kids increases from 75 percent to 93 percent. This means that Georgia’s financial responsibility for PeachCare for Kids will decline from 25 percent of program costs to 7 percent.  This is great news for Georgia’s children!

THE BAD NEWS: Funding for PeachCare for Kids is only guaranteed through September 2015.  That’s right, this crucial program that has been so successful in keeping Georgia’s children healthy is precariously close to running out of money.

PeachCare for Kids, Georgia’s Children Health Care Insurance Program (CHIP), provides more than 220,000 children with access to primary, preventive, specialist, dental care and vision care as well as hospitalization, emergency room services, prescription medications and mental health care services.  PeachCare for Kids serves children in families who earn too much to qualify for Medicaid but still cannot afford private health insurance. The program, which started in 1999, leverages federal dollars to support the state’s commitment to access to care for our state’s children. PeachCare for Kids has been very successful, with Georgia ranking 8th in the nation for the number of enrolled children.

How can you help?  Let your Congressman know that CHIP/PeachCare works and we want it to keep working!  Click here to find your federal Representative and Senator and their contact information.  For up to date information on this developing issue, follow GHF on Facebook and Twitter.

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Medicaid Minute

For Georgians who fall into the coverage gap,
living without health insurance and access to comprehensive health care services is a part of everyday life. To raise awareness about the importance of this issue, Mercy Care took to the streets, bringing it into the everyday lives of Atlanta workers on their lunch break with a flash mob!  We may not like that Georgia hasn’t expanded Medicaid, but we sure were happy to see this display of support in Woodruff Park!  Click the picture to check it out!

Georgians for a Healthy Future is honored to call Mercy Care a partner in the campaign to close the coverage gap in Georgia. To learn more about the Cover Georgia campaign to expand Medicaid in Georgia, visit www.coverga.org. If your organization would like to join the coalition, please contact Laura Colbert, Georgians for a Healthy Future’s Community Outreach Manager.

Thank you for helping us celebrate our first five years of health advocacy!

Georgians for a Healthy Future is celebrating our fifth anniversary this year, and last week we gathered to reflect on the important role that consumer health advocacy plays in Georgia and look ahead to the next five years. Thank you to our speakers, Dr. Gary Nelson, President of the Healthcare Georgia Foundation, and Andy Miller, CEO and Editor of Georgia Health News, and to Georgians for a Healthy Future’s board members, friends, and supporters for coming out celebrate our work and gear up for the work ahead.

Click on any photo to visit our Facebook page to see the entire album and our timeline highlighting our work over the past 5 years!

GHF welcomes new Communications Coordinator! 

Georgians for a Healthy Future is excited to welcome Anna Cullen as our Communications Coordinator!  In this capacity she will work to strategically develop and implement concise and effective messages across multiple outlets – from traditional to social media as well as stakeholder communications.  Anna comes to Georgians for a Healthy Future from the United States House of Representatives where she worked as a Legislative Assistant for a senior member of Congress and gained a strong understanding of the most effective tools to activate change in a divisive political atmosphere.  In that capacity Anna also managed the congressman’s external communications as well as interactions with agency officials and stakeholders within her policy portfolio which included environment, energy, social justice, housing and health issues.  Anna earned her B.A. in Communications, Legal Institutions, Economics, and Government from American University in Washington D.C. We’re thrilled to have Anna on board–please feel free to welcome her to GHF and to contact her atacullen@healthyfuturega.org!

Celebrating 5 years!

It’s been five years since Georgians for a Healthy Future launched in 2009 with a commitment to provide a strong voice for Georgia health care consumers and communities as health policy is made in our state, and it’s been an action-packed five years!

Please join our board, staff, and our longtime champions on the evening of August 7th as we reflect on our successes and challenges over the past five years and look ahead to the next five.

We’ll hear remarks from our special guests Dr. Gary Nelson, President of the Healthcare Georgia Foundation, and Andy Miller, CEO and Editor of Georgia Health News.

WHAT’S HAPPENING IN GEORGIA

Georgia’s Health Insurance Marketplace is open for business

On Tuesday, October 1, 2013, Georgia’s Health Insurance Marketplace opened for business.  Uninsured Georgians can now go to www.healthcare.gov to shop the Marketplace and see what insurance plan makes the most sense for them and their families.  Open enrollment runs from October 1 to March 31 so there is plenty of time for consumers to take their time, research their options, and pick a plan that works for them.
The work of outreach and education to communities across our state will never be more important.   78% of people report that they do not know about the Marketplace or how it will affect them—we are working hard to change this! Georgians for a Healthy Future along with Seedco and our other navigator consortium partners is working hard to make sure we are connecting Georgians to coverage.  We cannot do it alone and we hope we can count on your support and partnership. To read more about the launch of open enrollment, click here.

New Open Enrollment Resource Center

There is a new resource center on the Georgians for a Healthy Future website that is a centralized destination for everything consumers and community partners might need related to the Health Insurance Marketplace.  There they can find resources, tools, updates and more about new opportunities for healthcare coverage as we move forward with implementation of the Affordable Care Act.  Visit and refer others to the resource center to find:

• Information on the roles of  navigators, certified application counselors, agents and brokers

• Previous Marketplace updates and presentations

• Information about preparing for enrollment in the Health Insurance Marketplace

• Assistance with enrollment in the Health Insurance Marketplace

• Official resources from the Department of Health and Human Services 

Be sure to check the resource center frequently for updates and new resources.

Insurance plan data now available for browsing

Since the launch of www.healthcare.gov, consumers have had a difficult time creating an account, logging in and browsing information about insurance plans.  To help more people shop and enroll in these new coverage options, HHS has added more servers and engineers, and improved the system configuration so it can handle more volume and will have shorter wait times.  HHS has designed the system to be dynamic, and will continue to make adjustments to improve the consumer experience.

As of late last week, HHS allows consumers to preview Marketplace health plans and prices available in their area without having to create an account. To find out their actual costs, consumers will still need to apply.  The estimates provided on this site do NOT include the premium subsidies. Individuals between 100% and 400% of federal poverty level (FPL) are eligible for subsidies in the exchange that make their insurance more affordable.  To calculate the premium assistance they may be eligible for, consumers can visit the Kaiser Family Foundation’s subsidy calculator.

HHS will continue to work with consumers during the next six months to get people enrolled in the health insurance plans they need and want. People have until December 15 to apply for coverage starting January 1, 2014, but open enrollment is on-going through March 31, 2014.

THE UNINSURED IN GEORGIA

Georgians in the coverage gap

The Affordable Care Act was originally drafted so that individuals making up to 138% FPL (approx. $15,000 for an individual or $27,000 for a family of 3) would be eligible for Medicaid.  The Supreme Court decision in June 2012 made this optional for states and to date, Georgia has not elected to expand coverage through Medicaid.  The ACA also authorizes individuals between 100% and 400% FPL to receive premium subsidy assistance to make their insurance affordable.

So what happens to the individuals who are not currently eligible for Medicaid with incomes below 100% FPL?  They fall into the coverage gap.

So what will happen to people in the coverage gap? Unfortunately, these individuals will not qualify for Medicaid and are not eligible for exchange subsidies so insurance will remain unaffordable and they will not be able purchase it.  They do not have to pay a penalty under the “individual mandate” but they will also not have a reliable source of healthcare. While they can continue to access the healthcare system the way they do now–through the Emergency Room, at community health centers, and at free clinics, they will continue to suffer the consequences of avoidable hospitalizations and complications.

Georgia’s decision to expand coverage through Medicaid is one without a deadline.

Please join the Cover Georgia coalition in its efforts to move forward with this expansion.  There are several ways to get involved:

1. Take five minutes to call Governor Deal at 404-656-1776 and ask him to support expanding Medicaid in Georgia to people with incomes up to 138% FPL.  For talking points, click here.
2. Sign and share the petition to Governor Deal.
3. Share your story with us–are you one of the people who would gain coverage with expanded Medicaid? Do you know people who would? Have them share their story with us to help put a face on this important issue to policy makers and the media.
4. Join Cover Georgia and become an active member of our statewide coalition dedicated to expanding coverage for Georgians.

Georgians who have used the Health Insurance Marketplace

Since the launch of the Health Insurance Marketplace, GHF has been working to connect Georgians to coverage.  We are very eager to hear from consumers who have tried to navigate the online marketplace on their own or with the assistance of a navigator, certified application counselor, agent, or broker.  Please share your experience with us–good or bad–so that we can continue to learn and assist Georgians with the enrollment process.

RECENT AND UPCOMING EVENTS  

Help us plan an open enrollment event in your community

With nearly 2 million uninsured Georgians, we have a lot of work over the next several months to connect those Georgians to the resources they need to access affordable health insurance.  GHF and our Seedco consortium partners are working hard to plan events across the state in local communities and with local partners.  If you are interested in partnering with us to identify a community who will benefit from this information, please reach out to us and let us know.

GHF benefit concert with Paul Thorn

Thanks to Paul Thorn Band and Jackson County Line, and the music lovers in Atlanta, GHF’s first ever benefit concert on September 7 was a success! Thanks to all our supporters who came out for an evening of camaraderie and music.  A very special thank you to GHF Board Member, Jon Wollenzien for his leadership and vision for this event.  Click here to see pictures from the concert.

WHAT’S HAPPENING IN GEORGIA

CARE-M Coalition Update

CARE-M (Coalition to Advance Redesign Effectiveness for Medicaid) is a group of organizations who advocate on behalf of vulnerable populations, patients, and health care consumers in Georgia.  Georgians for a Healthy Future is a member of the coalition. The coalition was formed shortly after the Georgia Department of Community Health (DCH) announced plans to explore redesigning Georgia’s Medicaid and PeachCare for Kids (CHIP) programs to ensure that the voices of these patients and consumers were heard in the process. Many CARE-M partners have been appointed to and serve on task forces and work groups convened by DCH to gain stakeholder input.
In May 2013, CARE-M released an updated version of its principles and concerns around Medicaid redesign.  The revised guiding principle is:

• Improved healthcare outcomes for members should be the primary goal that drives changes to Medicaid. Improvement in the Medicaid system of services and supports will result in improved healthcare outcomes for the members.

To read more about the principles and concerns with the redesign process, click here.  For more information about CARE-M, click here.

Medicaid expansion could be a game changer for Georgians with mental illness

Georgia ranks 9th in the nation in the number of uninsured adults with a mental illness who could gain coverage through the Medicaid expansion, according to a new report from the National Alliance on Mental Illness (NAMI). The NAMI report describes the barriers that people with mental illness face in accessing services and the important role that Medicaid plays in connecting people to services so they can be healthy and productive members of their communities. Expanding Medicaid in Georgia is a major opportunity to change the lives of more than 86,000 low-income uninsured adults with mental illness in Georgia–if you haven’t already, please sign the petition in support of expanding Medicaid in Georgia and join us in our campaign to Cover Georgia!  The full NAMI report on Medicaid and mental health is available here.

ACA is estimated to significantly increase the number of Georgians who start their own business

According to a new report from the Robert Wood Johnson Foundation, thanks to provisions in the Affordable Care Act that preclude coverage denials based on pre-existing conditions and that will make health insurance more accessible and affordable, an estimated 56,000 Georgians will be able to start their own businesses who would not have otherwise done so.  To read the full report, click here.

THE UNINSURED IN GEORGIA

GHF and the work of the Cover Georgia coalition featured in the New York Times: States’ policies on health care exclude some of the poorest

On May 24, GHF was featured in a New York Times article focusing on how states are implementing the ACA and how that affects various populations.  When asked specifically about our state’s Medicaid expansion efforts, GHF outreach and advocacy director Amanda Ptashkin said, “Hundreds of thousands of people with incomes below the poverty level would be eligible for Medicaid if the state decided to move forward with the expansion of Medicaid. As things now stand, they will not be eligible for anything. What do we do for them? What do we tell them?”  To read the full article, click here.

Over the past several months, hundreds of Georgia health care consumers have chosen to speak out about what expanding Medicaid would mean for them by filling out postcards addressed to Governor Deal. The postcards ask him to support the Medicaid expansion in Georgia. Additionally, more than 1,700 Georgians have signed the online petition. The Cover Georgia coalition is collecting these signatures and stories and will deliver them to Governor Deal prior to the start of the 2014 legislative session.  We need your help to make sure these voices are heard!

Please join the efforts of the Cover Georgia coalition however you can. Here are some suggested ways to engage in this important issue:

1. Take five minutes to call Governor Deal at 404-656-1776 and ask him to support expanding Medicaid in Georgia to people with incomes up to 138% FPL.  For talking points, click here.
2. Sign and share the petition to Governor Deal.
3. Share your story with us–are you one of the people who would gain coverage with expanded Medicaid? Do you know people who would? Have them share their story with us to help put a face on this important issue to policy makers and the media.
4. Write an op-ed or letter to the editor.  Explaining how the expansion would affect different populations across the state is our best way to show how widespread the effects of the decision’s reach.  For help with media outreach, email Amanda Ptashkin.  For an excellent example of a compelling op-ed on the topic, click here.
5. Join Cover Georgia and become an active participant in a statewide coalition dedicated to expanding coverage for Georgians.

RECENT AND UPCOMING EVENTS  

Recent Event Recap!

Core to our mission at Georgians for a Healthy Future is robust outreach and education to various audiences throughout the state.  GHF staff has been busy at work sharing critical information about implementation of the ACA, the upcoming wave of enrollment through the marketplace, or exchange, and the consequences of expanding or declining the Medicaid expansion.  Here are some of our recent presentations:

• On June 4, executive director Cindy Zeldin presented to the Midtown Atlanta Rotary on the future of health in Georgia, part of the Rotary’s health theme for the month of June. Her presentation is available for download here.

• On May 28, outreach and advocacy director Amanda Ptashkin joined the Voters Guild of Metro Atlanta for their monthly meeting and shared information about the ACA, its implementation and the next big things on the horizon.

• On May 21, outreach and advocacy director, Amanda Ptashkin, joined the Greater Augusta Health Network at their board meeting to discuss the role of navigators in the context of assisting consumers enroll in the new health insurance marketplace.

• On May 3, executive director Cindy Zeldin served on a panel at the Georgia Charitable Care Network’s annual conference and discussed Georgia’s uninsured and the opportunities and challenges ahead for connecting Georgians to coverage. Her presentation is available for download here.

Decoding the Affordable Care Act: Issues Conference 2013

Please join Georgians for a Healthy Future at the 2013 Issues Conference: “Decoding the Affordable Care Act” taking place on Saturday, June 15, 2013 from 10am to 12pm at the Fayette County Library.  This event is being sponsored by State Representative Ronnie Mabra, District 63.

This year’s conference is purposed at helping individuals understand the implications of the new health care law and highlight its major provisions. The conference will feature presentations and discussion by an expert, non-partisan panel followed by a question and answer session.

Moderator:
Natalie D. Hernandez, PhD, MPH
Health Policy Leadership Fellow
Satcher Health Leadership Institute
Morehouse School of Medicine

Panelists:
Starla Hairston Blanks, MBA, CPHP
Director of Community Health Promotion and Policy Development
Community Voices: Healthcare for the Underserved
Morehouse School of Medicine

Kirkland McGhee, Esq.
Vice President & Regional Counsel
Legal Services and Government Relations
Kaiser Foundation Health Plan of Georgia

Amanda Ptashkin, JD
Outreach and Advocacy Director
Georgians for a Healthy Future

This event is free and open to the public.  Please help us prepare for your arrival by RSVPing to 2013 Issues Conference.

All Hands on Deck! An Evening with Georgians for a Healthy Future

The Georgians for a Healthy Future board of directors invites you to join us for an evening of camaraderie, conversation, and celebration as we gear up for the next big phase of health reform implementation: connecting hundreds of thousands of uninsured Georgians to coverage. Thanks to national health reform, consumers have more options than they have ever had before. But covering Georgia’s uninsured will take all of us, working in concert, to move our state forward. We need all hands on deck! Please join us on the evening of June 27th to celebrate our successes and prepare for the challenges ahead.

 
Featuring remarks by: Senator Jason Carter

WHEN:  Thursday, June 27, 2013, 6pm to 8pm
WHERE:  18th Floor Deck, Nelson Mullins Riley & Scarborough

Host committee (in formation)

CAPTAIN

Dr. Harry Heiman & Abby Friedman

Representative Pat Gardner

Dr. Doug Skelton

Healthcare Georgia Foundation
FIRST MATE

Dr. Edward Fernández-Vila and Mr. Jeff Cornett

Cindy Zeldin & Doug Busk

Lenz Marketing
CADET

AARP Georgia

Advocates for Responsible Care

Kent & Diane Alexander

Julie Edelson

Iris & Bruce Feinberg

Jeff Graham

Healthy Mothers Healthy Babies Coalition of Georgia

Susan Kupferberg

Jeanney & Steve Kutner

Catherine Smith

Statewide Independent Living Council of Georgia

Marci Thomas

Joann Yoon

***

Host committee opportunities available:

Captain ~ $1000 and up (6 tickets)
First Mate ~ $500 (4 tickets)
Cadet ~ $250 (2 tickets)

Please contact Cindy Zeldin to join the host committee or for more information about the event.

General tickets are $60.  To register, click here.

WHAT’S HAPPENING IN GEORGIA

• Families USA, a national consumer health advocacy organization, has developed an online resource center for navigators and others working on outreach and enrollment. You can visit the resource center here.

• Consumers Union, the policy and action division of Consumer Reports, has developed a consumer-tested brochure to help consumers understand the new health insurance tax credits. The brochure is available here.

•  The Center for Consumer Information and Insurance Oversight (CCIIO) has an updated FAQ available on the navigator program.  You can view that document here.

• 10 – 12 p.m.    HB309 – Rep. Ben Harbin, (Ava’s Law)
• 1 – 2p.m.        HB74 – Rep. Ed Lindsey, (Hearing Aid Coverage for Children Act)
• 2 – 3p.m.        HB73 – Rep. Ed Lindsey, (Insurance; coverage for physician prescribed special dietary food)

WHAT’S HAPPENING IN GEORGIA

Preparing for the next phase of health reform: outreach and enrollment

Open enrollment into the new health insurance marketplace, or exchange, begins in just five months (October 1, 2013) for coverage starting in January 2014.  Georgia has one of the highest numbers of uninsured in the nation (1.86 million), and many of these uninsured Georgians will be able to access affordable health care coverage for the first time through the marketplace.  [However, unless Georgia implements the Medicaid expansion, our state’s lowest-income uninsured will still lack a pathway to coverage.  To learn more about this coverage gap and Georgians for a Healthy Future’s efforts to cover this population, click here.]

According to research from Enroll America, more than three-quarters of the uninsured don’t know about the new health insurance marketplace. Multiple surveys have also found that when uninsured individuals who would be eligible for affordable coverage through the marketplace learn about the new health insurance options that will become available to them, they say they will need help navigating the process.

Georgians for a Healthy Future is currently working with Enroll America to assess the interest and capacity of Georgia community-based organizations, health care-focused nonprofits, and other stakeholders in working collaboratively on education, outreach, and enrollment into the new health insurance options available to consumers in 2014 through the Affordable Care Act. As a first step, we held a webinar on April 10th and an in-person meeting on April 11th that many of you attended. For those who missed the meetings, the materials can be found here.

If your organization has a stake in covering the uninsured, we’re asking you to complete a brief survey about your current work and future plans to engage in connecting uninsured Georgians to coverage either through applying to become a health insurance navigator or in other ways. Georgians for a Healthy Future plans to use the overall results of the survey to guide the formation of a new enrollment-focused coalition and to inform an upcoming policy brief on health insurance outreach and enrollment.

Please take a few minutes to complete this survey. Georgians for a Healthy Future is committed to advancing the goal of covering Georgia’s uninsured by bringing stakeholders together who are interested in and able to collaborate towards this shared goal. The results of this survey will provide a baseline and starting point for this important work. Thank you!

More than 800,000 Georgians will be eligible for health care tax credits in 2014

Many of the Affordable Care Act’s major health insurance reforms take effect in 2014. One of the most important changes impacting consumers will be the availability of substantial new tax credits to help individuals and families afford health care coverage. Individuals with annual incomes between about $15,860 and $45,960 (or between about $32,500 and $94,200 for a family of four) will be eligible for the health insurance tax credits. According to a new study by Families USA, about 800,000 Georgians will be eligible for these credits to help make coverage more affordable for them. Georgians for a Healthy Future joined with Families USA in a co-release of the report to highlight the Georgia-specific findings. You can find media coverage of the report’s findings here, here, and here. You can download the report here.

HHS issues proposed regulations on health insurance navigators

Connecting uninsured Georgians to new coverage opportunities will be a major undertaking. To facilitate consumer education, outreach, and enrollment, the Affordable Care Act creates a health insurance navigator program. Earlier in April, the U.S. Department of Health and Human Services (HHS) issued proposed regulations providing more information about how the program will work. The proposed regulations contain strong conflict of interest provisions, cultural competency and accessibility requirements, and training standards. You can read an analysis of the proposed regulations from the journal Health Affairs here.  HHS is accepting public comments on the regulations until May 6^th. Please consider sending comments in support of these consumer-friendly provisions.

The proposed regulations also indicate that state-level restrictions on navigators that are so burdensome as to prevent the viability of the navigator program will be preempted. This was included in response to a spate of bills that have popped up in legislatures across the country at the behest of the health insurance broker and agent lobby. Many of these bills are nearly identical across states and, if implemented, could impede the critically important navigator program. During the 2013 legislative session, Georgia legislators passed HB 198, which would place restrictions on navigator functions and require navigators to meet licensing and training requirements in Georgia. Although there is good reason to believe at least parts of HB 198 will be preempted, Georgians for a Healthy Future remains vigilant about the potential negative impact of HB 198 on the participation of small consumer and community-focused nonprofit organizations in the navigator program. The robust participation of these types of entities will be needed to ensure hard-to-reach populations in Georgia learn about and enroll in the new health insurance options available to them. Should HB 198 be signed into law, Georgians for a Healthy Future hopes to work with state officials to implement it in a way that is consistent with federal law and that strengthens the navigator program, perhaps by offering a training curriculum on state-specific programs like Medicaid and PeachCare, rather than weakens it.

The Augusta Chronicle recently interviewed Georgians for a Healthy Future’s executive director about the importance of the navigator program, the proposed rules, and Georgia’s HB 198. That article is available here.

CMS announces simplified health coverage application

Based on feedback from consumer groups, the Centers for Medicare & Medicaid Services (CMS) announced today a shortened and simplified health coverage application that will help individuals easily apply for coverage when open enrollment begins on October 1, 2013.  Additionally, for the first time consumers will be able to fill out one simple application and see their entire range of health insurance options including those in the marketplace, Medicaid, PeachCare, and tax credits to help pay for premiums.  To view the new applications for individuals and families, click here and here, and here.

THE UNINSURED IN GEORGIA

The stakes are highest for the state’s lowest income citizens

One of the guiding principles of the Affordable Care Act is that everyone should be eligible for some type of health care coverage.  While the new health insurance marketplace opens in 2014 and will make affordable health insurance available for nearly 800,000 Georgians, hundreds of thousands of additional low-income Georgians could be left out in the cold unless Georgia policymakers implement the Medicaid expansion, which was made optional by last summer’s U.S. Supreme Court decision.  Tax credits are available to consumers with incomes between 100% and 400% of the federal poverty level (or starting at about $15,860 for an individual or $32,500 for a family of four) to purchase coverage through the health insurance marketplace. Medicaid was intended to be the route to coverage for individuals and families with incomes below that threshold, and many states are indeed extending Medicaid to their lowest-income citizens. We need your voice to move Georgia from no to yes on the Medicaid expansion!

Please join the efforts of the Cover Georgia coalition however you can. Here are some suggested ways to engage in this important issue:

1. Take five minutes to call Governor Deal at 404-656-1776 and ask him to support expanding Medicaid in Georgia to people with incomes up to 138% FPL.  For talking points, click here.
2. Sign and share the petition to Governor Deal.
3. Share your story with us–are you one of the people who would gain coverage with expanded Medicaid? Do you know people who would? Have them share their story with us to help put a face on this important issue to policy makers and the media.
4. Write an op-ed or letter to the editor.  Explaining how the expansion would affect different populations across the state is our best way to show how widespread the effects of the decision’s reach.  For help with media outreach, email Amanda Ptashkin.  For an excellent example of a compelling op-ed on the topic, click here.
5. Join Cover Georgia and become an active participant in a statewide coalition dedicated to expanding coverage for Georgians.  Once October hits and we see hundreds of thousands of Georgians begin to learn about their coverage options, we will also begin to see just how many people stand to fall into the coverage gap created by the failure to expand Medicaid.  Help the advocacy community overcome this obstacle by joining our efforts to #CoverGeorgia.
   

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UPCOMING AND RECENT EVENTS  

SAVE THE DATE: All Hands on Deck! An Evening with Georgians for a Healthy Future

Please save the date for Georgians for a Healthy Future’s annual cocktail reception and fundraiser.  This year’s event, All Hands on Deck!, stresses the critical nature of our collaborative work as we collectively navigate the health care landscape in our state.  Please join us for a fun and entertaining evening!

WHEN:  Thursday, June 27, 2013, 6pm to 8pm
WHERE:  18th Floor Deck, Nelson Mullins Riley & Scarborough

Invitation and RSVP link to follow shortly.

Health care town hall focused on how the ACA affects Georgia’s LGBT community

On April 17th,  Georgia Equality and Georgians for a Healthy Future held a health care town hall meeting to share the specifics of what health care reform means for Georgia’s LGBT community.

The ACA brings with it great changes to our health care system and how people are able to access coverage.  While these changes will affect everyone, there are some very specific issues that the LGBT community should be aware of.

Brian Bassinger, an associate at King & Spalding and former Georgia Equality Board member, gave an informative presentation which included the history of LGBT health care access and the implications of the ACA’s provisions for LGBT individuals.  To view Brian’s presentation, click here.  Georgians for a Healthy Future’s Amanda Ptashkin also presented at the town hall about the importance of coverage, particularly through the lens of the Medicaid expansion. To view Amanda’s presentation, click here.  To download two health reform focused LGBT specific fact sheets, click here and here.

WHAT’S HAPPENING IN GEORGIA

Legislative Update

The 2013 Georgia Legislative Session has ended. The 2014 state budget and dozens of bills now go to Governor Deal for his signature or veto (the governor does have the authority to line-item veto parts of the state budget). Bills that did not pass this year are still viable in the 2014 Legislative Session, which will be the second year of a two-year session. Below is a summary of bills that passed the General Assembly this year that could impact health care consumers. For a complete rundown of how health care-related legislation fared, see Georgia Health News’s recap.

Legislation that could impact Medicaid and PeachCare beneficiaries

The final 2014 budget eliminated proposed rate cuts for health care providers (a 0.74% rate cut had been proposed for non-primary care providers within Medicaid and PeachCare for Kids), eliminated a proposed coding change that would have resulted in cuts for certain providers, and included funds for enrollment growth in Medicaid. This is good news for access to health care services; however, Medicaid, PeachCare, and other public health programs have sustained deep budget cuts in recent years. In future years, if we are to improve the state’s health, additional investments in public health and health care delivery will be needed.
HR 107 would create a joint study committee on Medicaid reform that would study current Medicaid policies and procedures, models in other states, and other aspects of the Medicaid program and report to the General Assembly and the Governor by December 31, 2013 with recommendations. HR 107 passed both the House and the Senate.

SB 62 would create a Federal and State Funded Health Care Financing Programs Overview Committee, a joint committee of the General Assembly. SB 62 has passed both the House and the Senate.

SB 24, which would authorize the Department of Community Health to levy a fee on hospitals to continue drawing down federal funds to support Medicaid and PeachCare for Kids, was passed by both the House and Senate and was signed into law by the Governor back in February. The current hospital fee had been set to expire on June 30, 2013. The renewal of the fee was essential to ensuring Medicaid and PeachCare’s solvency and preserving access to hospital care in Georgia.

Legislation impacting health insurance consumer protections and access to insurance

SB 236 would require insurance companies to send concurrently with any statements sent to consumers that provide notice of premium increases an estimate of the portion of any premium increase that is due to the Affordable Care Act. How this is determined would be left to insurance companies to calculate, and they would not have to disclose their methodology. There would also be no requirement to present information about any other factors leading to premium increases or to notify consumers about available tax credits that may more than offset premium increases or about any cost savings or benefit enhancements they are receiving as a result of the Affordable Care Act. As such, this bill would result in consumers receiving incomplete and potentially misleading information.  SB 236 has passed both the House and the Senate.

HB 198 would require licensing, certification, and training for health benefit exchange navigators and would restrict their ability to assist consumers. While ensuring that consumers receive accurate information from navigators about their health insurance options and protecting consumers is an important goal shared by Georgians for a Healthy Future, HB 198’s restrictive language and potentially duplicative training requirements could deter community-focused nonprofits, whose participation in the navigator program will be essential in reaching vulnerable populations who have historically faced barriers to enrolling in health insurance, from becoming navigators or from providing appropriate consumer assistance. Georgians for a Healthy Future looks forward to working with policymakers to ensure this bill is implemented in a manner that minimizes duplication and encourages participation from community-focused nonprofit organizations. HB 198 has passed both the House and the Senate.

HB 389 would allow insurance companies to terminate, cancel, or non-renew conversion policies or any health insurance policies offered through the health insurance assignment system when guaranteed issue becomes available (with a 90-day cancellation period and a 90-day open enrollment period into new health insurance options made available through the Affordable Care Act). HB 389 has passed both the House and the Senate.

Commission on mandated health benefits holds its first meeting

The Commission on Mandated Health Benefits, created through legislation passed in 2011 to advise the governor and the General Assembly on the social and financial impact of current and proposed mandated benefits and providers, held its first meeting on March 12^th. The meeting was largely an organizational one, but members also discussed how the commission’s work might intersect with aspects of the Affordable Care Act such as essential health benefits and the bills before the General Assembly that would require insurance companies to cover autism, child hearing aids, and medical foods. The next meeting date has not yet been announced. To read the minutes from the March 12th meeting, click here.

Georgians for a Healthy Future ED appointed to the Georgia Health Information Network board of directors

Cindy Zeldin, Georgians for a Healthy Future’s Executive Director, has been appointed to the Georgia Health Information Network board of directors to represent the health care consumer perspective. The Georgia Health Information Network serves with the Georgia Department of Community Health and the Georgia Health Information Technology Regional Extension Center in a public-private collaborative to establish Georgia’s statewide health information exchange, which will eventually connect hospitals, labs, clinicians, regional HIEs, and other health care stakeholders.

THE UNINSURED IN GEORGIA

 Grassroots support grows for expanding Medicaid in Georgia

The Cover Georgia coalition, a group of more than 60 organizations advocating for the Medicaid expansion in Georgia, has collected nearly 1500 signatures on its online petition and distributed approximately 2000 postcards garnering messages about why expanding Medicaid is important to individuals, families, and communities.

But we’re just getting started—please help us spread the word about the importance of expanding coverage for approximately 650,000 Georgians.  Sign the petition and share it with your networks.  Explain what coverage means for nearly 2 million uninsured Georgians.  Explain the economic impact that an influx of $40.5 billion in federal dollars will have on our state over a decade.  Help us make the case that Georgia should implement the Medicaid expansion.  Help us #CoverGeorgia today.  For more specifics on how the expansion would affect our state, click here.

UPCOMING AND RECENT EVENTS

Join us for a webinar and in-person meeting about ACA Navigators April 10 and 11

If you or your organization are interested in applying for the upcoming funding opportunity provided through the Department of Health and Human Services (HHS) for navigator grants or you would like to connect with other organizations who will be applying, please join Georgians for a Healthy Future, Seedco, Families USA and Enroll America for an important webinar on April 10th, 2013 at 11am and an in-person meeting on April 11th, 2013 from 2:30 to 4:30pm at the Philip Rush Center (1530 DeKalb Ave).

In the next few days, HHS is planning to announce funding that will be available to organizations for outreach and assistance to help individuals and small employers enroll in health coverage. These grants are created as part of the navigator program that was established by the Affordable Care Act.  To learn more about navigators, click here. 

To join us for the webinar, please click here to RSVP.  To join us for the in-person meeting to further discuss this funding opportunity and opportunities for collaboration on outreach and enrollment, click here.

LGBT health care town hall

Join Georgia Equality and Georgians for a Healthy Future to learn more about the specifics of what health care reform means for Georgia’s LGBT community. On Wednesday April 17^th from 6:00 – 7:30, we will host a public meeting at the Phillip Rush Center, 1530 DeKalb Avenue, Atlanta 30307. We will also be streaming the town hall meeting live for those outside of the Atlanta area who would like to participate.

Starting later this year and continuing throughout 2014, there will be great changes to our health care system and how people are able to access coverage.  While these changes will affect everyone, there are some very specific issues that the LGBT community should be aware of.  The town hall meeting will not only discuss how the Affordable Care Act will change the health care landscape for everyone, but how it will specifically impact LGBT individuals, couples, youth and people living with chronic medical conditions such as HIV/AIDS.

The program is free for participants but we do ask that you RSVP.  Light refreshments will be available.  We hope to see you there on the 17^th.

GAIRS quarterly meeting and training held in Macon

On Wednesday, March 20, GAIRS (Georgia Alliance of Information and Referral Systems) held their quarterly meeting and training in Macon and welcomed Amanda Ptashkin, Georgians for a Healthy Future’s Outreach and Advocacy Director, to educate their members on implementation of the Affordable Care Act.  GAIRS is an organization made up primarily of individuals who work in the field of information and referral/assistance.  The training aimed to prepare members to respond to the hundreds of inquiries received about different services and programs from seniors, caregivers, persons with developmental disabilities, and the general public. Participants in the meeting came eager to learn more about the provisions of the law that affect their patients and to learn more about how individuals will be able to access the new health insurance marketplace (exchange). In the coming months, Georgians for a Healthy Future will continue to share information about the exchange, the role of navigators, and anything else relating to upcoming changes resulting from the ACA that will impact health care consumers. To view Amanda’s presentation, click here. 

CEU Concepts Resource-a-Palooza

On Friday, March 22, CEU Concepts held an all day training session, Resource-a-Palooza, and provided social workers, case managers, discharge planners and other healthcare professionals with an opportunity to expand their knowledge base and have a better understanding of how to access various resources in the community.  Amanda Ptashkin joined participants in the morning to share information about the work of the Cover Georgia coalition and explain how critical the expansion is to the nearly 534,000 Georgians who run the risk of falling into the “coverage gap” if our state does not accept the expansion dollars.  Participants were surprised to learn that if our state does not expand our Medicaid program, individuals between our current eligibility levels and 100% of Federal Poverty Level (FPL), will have no affordable options for coverage and will likely remain uninsured and less likely to access care when it is needed.    Participants at the event shared their patient stories and signed postcards directed at the governor asking him to move forward with the expansion.  If you haven’t signed a postcard, please be sure to sign our petition to the Governor.  To view Amanda’s presentation, click here.

WHAT’S HAPPENING IN GEORGIA

 Legislative Update

The General Assembly has now completed 30 days of its 40-day session. For a bill (except for the state budget) to remain viable, it must pass at least one chamber by the end of Day 30, known as Crossover Day. The Legislature will be in Session for Days 31 through 34 Monday through Thursday of this week. Below is a summary of bills that have passed at least one chamber and that Georgians for a Healthy Future is monitoring, as they could have an impact on Georgia health care consumers if enacted into law.

Legislation impacting health insurance consumer protections and access to insurance

A trio of health insurance related bills are moving through the General Assembly. Consumer health advocates are concerned about these bills because they could restrict information and choices for consumers. 

SB 236 would require insurance companies to indicate on statements sent to consumers that provide notice of premium increases the portion of any premium increase that is due to the Affordable Care Act. How this is determined would be left to insurance companies to calculate, and they would not have to disclose their methodology. There would also be no requirement to present information about any other factors leading to premium increases or to notify consumers about any cost savings or benefit enhancements they are receiving as a result of the Affordable Care Act. As such, this bill would result in consumers receiving incomplete and potentially misleading information.  SB 236 has passed the Senate and is in the House insurance committee.
HB 198 would require licensing, certification, and training for health benefit exchange navigators and would restrict their ability to assist consumers. While ensuring that consumers receive accurate information from navigators about their health insurance options is an important goal, HB 198’s restrictive language and potentially duplicative training requirements could deter community-focused nonprofits, whose participation in the navigator program will be essential in reaching vulnerable populations who have historically faced barriers to enrolling in health insurance, from becoming navigators or from providing appropriate consumer assistance. HB 198 has passed the House and is on the Senate floor today.

HB 389 would allow insurance companies to terminate, cancel, or non-renew conversion policies or any health insurance policies offered through the health insurance assignment system when guaranteed issue becomes available (with a 90-day cancellation period and a 90-day open enrollment period into new health insurance options made available through the Affordable Care Act). HB 389 has passed the House and is in the Senate Insurance committee.

Legislation that could impact Medicaid and PeachCare beneficiaries

HR 107 would create a joint study committee on Medicaid reform that would study current Medicaid policies and procedures, models in other states, and other aspects of the Medicaid program and report to the General Assembly and the Governor by December 31, 2013 with recommendations. HR 107 has passed the House.

SB 62 would create Federal and State Funded Health Care Financing Programs Overview Committee, a joint committee of the General Assembly. SB 62 has passed the Senate.

SB 163 would direct the Department of Community Health to examine and identify options for reforming Medicaid in Georgia, including but not limited to more use of managed care, with the purpose of bringing savings to the state. SB 163 has passed the Senate and is in the House Health and Human Services committee.

Commission on mandated benefits to convene this week

The Commission on mandated health benefits, created by legislation in 2011, is finally set to hold its first meeting tomorrow, March 12^th, at 1:30pm in the Ninth Floor Training Room of the West Tower of the James H. Floyd Building.  The commission is charged with evaluating the social and financial impact of current and proposed benefit mandates. Read the Governor’s announcement about the commission’s first meeting here and to read a recent Georgia Health News article about the commission, click here.

THE UNINSURED IN GEORGIA

Without Medicaid expansion, Georgia will continue to have high numbers of uninsured

Georgians for a Healthy Future is a proud partner in the Cover Georgia coalition. The coalition supports covering Georgia’s uninsured by taking advantage of the resources on the table through the Affordable Care Act to invest in our state’s Medicaid program. Governor Deal has thus far said that he does not support expanding Medicaid in Georgia. However, without the expansion, Georgians will represent an even larger portion of the nation’s uninsured and our state will have fewer resources to invest in our health system as compared to other states.

According to new data from Enroll America, nearly two-thirds of the nation’s uninsured live in 13 states, one of which is Georgia. Of these 13 states, 8 have indicated that thus far that they plan to implement the Medicaid expansion. More than 10 million of the nation’s uninsured live in 10 metropolitan areas, one of which is Atlanta. Of these 10 metropolitan areas, 7 are in states that have indicated they plan to move forward with the Medicaid expansion. There are approximately 1.9 million uninsured Georgians, about 861,000 of whom are located in metropolitan Atlanta.

In recent weeks, several governors have announced support for expanding Medicaid in their states. So far, 24 states and the District of Columbia are planning to participate in the Medicaid expansion, including 8 states with Republican governors. Most recently, Governor Chris Christie of New Jersey and Governor Rick Scott of Florida announced their support for expanding Medicaid in their states. To see a complete chart of where each state stands, click here.

Here are some new resources that you may find helpful in advocating for the Medicaid expansion.  They can also be found on the www.coverga.org website:

• The Economic Impact of Medicaid Expansion in Georgia, William S. Custer, Ph.D., Georgia State University
• Medicaid Expansion Fact Sheet and Postcard, Cover Georgia
• Official Figures Overstate Fiscal Impact of Medicaid Expansion, Georgia Budget & Policy Institute (GBPI)
• The Dollars and Sense of Expanding Medicaid in Georgia: Medicaid Expansion Yields Great Return for Georgia’s Economy, Georgia Budget & Policy Institute (GBPI)
• Six Key Facts: Veterans and Medicaid Expansion In Your State, NHeLP
• The Medicaid Expansion is Good for Business, NHeLP

UPCOMING AND RECENT EVENTS

Save the Date: NHeLP hosting Medicaid expansion webinars

The National Health Law Program (NHeLP) is hosting a series of webinars on the Medicaid expansion focused on five states: Georgia, Kansas, Kentucky, Montana, and West Virginia.

• Medicaid Expansion Messaging and Strategy (201) on Mar 14, 2013 1:00 PM EST: For this webinar they will have a guest from the Herndon Alliance talk us through Medicaid Expansion messaging. The format will include time for you to raise state specific examples to discuss messaging strategies in your states. We will also emphasize: all Medicaid and Med Ex messaging (not just recent surveys), messaging to policy makers, and how to actually get the message out there. It will also be an important chance to strategize about how to pursue Medicaid Expansion in your challenging environments.
• Medicaid Expansion Benefits (301) on Mar 21, 2013 1:00 PM EST: This webinar will cover the complex rules about the services that would be available in the Medicaid Expansion. We’ll discuss the key advocacy opportunities for state advocates to improve coverage.

Medicaid expansion takes center stage at recent events

On February 26th, Georgians for a Healthy Future and Georgia Equality hosted a training and information session for social justice advocates who want to learn more about Medicaid. Entitled “Medicaid Advocacy 101,” presenters talked about the basics of the Medicaid program, how it is funded, and how expansion will benefit Georgia’s uninsured and our state’s economy.  Click here for more pictures from the event.

On February 19th, the Cover Georgia coalition and more than 100 volunteer advocates brought the message about the importance of coverage to their elected officials under the Gold Dome.  Volunteers spoke to their State Representatives and Senators about why Georgia should take advantage of the federal dollars on the table to expand coverage to more than 650,000 uninsured Georgians through Medicaid.  For more pictures, click here and here.

On February 14th, Georgians for a Healthy Future’s Executive Director Cindy Zeldin participated as one of the featured panelists in a forum hosted by the Carter Center: “Improving Access to Mental Health and Addiction Services: Medicaid Expansion and Alternative Approaches – A Public Policy Forum.” Materials from the event are now available, including video highlights from the panel discussion and copies of the speaker presentations.

WHAT’S HAPPENING IN GEORGIA

New report quantifies the economic impact of expanding Medicaid in Georgia

An analysis conducted by Dr. Bill Custer of Georgia State University and released today by the Healthcare Georgia Foundation finds that, if Georgia policymakers choose to accept the $40.5 billion in federal funds available to the state between 2014 and 2023 to expand Medicaid, this infusion of resources would create more than 70,000 jobs statewide, adding an annual $8.2 billion to statewide economic output and generating $276 million in state and local tax revenue annually.

As part of the Affordable Care Act, states can create a new eligibility category for Medicaid for people with incomes up to 138 percent of the federal poverty level, or approximately $15,850 for an individual or $26,950 for a family of three. In Georgia, according to the report, about 694,000 people would gain health coverage under this expansion, mostly childless adults and some parents.

To date, Governor Deal has rejected the offer to expand coverage citing concerns about the cost to the state.  As this new report details, however, expanding Medicaid would be an economic engine for Georgia. Of the more than 70,000 jobs that would be created, just over half would be in the health care sector; however, other industries such as real estate, food services, and wholesale trade businesses would also gain jobs. The report also shows the geographic distribution of jobs created throughout Georgia by state service delivery region. To read the full report, click here.  For AJC coverage of the report, click here.

Legislative Update

The 2013 Legislative Session continues at a swift pace, with legislators in session today for day 17 of the 40-day session (the legislative calendar is available here). Here are some key health care updates:

• Yesterday, the Health Subcommittee of the House Appropriations Committee heard from the Commissioners of the state’s health-related agencies, including the Department of Community Health and the Department of Public Health, about their proposed FY 2014 budgets. Today, the subcommittee will meet again from 2 – 4pm in Room 506 CLOB to take public comment on the proposed budgets. If you would like to comment, you must sign up in advance in Room 245 of the State Capitol. The Georgia Budget & Policy Institute has released an analysis of the 2014 proposed budget for the Department of Community Health, available here.

• SB 24, which would authorize the Department of Community Health to levy a fee on hospitals to continue drawing down federal funds to support Medicaid and PeachCare for Kids, was passed by both the House and Senate and was signed into law by the Governor this morning. The current hospital fee is set to expire on June 30, 2013. The renewal of the fee was essential to ensuring Medicaid and PeachCare’s solvency and preserving access to hospital care in Georgia. To read AJC coverage of the renewal, click here.

• HB 198 would require navigators to be licensed, place certain restrictions on their functions, and would give the Georgia Insurance Commissioner regulatory authority over them. Navigators are organizations or entities that apply for and receive federal grants authorized by the Affordable Care Act to provide individuals and small businesses with impartial information and assistance with enrollment in health coverage in the new health insurance marketplaces, or exchanges. While it is important that navigators are qualified to perform these functions and that there is adequate oversight to protect consumers, consumer advocates are also concerned that overly restricting navigators could have a chilling effect on the community-focused organizations whose participation in the navigator program will be critical in connecting hard-to-reach and vulnerable populations to coverage. Advocates worked with legislators to improve the bill, which passed the House Insurance Committee last week and was passed by the Rules Committee yesterday. To read a recent AJC article on this issue, click here.

Advocates Will Convene at the Capitol on 2/19/13 to Highlight Importance of Coverage

Georgians for a Healthy Future and the Cover Georgia coalition will be heading to the State Capitol on Tuesday, February 19th from 9am to 1pm to advocate for covering Georgia’s uninsured through an expansion of the Medicaid program.  For more details about the event and to RSVP, click here.

With one in five Georgians currently uninsured, many Georgians have no access to health insurance coverage.  The Affordable Care Act gives us the option of accepting federal dollars to expand coverage to low income adults who make up to 138% of the federal poverty level, approximately $15,400 a year in 2012. This would allow about 600,000 Georgians to gain health coverage.

Our state policymakers need to hear from health care consumers, patients, providers, and stakeholders about how important this issue is to them. We need your voice! Please join us at the Capitol on the 19th!

EVENTS AND ANNOUNCEMENTS

Carter Center Hosting Event on the ACA’s Impact on Access to Mental Health Services in Georgia 2/14/13

The Carter Center, in partnership with the Georgia Association of Community Service Boards, and the Georgia Association for Primary Health Care, is hosting a nonpartisan public policy forum on the Affordable Care Act’s impact on Georgia’s efforts to improve and expand access to mental health and substance abuse services on Feb. 14, 2013, from 2-4:30 p.m. in the Carter Center’s Ivan Allen III Pavilion.  The event will include opening remarks from the Department of Behavioral Health and Developmental Disabilities Commissioner Frank Berry, Healthcare Georgia Foundation President Gary Nelson and a panel discussion to include:

• Cindy Zeldin, executive director of Georgians for a Healthy Future
• Tim Sweeney, director of Health Policy at the Georgia Budget and Policy Institute
• Ron Bachman, president and CEO of Healthcare Visions Inc.
• Frank Bonati, executive director, Gateway Behavioral Health

To register for the event, email CarterCenterMHP@gmail.com.  For more information about the event, click here.

Medicaid 101: An Advocate Training 2/26/13

Expanding Medicaid is one of the most important steps that the State of Georgia could take to help low income people and families in Georgia. In order to convince policymakers, it will take the combined efforts of all advocacy organizations who care about social justice and equity.

Join Georgia Equality, Georgians for a Healthy Future, and the Cover Georgia coalition for a training for advocates on  Tuesday, February 26th, 6:00 pm – 7:30 pm at the Phillip Rush Center (1530 DeKalb Avenue).

There is no cost to attend but registration is requested. Space is limited so please register today.

WHAT’S HAPPENING IN GEORGIA

The 2013 Legislative Session: budget hearings held, hospital tax renewal moving through the House of Representatives

Last week, state agency heads presented Governor Deal’s proposed budgets for their respective agencies to the House and Senate Appropriations committees.

Access to care: the good news
Primary care providers will receive an increase in Medicaid reimbursement rates to parity with Medicare rates, funded entirely with federal dollars made available to Georgia through the Affordable Care Act. This can help preserve and strengthen access to care for Medicaid patients seeking primary care and prevention services.

Access to care: the bad news
The Department of Community Health’s proposed budget would reduce provider reimbursement rates within Medicaid by .74 percent for providers other than hospitals, primary care, FQHC, RHC, and hospice providers. This proposed rate cut, if implemented, could jeopardize access to care for Medicaid patients who require services such as dental care, obstetrics and gynecology, and oncology, among other non-primary care services.

The Department of Community Health’s proposed budget can be found here. Please contact your legislators and ask them to preserve access to care by restoring these important funds in the state budget.

Hospital fee renewal moves through the Legislature
SB 24, which would authorize the Department of Community Health to levy a fee on hospitals to continue drawing down federal funds to support Medicaid and PeachCare for Kids, has passed the State Senate and will be before the House of Representatives for a vote today. The current hospital fee is set to expire on June 30, 2013. The renewal of the fee is essential to ensuring Medicaid and PeachCare’s solvency and preserving access to hospital care in Georgia.

EVENTS AND ANNOUNCEMENTS

Hot off the press: A Consumer Health Advocate’s Guide to the 2013 Georgia Legislative Session

Each year, Georgians for a Healthy Future releases A Consumer Health Advocate’s Guide to the Georgia Legislative Session to provide you with the information and tools you need to take action on the health care issues you care about. Our 2013 guide is now available and features an overview of the legislative process in Georgia; contact information for all state legislators; descriptions and listings for each legislative committee with jurisdiction over health care issues; contact information for state agencies and officials; contact information for health care organizations and associations active in Georgia; key media contacts; and tools and strategies for effective consumer health advocacy. You may download the guide here or request hard copies of the guide by e-mailing Georgians for a Healthy Future’s Outreach & Advocacy Director here.

Advocating for Coverage for Georgia’s Uninsured: Join us at the Capitol on 2/19/13

Please join Georgians for a Healthy Future and the Cover Georgia coalition at the State Capitol on Tuesday, February 19th from 9am to 1pm as we advocate for covering Georgia’s uninsured through an expansion of the Medicaid program.  For more details about the event and to RSVP, click here.  Help us Cover Georgia.

One in five Georgians is currently uninsured.  That translates to close to 2 million people in our state with no access to health insurance coverage.  Under the Affordable Care Act, states have the option of accepting federal dollars to expand coverage to low income adults who make up to 138% of the federal poverty level, approximately $15,400 a year in 2012. This would allow about 600,000 Georgians to gain health coverage.

This is an unprecedented opportunity to drastically reduce the number of uninsured Georgians while also bringing in federal dollars to help our health care infrastructure and local economies.  Despite the tools and resources available to Georgia, our state’s leadership is rejecting the federal funds. Our state policymakers need to hear from health care consumers, patients, providers, and stakeholders about how important this issue is to them. We need your voice! Visit www.coverga.org for more information on this issue.

Georgians for a Healthy Future welcomes new board members

Georgians for a Healthy Future is proud to welcome four new board members, all of whom joined the Board of Directors this month after being elected in December. These new board members are:

Allyson Burroughs, Vice President, Marketing, Xerox State Healthcare LLC

Iris Feinberg, Doctoral Candidate in Health Literacy, Georgia State University

Doug Skelton, Vice Chancellor for Academic Affairs and Dean, Trinity School of Medicine

Marci Thomas, Principal and Director of Quality Control, Metcalf-Davis

We also recognize the service of Patricia Nobbie, Scott Mathews, and Robert Bush, all of whom left the Board of Directors at the end of 2012 after years of dedication to the mission of Georgians for a Healthy Future. Full bios for all Georgians for a Healthy Future board members can be found here.

Georgians for a Healthy Future Presents at National Health Advocacy Conference in Washington DC

On Thursday, January 31st, Georgians for a Healthy Future’s Outreach and Advocacy Director Amanda Ptashkin presented at the Families USA Health Action 2013 Conference–an annual gathering of state advocates, national advocacy organizations, and health care and policy professionals that takes place in Washington DC every January. Speaking on a panel entitled “Getting to Yes on the Medicaid Expansion,” Amanda shared her thoughts on our state’s approach to health reform implementation as well as the work of the Cover Georgia coalition, aimed at getting our state to accept the federal dollars to expand coverage for thousands of Georgians.  To view her presentation, click here.   The conference goes on until Saturday, February 2nd, and includes advocates from around the country sharing their health care obstacles and successes.  Follow the conversation on twitter, #ha2013, and learn about the great work taking place across the country.

THE UNINSURED IN GEORGIA

Please voice your support for covering Georgia’s uninsured by expanding Medicaid

Nearly two million Georgians have no health insurance at all, among the highest in the nation. This problem has long been recognized 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. Georgia has the ability to comprehensively address this problem thanks to approximately $33 billion in new federal funding over 10 years to cover low-income uninsured Georgians through Medicaid. As these dollars filter through Georgia’s economy, they will have an estimated economic impact of $72 billion.

But Governor Deal is still saying no to the Medicaid expansion, even as other states across the country are saying yes and even though Georgia would be responsible for zero cents on the dollar for the first three years and no more than ten cents on the dollar thereafter. Georgia cannot afford to maintain the status quo while other states invest heavily in their health systems with federal tax dollars paid by Georgians.

Last week, Georgians for a Healthy Future and more than forty organizations joined together to launch the Cover Georgia campaign in support of the Medicaid expansion, but policymakers also need to hear from their constituents. Here is what you can do:

1. Please take five minutes to call Governor Deal at 404-656-1776 and ask him to support expanding Medicaid in Georgia to people with incomes up to 133 percent of the federal poverty level.
2. Please visit www.coverga.org to learn more about Medicaid and sign the petition in support of the Medicaid expansion.
3. Find out who your legislators are here and ask them to support expanding Medicaid.
4. Please share this information with your friends and neighbors and ask them to join you in supporting the Medicaid expansion by contacting their elected officials and signing the petition.

WHAT’S HAPPENING IN GEORGIA

The 2013 Georgia Legislative Session is underway

It was a busy first week at the State Capitol, as the Senate passed legislation (SB 24) authorizing the Department of Community Health to assess a fee on hospitals to secure federal matching funds for the state’s Medicaid program. Without the assessment, the Medicaid program faces a budget shortfall.  SB 24 now moves to the House.

The Legislature will not officially be in Session next week but the House and Senate Appropriations Committees will hear from state agencies about their budget proposals. The health-related agencies will make presentations on Thursday morning in Room 341 of the State Capitol. These presentations are open to the public. The Department of Community Health’s presentation is scheduled for 10:15am and the Department of Public Health is at 11:15am on January 24th.

Open enrollment for child only policies

Thanks to the enactment of HB 1166, child only policies are once again available in the individual health insurance marketplace in Georgia. However, there is a short open enrollment period to sign up (January 1 – 31st of this year). To learn more, click here or contact the Georgia Department of Insurance at 800-656-2298.

EVENTS AND ANNOUNCEMENTS

Georgians for a Healthy Future’s 2013 Policy Priorities

Each year, Georgians for a Healthy Future develops policy priorities that guide our advocacy work on behalf of health care consumers. In 2013, we have identified six priority areas that, if implemented, would extend health care coverage to more Georgians, improve access to care, and make Georgia a healthier state. These priorities were developed with input from community partners and stakeholders and we hope you’ll join us in advocating for them this year:

• Extend health insurance coverage to a substantial portion of Georgia’s uninsured by expanding Medicaid
• Preserve and strengthen consumer protections for Georgians in private health insurance plans through both federal and state advocacy
• Ensure access to quality health care for Medicaid and PeachCare beneficiaries
• Strengthen Georgia’s public health system
• Increase the tobacco tax; and
• Support policies and practices that advance health equity.

To learn more about our priorities, click here.

Thank you for making Health Care Unscrambled a success!

More than 200 health care consumer and patient advocates, stakeholders, and providers came out on the morning of January 10th for Georgians for a Healthy Future’s third annual Health Care Unscrambled policy breakfast event. Jonathan Cohn of The New Republic, one of the nation’s leading health and social policy writers, shared his insights about health reform and we heard from Georgia policymakers about what’s on their minds for 2013. Pictures from the event can be found here.

THE UNINSURED IN GEORGIA

Mapping Georgia’s Uninsured

Approximately 1.9 million Georgians are uninsured, among the highest in the nation. Our new interactive resource, Mapping Georgia’s Uninsured, visually displays detailed information on Georgia’s uninsured population by age, income, and region. Click on the shaded regions within each map to see the total number of uninsured by age and income, uninsured rate, and the number of Georgians who would potentially be eligible for Medicaid within each region if Georgia policymakers chose to expand the program. This mapping resource is part of our Cover Georgia initiative to educate policymakers and the public about Georgia’s uninsured, the benefits of coverage, and the opportunity the Medicaid expansion presents for Georgia patients, consumers, providers, and the state’s economy. To view the interactive maps, click here.

Explaining the Coverage Gap

Georgians for a Healthy Future is spearheading Cover Georgia, a new coalition in support of expanding Medicaid in our state to cover the uninsured.  As part of this on-going effort, each edition of the Peach Pulse will explore what is at stake for Georgia families and consumers as policymakers weigh this option in the coming months.

In 2014, Georgia consumers with incomes between 100% and 400% of the federal poverty level (FPL), or roughly between $11,170 and $44,680 for an individual, will be eligible for tax credits to purchase health insurance through the new federally facilitated health insurance exchange. Adults with incomes below 100% FPL, however, will not be eligible for these tax credits. This is because the Affordable Care Act envisions individuals with incomes this low becoming eligible for Medicaid through an expansion of that program. If Georgia fails to adopt this expansion, this would create a “coverage gap,” leaving many Georgians with no options for affordable health coverage. This infographic helps explain how this would play out for two Georgians: Jan would make too much money to be eligible for Medicaid but would not make enough to access tax credits to purchase affordable private health insurance (a typical health insurance policy would consume nearly her entire income).  Meanwhile, John would be able to purchase insurance in the exchange with a tax credit, making health insurance reasonable for his budget.  This is simply not fair. All Georgians should have a pathway to affordable health care coverage. To learn more about Cover Georgia and to join our efforts, click here.

HEALTH REFORM UPDATE

Essential Health Benefits: HHS Issues Proposed Rule

As part of the Affordable Care Act, beginning in 2014 all new individual and small group health insurance plans must cover a core set of health care services and items across ten broad categories including hospitalization, prescription drugs, maternity and newborn care, and preventive services, among others. This core set of services and items is known as Essential Health Benefits. The benefits that health plans are currently required to cover vary by state. To ease the transition to essential health benefits in 2014, the U.S. Department of Health and Human Services (HHS) set out a process for each state to select a benchmark health insurance plan (which would include all benefits currently mandated in that state) that would then be supplemented to fill in any gaps and ensure health benefits across all ten categories are covered.  Last week, HHS issued a proposed rule outlining each state’s benchmark plan.  HHS is accepting public comment on all states’ proposed benchmark plans, including Georgia’s benchmark, until December 26th, 2012 (instructions for how to comment are included within the proposed rule). You can view the proposed benchmark plan for Georgia here. For additional information about the Essential Health Benefits process, see a recent Health Affairs article here. For additional information through a Georgia lens, see a recent Georgia Health News story on Essential Health Benefits here.

Governor Deal opts not to build health exchange, defaulting to federal exchange

On November 16th, Governor Deal announced that Georgia would not move forward with a state-based health insurance exchange. Instead, Georgia will have, by default, a federally facilitated exchange. While a state-based exchange would have been more easily tailored for Georgia and could have been more responsive to the needs of Georgia’s health care consumers, a federally facilitated exchange will still provide information, decision tools, and access to tax credits to help consumers find and purchase meaningful and affordable health insurance.

As the federal exchange gets built out, it will be important that federal officials consider the needs of consumers in states like Georgia. To that end, Georgians for a Healthy Future joined with consumer advocates in states across the country to submit a letter to the U.S. Department of Health and Human Services recommending that federal officials create a robust stakeholder planning process, ensure in-person consumer assistance programs meet consumers’ needs, and ensure that qualified health plans available on the exchange protect consumers and meet their needs. You can learn more about health insurance exchanges in Georgia by visiting Georgians for a Healthy Future’s health insurance exchange resource page here. We look forward to working with policymakers to ensure that the federally facilitated exchange is successful in Georgia and that consumers have better access to meaningful and comprehensive health coverage for themselves and their families.

EVENTS AND ANNOUNCEMENTS

Show Your Support for Georgians for a Healthy Future on Georgia Gives Day
We are excited to announce that Georgians for a Healthy Future is taking part in Georgia Gives Day, a 24-hour, statewide giving event organized by the Georgia Center for Nonprofits. On December 6^th, Georgia Gives Day encourages individuals to take a minute and realize how interwoven non-profits are in their lives and to feel inspired to give to their favorite non-profits through www.gagivesday.org.

At Georgians for a Healthy Future, we strive to provide a strong voice for Georgia consumers and communities on the health care issues and decisions that impact their lives. We hope you think we’re doing a good job! We would love your show of support on Georgia Gives Day.  How has GHF impacted you? Your work? Your interaction with the health care system? If we’ve had any impact on you, we hope you’ll consider supporting us so that we can continue to do this important work.  We are committed to working towards a day when all Georgians have access to quality, affordable health care and we need your help to do it.

For those “Super-GHF” fans (we think there are some of you out there), why not help us spread the word? Share our message with your friends and family. Post on Facebook and Twitter. Help us make the most out of Georgia Gives Day!

Health Care Unscrambled: A Look Ahead to the 2013 Legislative Session

Georgians for a Healthy Future is excited to announce that Jonathan Cohn of The New Republic will be the keynote speaker for our third annual Health Care Unscrambled policy breakfast on January 10, 2013! We hope you’ll join us for this important event that brings together health care consumer advocates, stakeholders, and policymakers for a look ahead to the biggest health policy issues facing Georgia in the coming year.

Jonathan covers domestic policy and politics for The New Republic, with a particular emphasis on social welfare, labor, and health care. He is also the author of Sick: The Untold Story of America’s Health Care Crisis—and the People Who Pay the Price.  Jonathan has been recognized in the pages of the Washington Post as “one of the nation’s leading experts on health care policy” and in the New York Times as “one of the best health care writers out there.” An item from Time suggested he “may be the smartest, most well-sourced health care writer in the country.”

We are thrilled that Jonathan will be joining us for our signature policy event and we hope that you will too.  Sponsorship opportunities are still available.  Click here for more information about sponsorships.  Click here to purchase tickets to the event.   We hope to see you on January 10^th!

Georgians for a Healthy Future’s Executive Director named a consumer representative to the NAIC again for 2013

Georgians for a Healthy Future’s Executive Director Cindy Zeldin was named a consumer representative to the National Association of Insurance Commissioners (NAIC) again for 2013. The program provides a structured way for health care consumer and patient advocates from around the country to provide input from the consumer perspective. Having representation from Georgia’s health advocacy community in this program helps to ensure the voices of health care consumers in Georgia are heard as important decisions about health insurance and consumer protections are made. Through the NAIC, state insurance regulators establish standards and best practices, conduct peer review, and coordinate their regulatory oversight. The work of the NAIC is particularly timely and important this year because they are developing model rules and regulations for implementation of the private health insurance reforms associated with the Affordable Care Act. To that end, earlier this year the NAIC consumer representatives collaboratively released “Implementing the Affordable Care Act’s Insurance Reforms: Consumer Recommendations for Regulators and Lawmakers,” available for download here. To view the NAIC press release announcing the 2013 consumer representatives, click here.

Georgia expected to spar over Medicaid expansion in election aftermath
The Augusta Chronicle  | November 8, 2012

Big healthcare decisions loom for state in election’s wake
Atlanta Journal-Constitution  | November 7, 2012

Deal: No state exchange likely under Obamacare
11 Alive News  | November 8, 2012

Deal suggests Ga. unlikely to run health exchange
Columbus Ledger-Enquirer  | November 7, 2012

Health care law lives — and Ga. faces big choices
Georgia Health News  | November 7, 2012

Perhaps the biggest issue for Georgia’s policymakers to consider in the coming months is the Medicaid expansion. Leveraging the resources on the table to expand Medicaid will improve access to care, strengthen our state’s health care delivery system, and bolster Georgia’s economy. If your organization would like to join the Cover Georgia coalition in support of expanding Medicaid, email Georgians for a Healthy Future’s Outreach and Advocacy Director Amanda Ptashkin.

Happy Halloween! We all know ghosts, goblins and skeletons are scary. What is far scarier, however, is being uninsured. Yet nearly 1.9 million Georgians are without any health insurance coverage at all, among the highest in the nation. This tragic reality means that one in five Georgians struggle to access medical care when they need it and suffer poorer health outcomes as a result. It’s time to Cover Georgia by implementing the Medicaid expansion.

Earlier this month, Georgians for a Healthy Future’s Executive Director Cindy Zeldin joined the Georgia Budget & Policy Institute’s Director of Health Policy Tim Sweeney for a panel discussion with nationally renowned researchers Dr. Benjamin Sommers and Dr. Heidi Allen at GBPI’s Fall Policy Forum.  Dr. Sommers and Dr. Allen presented their respective findings on the impact of expanding Medicaid on access to care and health outcomes. In sum, their research showed 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. 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. Additionally, Dr. Sommers research suggests that expanding Medicaid here in Georgia would save approximately 3,600 lives a year.  To view Dr. Sommers’ presentation, click here.  To view Dr. Allen’s presentation, click here.

Over the upcoming months, advocates, health care consumers, providers and industry stakeholders will be banding together to convince our elected officials that the Medicaid expansion is the right decision for Georgia.  To join our efforts to Cover Georgia, email Amanda Ptashkin.

Update on child-only policies

Earlier this year, Governor Deal signed into law House Bill 1166 to restore child-only health insurance plans to the Georgia marketplace. The legislation was sponsored by Representative Atwood and supported by a broad coalition of consumer health advocates, including Georgians for a Healthy Future, health care industry stakeholders, and legislators. The law goes into effect on January 1, 2013, and will make stand-alone insurance policies for children available through an open enrollment period in January or in the event of a qualifying event throughout the year. The Georgia Department of Insurance is currently preparing the draft regulation, after which there will be a public comment period with the final regulation expected in December.

Several states around the country have taken similar action to make these plans available for children, and earlier this month the Commonwealth Fund issued a report examining legislative and regulatory efforts around the country during 2010 and 2011 and found that, in states that had taken action during those years, child-only coverage is now available in nearly all of those states. Since Georgia’s legislation was passed in 2012 and has not yet gone into effect it was not included in the analysis; however, the authors interviewed officials and advocates in Georgia and noted that legislation had been signed into law in 2012. Kaiser Health News also reported on the story last week. That article is available here. The study is available here.

Health exchange deadline looms

Health exchanges are a central feature of the Affordable Care Act and are intended to provide meaningful and affordable health insurance options for individuals and families who don’t have access to health insurance at work. The exchange, or marketplace, will be a place where consumers can shop for private health insurance plans utilizing decision tools and accessing tax credits to make the plans affordable. By 2014, these marketplaces will be up and running in every state, with some states operating their own exchange marketplaces, some states partnering with the U.S. Department of Health and Human Services on a “state partnership exchange,” and some states deferring to a federally facilitated exchange.

States planning to move forward with their own state-based exchanges must submit a blueprint by November 16th of this year.  Georgia is not expected to be ready for a state-based exchange, as reported in the Atlanta Journal Constitution last week, and thus a default to a federally facilitated exchange is likely in Georgia.

Ensuring that a health insurance exchange works for Georgia consumers is a key priority for Georgians for a Healthy Future, whether it is a state-based exchange, partnership exchange, or federally facilitated exchange. Regardless of who is administering the exchange on the back end, we must make sure it works for consumers on the front end. To that end, Georgians for a Healthy Future remains engaged in this important issue on behalf of health care consumers. Our Executive Director served on the Governor’s Health Insurance Advisory Committee in 2011, which studied options for Georgia, and submitted a minority report advocating for Georgia to move forward with planning for a state-based exchange despite the full committee’s recommendations against doing so.  Georgians for a Healthy Future also released a well-received policy brief in August 2011 making policy recommendations for a Georgia exchange and our staff and coalition partners have been active in discussions with federal officials, along with consumer health advocates from around the country, about how to make sure federally facilitated exchanges are responsive to the needs of consumers within the states.

More information about the exchange blueprint submission process is available here; a summary of Georgia’s status on exchange planning is available here; and all archived materials from Governor Deal’s health insurance exchange advisory committee are available here.

Keeping Treatment in Reach

Georgians for a Healthy Future is a proud partner in the Specialty Tiers Coalition of Georgia, a group of consumer and patient advocates committed to ensuring affordable access to medications for patients with rare, chronic conditions. Earlier this month, the coalition hosted an educational forum at Emory University in Atlanta to raise awareness among policymakers and consumers about the growing trend of specialty tiers and the related risks to patients and consumers.

Specialty drugs are typically breakthrough prescription drugs that are used to treat complex, chronic health conditions such as cancer, multiple sclerosis, rheumatoid arthritis, hemophilia, and HIV/AIDS. Traditionally, insurance plans cover prescription drugs on a 3-tiered drug formulary (Tier One: generic drugs; a typical co-pay is around $10; Tier Two: preferred brand name drugs; a typical co-pay is around $30; Tier Three: non-preferred brand drugs; a typical co-pay is around $50). Specialty tiers, also known as Tier IV, V, or VI, add an additional structure for specialty medications — cost sharing known as “co-insurance” — where the patient pays 20-35% of the cost of the medication, rather than a fixed, predictable co-payment.  Unfortunately, there is no limit on what a beneficiary may be required to pay for therapies relegated to specialty tiers.

The trend towards specialty tiers shifts costs to patients and places needed treatment out of reach for too many patients who are paying health insurance premiums to get the medical care they need.  Specialty tiers can result in drug costs well into the thousands of dollars per month for patients, increasing the likelihood that patients will go without needed treatment. In fact, a recent study found that one in four patients with an out-of-pocket prescription cost of $500 or more failed to fill their prescriptions. This indicates patients with insurance are having to choose between needed medications and everyday living expenses.

The Specialty Tiers Coalition will be active in the upcoming 2013 Legislative Session to grow awareness about this issue, and advocate for patient protections. Georgians for a Healthy Future and the coalition are currently serving as a community partner to the Health Legislation & Advocacy course at Georgia State University’s College of Law. Through this partnership, law students are providing research assistance and helping craft potential legislation to ensure adequate patient protections.

To read coverage of the October 10^th forum at Emory University, click here and here. To download a fact sheet on this issue from a coalition leader, Advocates for Responsible Care, click here.

Managed Care for Foster Care Kids 

Back in July, the Department of Community Health (DCH), decided to postpone plans to undergo a full-scale redesign of Georgia’s Medicaid and PeachCare programs.  Instead, DCH decided to focus on a few particular pieces of the current system and work to improve them–focusing on foster kids was one such designated area.  Over the last several months, DCH has continued to engage the Children and Families Task Force that was created at the beginning of the redesign process and has asked for task force members to provide input on the Department’s plans to manage care for our foster care populations.  While DCH anticpate that the new plan will go live until January 2014, a lot of work is being done behind the scenes to ensure that the transition for those children is seamless and that their care can be properly managed moving forward.  To view the presentation from the Children and Families task force meeting last week, click here and here.

Upcoming Events

Health Care + Substance Abuse Webinar: November 8th 12pm-1pm: There are many provisions in the ACA that impact people needing services for substance use disorders. This is a critical time in Georgia for families of and people suffering from addiction.  The Affordable Care Act will, for the first time:

• require insurers to cover treatment for drug and alcohol addiction the same way they cover other chronic illnesses (think, diabetes and hypertension.
• could bring 650,000 to 900,000 currently-uninsured Georgians into the expanded Medicaid program.

If you are still wondering about how the ACA impacts you or those you work with, join GHF and the Georgia Council on Substance Abuse for a one-hour webinar on substance use disorder policy in Georgia and what the ACA and Medicaid expansion mean for those suffering from or serving people with substance use disorder.  To RSVP, click here.
The Georgia Supportive Housing Association Annual Conference: November 13:  The conference will explore the role that housing must play if the state is to succeed in reforming the criminal justice system, the healthcare system, and the mental health system.  If people with health needs are going to live outside expensive institutions they must have affordable housing in the community that connects them to the health services they need. The Conference will explore policies that can help expand the state’s capacity to serve people with supportive housing. Supportive housing works but production and finance are laging behind need. To register for the annual conference, click here.

Shine a Light on Lung Cancer Vigil: November 13th 6:30pm
On November 13, 2012 at The SunTrust Club at Turner Field (behind homeplate) at 6:30pm, join the Lung Cancer Alliance as they will ease the burden of all those impacted by lung cancer and connect the community in a national call to action. The Atlanta, GA Vigil will provide hope and compassion and empower attendees to join the historic movement to reduce lung cancer mortality by 50% by 2020.  Speakers include:

• Dr. Bill Mayfield, WellStar, on lung cancer screening;
• Dr. Suresh Ramalingam, Emory Healthcare, on current issues in lung cancer
• Comments from lung cancer survivors/caregivers
• Our guest emcees are Elaine Hendrix, TV and movie actor, and Chris Draft, former Atlanta Falcon

On the night of the 13th, they will honor those impacted by lung cancer with a lighting of glow sticks and a reflection on experiences. It is a moving event and not one to be missed.  Registration is free. To register, click here.

Georgians for a Healthy Future’s 3rd Annual Policy Breakfast, Health Care Unscrambled: January 10, 2013 7:30am to 10:30am: Please join us for the third annual Health Care Unscrambled policy breakfast event, where health care consumer and patient advocates, health care experts and stakeholders, and policymakers come together for an energizing look ahead at the top health issues facing our state as the 2013 Legislative Session gets underway.  Sponsorship opportunities at a range of levels are available to help support this important event, and tickets are also available for purchase here.

Medicaid Expansion and Cover Georgia

Update on Essential Health Benefits (EHB)

Upcoming Events

An opportunity to cover Georgians and improve access to care

Special Medicaid Redesign Edition

This morning the Department of Community Health announced its plans for moving forward with changes to our Medicaid and PeachCare for Kids systems.  Over the last several months, DCH along with consulting firm Navigant have been convening task forces and work groups to work through recommendations and innovations to our current delivery system.  This redeisgn process is seperate but parallel from the conversations currently taking place regarding whether or not to move forward with the Affordable Care Act’s Medicaid expansion provisions but ultimately will impact our overall Medicaid delivery system.  In their press release, DCH said:

Special Post SCOTUS Edition

Last week, 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.

The Medicaid Expansion
The Affordable Care Act (ACA) expands the Medicaid program by creating a new eligibility category for people with incomes at or below 133% of the federal poverty level (approximately $14,856 for a single adult or $25,389 in annual income for a family of 3). While the ACA, as written, made this expansion mandatory for states, the Supreme Court ruled that it was effectively optional for states. Because a large portion of Georgia’s uninsured population stands to gain coverage only if Georgia moves forward with the Medicaid expansion, it is critically important that state policymakers implement this piece of the law. Here is what you need to know about the Medicaid expansion:

• If the state does not expand Medicaid, approximately 684,000 Georgians who would have gained coverage through the Medicaid expansion would likely remain uninsured.

• The Medicaid expansion is financed entirely with federal dollars in the first three years and 90 percent federal dollars thereafter. This means that, for every ten dollars Georgia invests in Medicaid, the state will draw down ninety dollars in federal funds, a major infusion of resources into the state’s health care delivery system.

• The Affordable Care Act provides substantial tax credits for people with incomes between 100% of the federal poverty level and 400% of the federal poverty level to help purchase private health insurance. Because the law envisioned people with incomes below 100% of the federal poverty level obtaining health care coverage through Medicaid, these low-income Georgians will not be eligible for tax credits and will be without any affordable options for health insurance unless the Medicaid expansion is implemented.

Georgia policymakers have an unprecedented opportunity to improve the health of Georgia consumers and communities, address the state’s high number of uninsured, 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.

Health Insurance Exchanges
The Affordable Care Act (ACA) authorizes state-level health insurance exchanges for individual consumers and for small businesses. States can choose to design and implement their own exchanges within the basic framework outlined by the ACA or they can opt for a federally facilitated exchange. Governor Deal and key legislators have not yet announced a decision on which route Georgia will take.

Below is a summary of Georgia’s work and progress to date on making this choice:

• In June 2011, Governor Deal issued an executive order establishing an advisory committee to study the issue and report back at the end of 2011. The committee’s final report did not recommend moving forward at that time with a state-based exchange due to uncertainty pending the Supreme Court decision.

• The Governor’s Health Insurance Exchange Advisory Committee did, however, conduct considerable research on the issue. All materials from the committee’s work are housed here.

• At the federal level, the U.S. Department of Health and Human Services recently announced a new round of funding opportunities for states and has released considerable guidance for states on exchanges.

A health insurance exchange is an exciting concept for consumers. Put simply, it’s a one-stop shop where consumers can access tools and information to select an insurance plan that best meets their needs and can apply tax credits to ensure that plan is affordable.

Now that the Supreme Court has ruled, it is an ideal time for Georgia policymakers and stakeholders to ramp up planning to ensure Georgia consumers have affordable health insurance options available to them through an exchange by 2014. It is also critical that policymakers weigh consumer input throughout the process to ensure the exchange works for Georgia individuals and families who plan to use it to secure meaningful health coverage.

Georgians for a Healthy Future released an issue brief in August 2011 providing additional information and recommendations around designing a consumer-friendly exchange. Georgians for a Healthy Future’s Executive Director, Cindy Zeldin, also served on the Governor’s Health Insurance Exchange Advisory Committee and submitted a minority report advocating for Georgia to move forward right away in building an exchange. The issue brief is available for download here and the minority report is available for download here.

If you or your organization would like to engage in advocacy on either or both of these issues on behalf of Georgia consumers, please contact Amanda Ptashkin, Georgians for a Healthy Future’s Outreach & Advocacy Director, to get involved.

What’s New in Georgia

Governor Deal Signs Legislation Restoring Child-Only Health Plans

Governor Deal signed HB 1166 (sponsored by Representative Atwood) into law on May 1st. The legislation requires insurance companies who sell policies in the individual health insurance market to also sell child-only plans during an open enrollment period. These plans had previously been available in Georgia, but insurance companies stopped writing new policies in response to a change in federal law that prohibited discrimination against children due to pre-existing conditions. HB 1166 drew widespread support and Georgians for a Healthy Future was proud to be a part of the coalition effort that ensured its passage.

Access to Care a Concern for Georgians

Two recent studies highlight the need for statewide strategies to improve access to care in Georgia. Last week, Kaiser Health News reported that Georgia was one of three states with the greatest increase in the number of people with unmet medical need over the past decade. Back in April, USA Today reported on a study of community health centers that found Georgia was the only state to rank at the bottom on 4 of 6 performance measures.

Insurance Rebates on the Way for Some Georgia Health Care Consumers

A provision of the Affordable Care Act requires health insurance companies in the individual market to spend at least 80 percent of premium dollars on medical care or quality improvement activities (it is 85 percent in the group market). Georgia insurance companies were permitted to phase this requirement in for the individual market over three years (requiring them to spend at least 70 cents on the premium dollar on actual health care in 2011, 75 cents on the dollar in 2012, and 80 cents on the dollar in 2013.) Designed to spur greater transparency, value, and accountability, the provision also requires insurance companies who do not meet this reasonable standard to issue rebates to consumers. As a direct result of this provision, Georgia consumers will receive an estimated $30 million in rebates this year. State-by-state information about anticipated rebates is available here, and a report from Georgia Health News is available here.

Medicaid and PeachCare Redesign Continues

The Department of Community Health (DCH) is continuing its work in redesigning Georgia’s Medicaid and PeachCare programs.  Various taskforces and workgroups have been convening to provide input into the process to ensure that the resulting redesign ensures coverage, access, and quality care to those eligible or enrolled in the programs.  There is still an opportunity to reach out to DCH to share your opinion on the process.  Send an email to MyOpinion@dch.ga.gov and let DCH what you care about when it comes to covering our most vulnerable populations.

Georgians for a Healthy Future is proud to be a part of CARE-M: the Coalition to Assure Redesign Effectiveness for Medicaid.  CARE-M is comprised of several advocate groups across the state that have a vested interest in the ultimate redesign of Georgia’s Medicaid and PeachCare systems.  Many of these groups have been following DCH and Navigant’s progress and have drafted recommendations and policy papers on the topic.  To access these documents, click here. To learn more about our collective efforts, click here.  If you or your organization would like to learn more about the redesign process and would like to request a presentation, email Amanda Ptashkin.

New Changes in Effect for Pre-Existing Condition Insurance Plan (PCIP)

As of May 1, 2012, the Department of Health and Human Services, which administers high-risk insurance pools in twenty-four states including Georgia, reverted to its original requirements. In order to enroll in the program, applicants must submit one of the following pieces of documentation:

• A denial letter from an insurer
• An offer of coverage from an insurer that includes a pre-existing condition clause
• A letter from a broker or agent that states the individual would be denied coverage

Applicants must still be uninsured for six months before enrolling in the PCIP, a provision that has not changed since the program began. The Department will also end the $100 broker referral bonus, which began in spring of 2011, as an incentive to increase enrollment.

As of February 2012, 56,257 people were enrolled in the 24 states that participate in the federal PCIP. In Georgia, 1,707 people have been enrolled since August 2010.

Celebrate National Women’s Health Week

National Women’s Health Week is a week-long health observance coordinated by the U.S. Department of Health and Human Services’ Office on Women’s Health. National Women’s Health Week empowers women to make their health a top priority. It also encourages women to take the following steps to improve their physical and mental health and lower their risks of certain diseases:

• Visit a health care professional to receive regular checkups and preventive screenings.
• Get active.
• Eat healthy.
• Pay attention to mental health, including getting enough sleep and managing stress.
• Avoid unhealthy behaviors, such as smoking and not wearing a seat belt or bicycle helmet.

Representative Pat Gardner sponsored HR 2027 declaring May 13 through May 19, National Women’s Health Week in Georgia. The resolution urges all Georgians to participate in activities that support women’s health awareness and support all local efforts and initiatives to improve awareness of key women’s issues, including women participating on May 14, 2012, in National Women’s Checkup Day, a day on which women across the country are urged to visit their health care professionals.

What’s New in Georgia

Legislative Wrap-Up

The 2012 Legislative Session came to a close on March 29th with mixed results for health advocates.

The good news: Our top legislative priority, restoring child-only plans to the individual health insurance market (HB 1166 sponsored by Representative Atwood), was successfully passed by both the House (by a vote of 161-1) and Senate (by a vote of 42-2). This legislation requires insurance companies who sell policies in the individual health insurance market to also sell child-only plans during an open enrollment period. These plans had previously been available in Georgia, but insurance companies stopped writing new policies in response to a change in federal law that prohibited discrimination against children due to pre-existing conditions. HB 1166 drew widespread support and Georgians for a Healthy Future was proud to be a part of the coalition effort that ensured its passage.

The bad news:  Georgia did not pass health insurance exchange legislation in 2012. While HB 801 and SB 418 were introduced by Representative Gardner and Senator Orrock, respectively, as companion bills to establish a health insurance exchange in Georgia, neither bill received a hearing. All information from the Governor’s Health Insurance Exchange Advisory Committee, which met throughout the second half of 2011 to develop recommendations on this issue and ultimately did not recommend establishing an exchange in 2012, is available here. Georgians for a Healthy Future had been strongly supportive of the exchange concept for Georgia (see our issue brief on this issue here); however, failure to pass legislation in 2012 means that Georgia will not be able to demonstrate readiness for an exchange on the timeline currently outlined by the U.S. Department of Health and Human Services. Georgia consumers will likely have access to a federal exchange beginning in 2014; Georgians for a Healthy Future will continue to monitor exchange developments at the federal and state level.

The rest: Georgians for a Healthy Future works collaboratively with a range of consumer and patient advocacy groups to advance policy priorities around health care coverage, access, quality, and affordability. Several organizations with whom we frequently partner have released excellent legislative summaries featuring health care issues. Here is a sampling:

• Voices for Georgia’s Children reports on legislation that impacted children here.

• The American Cancer Society gives us the lowdown on legislation that impacts access to care through the cancer lens here.

• The Georgia Council on Developmental Disabilities explains legislation that impacts Georgians with developmental disabilities here.

• Georgia Women for a Change fills us in on legislation that impacts women and girls in Georgia here.

• The Georgia Budget and Policy Institute provides its recap here.

Medicaid and PeachCare Redesign Continues

The Department of Community Health (DCH) has been convening taskforces to gather feedback from consumer advocates, providers and other stakeholders on the current state of Medicaid and PeachCare, areas to be improved, gaps, and other barriers. These task forces will continue to meet over the next several months and through the procurement process.  In a recent meeting, DCH officials noted that they have already heard from hundreds of providers, advocates and consumers on their ideas and suggestions for the redesign, but there is still an opportunity to reach out to DCH to share your opinion on the process.  Send an email to MyOpinion@dch.ga.gov and let DCH what you care about when it comes to covering our most vulnerable populations.

Georgians for a Healthy Future is proud to be a part of CARE-M: the Coalition to Assure Redesign Effectiveness for Medicaid.  CARE-M is comprised of several advocate groups across the state that have a vested interest in the ultimate redesign of Georgia’s Medicaid and PeachCare systems.  Many of these groups have been following DCH and Navigant’s progress and have drafted recommendations and policy papers on the topic.  To access these documents, click here. To learn more about our collective efforts, visit www.healthyfuturega.org/issues/careforgeorgiaskids.  If you or your organization would like to learn more about the redesign process and would like to request a presentation, email Amanda Ptashkin.

2nd Anniversary of the Affordable Care Act

March 23, 2012 marked the 2nd anniversary of the passage of the Affordable Care Act.  In the past two years alone, 1500 Georgians with pre-existing conditions have enrolled in the pre-existing condition insurance plan (PCIP); 85,000 Georgian young adults have gained health insurance through dependent care coverage; 106,000 seniors received rebates from the closing of the Medicare donut hole; and 850,000 Georgians accessed free preventive services.  To learn more about how the law has expanded coverage and saved the state money, read the Georgia Budget and Policy Institute’s latest report.

To celebrate these early successes and show support for the law, Georgians for a Healthy Future along with Doctors for America, Health STAT, Votehealthcare.org, and Know Your Care held a rally at the Capitol on March 26–the same day that oral arguments began at the Supreme Court on the constitutionality of the ACA.  After hearing from doctors, advocates, and patients affected by the new law, the crowd then walked in to the Capitol to present the Governor and Attorney General with a petition with close to 1000 signatures showing broad support of the law.  While a Supreme Court decision is not expected until June, thousands of Georgians have already seen the positive impact of the law and this rally urged our state leaders: “Don’t Take Away My ACA!”  To view more pictures from the rally, click here.   To view the ACA video, click here.

GASOPHE Names New Advocacy Chair on Board of Directors

GASOPHE, the Georgia Society for Public Health Education, recently appointed GHF’s Outreach and Advocacy Director, Amanda Ptashkin, to their Board of Directors.  GASOPHE is a professional organization for professional health educators and others in public or community health.  As the new Chair of the Advocacy Committee, Amanda will help advance the organization’s legislative priorities which include: strengthening Georgia’s public health infrastructure; increasing the tobacco tax; and supporting implementation of the Affordable Care Act.

What’s New in Georgia

Georgia Legislative Update

Now that Crossover Day (the 30th day of the 40 day Session and the day by which a bill must pass at least one chamber to remain viable for the Session) has passed, the 2012 Legislative Session enters its final stretch. The legislative calendar is now set through Day 37. Here is what health advocates are watching:

• HB 1166 would restore child-only health insurance policies to Georgia’s individual market. Georgians for a Healthy Future, along with a range of child health advocacy groups, is in strong support of this measure to provide this option for families who need coverage for their kids. The bill passed the House last week and passed through the Senate Insurance and Labor Committee this afternoon. It now heads to the Rules Committee.
• HB 879 would allow non-medical staff to be trained to assist students with diabetes in a school setting when a school nurse is not present. The legislation also allows children, who are able, to manage their own diabetes. This legislation passed the Georgia House of Representatives and will be before the Senate Health and Human Services committee tomorrow.
• SB 471 authorizes an alternative approval process for health insurance policies sold in Georgia and could place hard-fought consumer protections at risk. This bill passed the Senate last week and we will monitor it on the House side.

Several bills that consumer health advocates were supporting did not make the Crossover Day cut:

• HB 1159, sponsored by Representative Pruett, would have created a Joint Study Commission on Education for Parents with Newborn Children to determine how best to gather information, raise funds and create a comprehensive informational video.  The video would include but not be limited to information on the prevention of childhood obesity; how to prevent SIDS, shaken baby syndrome, and other forms of child abuse; how to prevent death and injury and additional information which would assist parents to raise safe and healthy children. HB 1159 passed through the House Health and Human Services Committee but did not make it out of the Rules Committee.
• SB 484 would help fight childhood obesity by encouraging – but not requiring – schools to open up and share their safe places for kids to play with responsible groups in their communities like churches, scouting troops, YMCAs and others. SB 484 passed the Senate Health and Human Services Committee but did not make it out of the Rules Committee.
• HB 801 and SB 418 were introduced by Representative Gardner and Senator Orrock, respectively, as companion bills to establish a health insurance exchange in Georgia. Neither bill received a hearing.

To read Georgia Health News’ Health Care Scorecard on Crossover Day, click here.

Redesigning Medicaid and PeachCare

In the on-going efforts to redesign Georgia’s Medicaid and PeachCare programs, the Department of Community Health (DCH) has been convening three taskforces to gather feedback from consumer advocates, providers and other stakeholders on the current state of these programs, areas to be improved and gaps and other barriers. For those not appointed to these task forces, there is still an opportunity to reach out to DCH to
share your opinion on the redesign process.  Send an email to MyOpinion@dch.ga.gov and let DCH what you care about when it comes to covering our most vulnerable populations.

To help advocates across the state get involved in the redesign conversation, GHF and Voices for Georgia’s Children have created these fact sheets focused on Access, Coverage and Quality.  Click here to download them now.

If you or your organization would like to learn more about the redesign process and would like to request a presentation, email Amanda Ptashkin.  To learn more about our efforts, visit www.healthyfuturega.org/issues/careforgeorgiaskids

Bump It Up a Buck: Kick Butts Day 3/21/12

On March 21st, national Kick Butts Day, the Bump It Up a Buck Coalition will gather at the Capitol to highlight the dangers of teen smoking as well as encourage the legislature to raise the tobacco tax rate–currently among the lowest in the nation.  Experts say a dollar increase in the tax would reduce smoking levels in the state, improve the health of all Georgians, conservatively generate more than $340 million in new tax revenue for the state each year, as well as deter youth smoking. According to a recently released report from the Surgeon General, nearly one in four high school seniors and one in three young adults under age 26 smoke and the use of smokeless tobacco is on the rise.  To read that full report, click here.

The event will be held on Wednesday, March 21, 2012, and will include a rally on the steps of the Capitol and online activities as well.  Georgia currently has the 48th lowest per pack tax in the nation at only 37 cents (national average: $1.46). You can show your support for the initiative by joining the hundreds who Like the idea at http://www.facebook.com/BumpItUpaBuck.

Update on Health Insurance Exchanges

While Georgia policymakers have adopted a “wait and see” approach on developing a health insurance exchange, or marketplace, progress continues at the national level and in many other states across the country. The U.S. Department of Health and Human Services has released its long-awaited final rule on health insurance exchanges. Information about the rule is available here. Separately, the National Academy for State Health Policy (NASHP) released a report spotlighting key issues for building a consumer-oriented health insurance exchange. NASHP interviewed policymakers and advocates from several states, including Georgia, for the report. It is available here. For Georgians for a Healthy Future’s policy brief on a state-based health insurance exchange, click here.

Update on Health Insurance Model Rules and Regulations from the NAIC Spring Meeting

Georgians for a Healthy Future’s Executive Director, Cindy Zeldin, participated in the Spring Meeting of the National Association of Insurance Commissioners (NAIC) as a consumer representative—one of 28 chosen from across the country. The NAIC is currently developing model rules to implement a number of features of the Affordable Care Act that will impact health care consumers across the country and here in Georgia. The group of consumer representatives presented to the NAIC’s Consumer Liaison Committee at the Spring meeting last week in New Orleans. The materials presented by the consumer representatives are available here. We will keep you updated on issues of importance to Georgia health care consumers as they arise.

What’s New in Georgia

Legislative Update

The 2012 Legislative Session continues today as legislators meet for Day 26 of the 40-day Session. Crossover Day (Day 30), when a bill must pass at least one chamber to remain viable for the Session, will be March 7th. Here is what health care advocates are watching:

• The House and Senate have both passed versions of the Amended FY 2012 Budget (HB 741); since there are minor differences, HB 741 now heads to conference committee. Notably, the Senate version added $1.2 million in the Department of Public Health budget for the Children 1^st program to replace the loss of Supplemental TANF funds. This program provides screenings for newborns. Also in the Senate version, funds were added to the Department of Community Health budget to reflect projected need in Medicaid but there were also cuts to reflect the rounding down of co-payments to the nearest dollar. Meanwhile, work continues on the FY 2013 budget. Click here for the Georgia Budget & Policy Institute’s analyses of the implications for the state’s health care agencies on the governor’s proposed 2013 budget recommendations.

• HB 1166, sponsored by Representative Atwood, would restore child-only health insurance policies to Georgia’s individual market. Georgians for a Healthy Future, along with a range of child health advocacy groups, is in strong support of this measure to provide this option for families who need coverage for their kids. The bill is expected to be before the House Insurance Committee on Wednesday. You can learn more about this issue by downloading our fact sheet.

• HB 801 and SB 418 were introduced by Representative Gardner and Senator Orrock, respectively, as companion bills to establish a health insurance exchange in Georgia. While leadership in the House and Senate have indicated that there will not be movement on an exchange this year, please thank Representative Gardner and Senator Orrock for their leadership on this important issue. You can learn more about how a Georgia exchange could work by downloading our issue brief here. All information from the Governor’s Health Insurance Exchange Advisory Committee, which met throughout the second half of 2011 to develop recommendations on this issue, is available here.

• HB 1159, sponsored by Representative Pruett, is known as the New Parent Information Bill and would create a Joint Study Commission on Education for Parents with Newborn Children to determine how best to gather information, raise funds and create a comprehensive informational video.  The video would include but not be limited to information on the prevention of childhood obesity; how to prevent SIDS, shaken baby syndrome, and other forms of child abuse; how to prevent death and injury and additional information which would assist parents to raise safe and healthy children. The bill is expected to be before the House Health and Human Services Committee this week.

Don’t forget to download our Consumer Health Advocate’s Guide to the 2012 Georgia Legislative Session to help you navigate the Capitol! A limited number of hard copy guides are available. Please contact us if you’d like a copy.

Redesigning Medicaid and PeachCare

In the on-going efforts to redesign Georgia’s Medicaid and PeachCare programs, the Department of Community Health (DCH)
is continuining to analyze and evaluate its options and has convened three taskforces to gather feedback from consumer advocates, providers and other stakeholders.  The latest taskforce, focused on children and families will hold its first meeting on March 9th.  GHF’s Outreach and Advocacy Director Amanda Ptashking will be there to represent health care consumers who currently access these programs or who will gain access through the Medicaid expansion in 2014.  Part of the charge of this taskforce includes identifying:

• Program features identified in the Navigant report that are most/least appealing to meeting the needs of families and children;
• Current features of the program that should be maintained;
• Largest unmet need of the current program;
• Better medical management and coordination for children in foster care;
• Additional insights not identified in the report; and
• Identification of critical design features needed to protect the needs of children and families

If you or your organization have thoughts on the above charge, please email Amanda Ptashkin.  To learn more about the redesign process, visit www.healthyfuturega.org/issues/careforgeorgiaskids

DCH is still soliciting feedback on Navigant’s Strategy Report either through their Feedback Tool or by submitting a brief comment or question to MyOpinion@dch.ga.gov.  The deadline for submitting detailed feedback, comments or questions is February 29, 2012, at 5 p.m. (ET).

Final rules issued for new plain-language information and tools

A new survey shows that consumers aren’t satisfied with the level of customer service they receive from their health insurance plans. In fact, the industry ranked the lowest of any industry measured in this survey. Additionally, other studies have found that consumers often find health insurance jargon confusing, which makes it challenging for consumers to select a policy that best meets their needs, to know what is covered and what isn’t, and to understand their rights as consumers if disputes arise. While overshadowed by some of the other major reforms included in the law, the Affordable Care Act contains some exciting reforms for consumers in this area, including making available access to clear, plain language information about their insurance plans. The U.S. Department of Health and Human Services issued final regulations on February 9^th requiring an easy-to-understand Summary of Benefits and Coverage and a uniform glossary of terms. These new tools will be available to consumers on September 23, 2012. More information is available here and here.

Hospital infection rate information now online

The U.S. Department of Health and Human Services has made data on hospital-acquired infections, including data for Georgia hospitals, available online. Nationally, about one in twenty patients are affected by a hospital-acquired infection. While 27 states require disclosure of patient safety information such as data on hospital-acquired infections, Georgia does not, making this new online resource an important tool for Georgia consumers. Georgia Watch, which has spearheaded support for public disclosure of this information in Georgia for years, has more information here.

Bump It Up a Buck Coalition Maintains Momentum in 2012

Members of the Bump It Up a Buck coalition (including Georgians for a Healthy Future) are working together to maintain the momentum needed to secure an increase in the consumption tax on cigarettes by $1.  Experts say the measure would reduce smoking levels in the state, improve the health of all Georgians and conservatively generate more than $340 million in new tax revenue for the state each year. As part of our efforts to increase awareness of the issue, members of the coalition will participate in the first celebration of national Kick Butts Day to be held in Atlanta since 2008. The event will be held on Wednesday, March 21, 2012, and will include a rally on the steps of the Capitol and online activities as well. Georgia currently has the 48th lowest per pack tax in the nation at only 37 cents (national average: $1.46). You can show your support for the initiative by joining the hundreds who Like the idea at http://www.facebook.com/BumpItUpaBuck.

What’s New in Georgia

2012 Legislative Session Update

Fifteen days of the 2012 Legislative Session have passed.  Last week, the House passed the Amended FY 2012 budget  with several changes to the Governor’s proposal. Both the House and Senate are continuing to hold hearings throughout the week on the FY 2013 budget.

Health Insurance Exchange Stalls in Georgia

Georgia lags other states in progress towards establishing a health insurance exchange as authorized by the Affordable Care Act (ACA), despite the fact that Georgia stands to experience one of the largest drops in the uninsured as a result of the ACA reforms, according to an analysis by the Urban Institute. At our Health Care Unscrambled breakfast in January, a panel of Georgia policymakers discussed prospects for a health insurance exchange and indicated that exchange legislation would not move through the General Assembly in 2012. Nevertheless, Representative Pat Gardner has introduced HB 801 to establish a Georgia health insurance marketplace, or exchange. Please thank Representative Gardner for taking a stand on this important issue! For recent news articles on health insurance exchanges and Georgia, click here and here.

Modernizing Medicaid and PeachCare

Bump It Up a Buck

With the 2012 Legislative Session underway, the Bump it Up a Buck campaign is once again advocating for a $1 per pack increase in the state’s tobacco tax. Raising cigarette taxes is one of the most effective ways to reduce smoking, particularly among Georgia’s kids, and will raise important new revenue for the state. Georgians for a Healthy Future is proud to be a part of the Bump It Up a Buck coalition along with leading members the American Cancer Society, the Campaign for Tobacco-Free Kids, the American Heart Association, the American Lung Association, the Cancer Action Network of the American Cancer Society, the Georgia Society of Clinical Oncology, and the Georgia Public Health Association. To learn more and to get involved, visit www.BumpItUpaBuck.org.

Update on Essential Health Benefits

Georgians for a Healthy Future is monitoring developments at the federal level that will impact benefits and consumer protections for new individual and small group health plans in Georgia beginning in 2014. In December, the Center for Consumer Information and Insurance Oversight (CCIIO), the division of the U.S. Department of Health and Human Services charged with implementing the provisions of the Affordable Care Act (ACA) related to private health insurance, released a bulletin on the essential health benefits (EHB) that all new plans will need to include.

The bulletin allows states to select the EHB for plans in their state from ten benchmark plan options. These include: (1) any of the three largest Federal Employees Health Benefits Program (FEHBP) plans by enrollment, (2) any of the three largest state employee health benefit plans by enrollment, (3) the largest plan by enrollment in any of the three largest small group insurance products offered in the state, or (4) the largest commercial non-Medicaid Health Maintenance Organization (HMO) plan in the state.

Information about which plans these are in Georgia can be found here. Georgia has not yet made a benchmark selection from among these plans, and we are working to identify more specifics about the benefit packages within these plans. We will keep advocates informed as we learn more about this ongoing process. If you’re also monitoring developments around EHB, please share information with us so we can communicate it to a range of health care advocates.

At Georgians for a Healthy Future, we envision a day in which all Georgians will have the quality, affordable health care they need to lead healthy lives and contribute to the health of their communities. Working towards this vision takes many forms: talking directly with local community members throughout Georgia about the health care issues they’re facing; partnering with other organizations to form coalitions to build and mobilize support for better health care policies to address these needs; and engagement with policymakers to extend health care coverage to more Georgians, expand access to care, and ultimately improve health outcomes. We couldn’t do any of this without YOU! Thank you for telling us your health care stories, for collaborating with us on shared goals, for volunteering with us, and for contributing your time and dollars to our health care advocacy efforts.

Please consider supporting Georgians for a Healthy Future with a financial contribution. As a nonprofit organization, our work is funded through foundation grants and contributions from supporters like you. Please provide your support and stand with us as we fight to improve health care for Georgia consumers.

Have a happy and healthy Holiday Season!

What’s New in Georgia

Georgians for a Healthy Future Executive Director Named as NAIC Consumer Liaison Representative

Our Executive Director, Cindy Zeldin, was named by the National Association of Insurance Commissioners (NAIC) as one of 28 consumer liaison representatives from across the country for 2012. The NAIC/Consumer Liaison Committee assists the NAIC in its mission to support state insurance regulation by providing consumer views on insurance regulatory issues and provides a forum for ongoing dialogue between NAIC Members and Consumer Representatives. This appointment comes at a critical time, as the NAIC has been delegated a central role in the implementation of the Affordable Care Act by establishing standards, definitions, and consulting on model regulations—policy choices that will have a big impact on health care consumers here in Georgia and around the country. The NAIC news release is available here.

Georgia Health Insurance Exchange Advisory Committee Issues Final Report

The Health Insurance Exchange Advisory Committee issued its final report this week, calling for the development of a small business health insurance marketplace outside the context of the exchange framework authorized by the Affordable Care Act but failing to explicitly recommend the establishment of a health insurance exchange for individual consumers. Georgians for a Healthy Future’s Executive Director, a member of the committee, wrote a minority report calling for Georgia to take advantage of the opportunity to cover the uninsured and improve our health insurance marketplace by building a Georgia exchange in 2012. You can read the committee report, the minority report, and all other supplemental materials here.

Healthcare Unscrambled

Georgians for a Healthy Future’s 2nd Annual Policy Breakfast

Health Care Unscrambled, Georgians for a Healthy Future’s annual policy breakfast, brings together health care policymakers, stakeholders, experts, and advocates for an energizing look ahead at the top health issues facing our state as the 2012 Legislative Session gets underway. Please be sure to register today! This year’s breakfast will be on Thursday, January 12th from 8 AM to 10:30 AM and boasts:

• A panel discussion with Georgia legislators and state officials, including Insurance Commissioner Ralph Hudgens, Representative Pat Gardner, Representative Richard Smith, Senator Renee Unterman, and Senator Nan Orrock

• A keynote presentation from Dr. Len Nichols, one of the nation’s leading health economists

• Highlights from GHF’s forums and workshops with community leaders across the state

• GHF’s 2012 policy priorities announced

To purchase tickets or to become a sponsor of the event, click here. We hope to see you in January!

What We Are Thankful For

At Georgians for a Healthy Future, we envision a day in which all Georgians will have the quality, affordable health care they need to lead healthy lives and contribute to the health of their communities. Working towards this vision takes many forms: talking directly with local community members throughout Georgia about the health care issues they’re facing; partnering with other organizations to form coalitions to build and mobilize support for better health care policies to address these needs; and engagement with policymakers to extend health care coverage to more Georgians, expand access to care, and ultimately improve health outcomes. We couldn’t do any of this without YOU!  Thank you for telling us your health care stories, for collaborating with us on shared goals, for volunteering with us, and for contributing your time and dollars to our health care advocacy efforts.
Have a happy and healthy Thanksgiving!

What’s New in Georgia

Advocacy Demystified: Tools and Strategies for Effective Consumer Health Advocacy

Advocacy may seem overwhelming, but it’s a lot easier–and can have a bigger impact–than you might imagine.  You already have the knowledge, passion, and commitment to be a successful and effective health care advocate.  All you need are the right tools.  Today we are releasing our latest issue brief: Advocacy Demystified: Tools and Strategies for Effective Consumer Health Advocacy, to arm you with the tools you need to advocate for health care change and empower you to start making a difference in your communities. This is a tool meant for sharing so feel free to send to any individuals or organizations who you think would find it useful. Click here to access the issue brief.

Georgia’s health insurance exchange committee finalizes work, receives national press

The final report of the Governor’s health insurance exchange advisory committee is expected on December 15^th. The committee held its last full meeting on October 27^th (click here for meeting minutes) and is now drafting the final report, which is expected to be the basis for legislation in 2012 reforming Georgia’s health insurance marketplace through the establishment of an exchange. The work of the committee received attention in the Washington Post and Kaiser Health News this week. Georgians for a Healthy Future is representing the consumer voice on the committee and will continue to provide updates and advocacy opportunities on this process as they arise. To see Georgians for a Healthy Future’s priorities for a consumer-friendly health insurance exchange, download our brief here.

Developing essential health benefits: Opportunity to provide input

Beginning in 2014, many health insurance plans, including those to be offered through the new state-based health insurance exchanges, must cover a minimum package of preventive, diagnostic, and therapeutic services and products comparable to those offered in a typical employment-based plan. The specifics of the package are being developed right now by the U.S. Department of Health and Human Services (HHS), and HHS has encouraged consumer advocates to provide input. Here is how to weigh in:

Step 1: Learn more about essential health benefits and this process by reading issue summaries here and here or by participating in an upcoming webinar hosted by the National Academy for State Health Policy here.

Step 2: Prepare and e-mail your comments to ExternalAffairs@HHS.gov. HHS has requested that comments address some or all of the following 5 points below:

• In keeping with the title of the Institute of Medicine report “Essential Health Benefits—Balancing Coverage and Cost,” how can the Department best meet the dual goals of balancing the comprehensiveness of coverage included in essential health benefits and affordability?
• How might the Department ensure that essential health benefits reflect an appropriate balance among the categories so that they are not unduly weighted toward any category?
• What policy principles and criteria should be taken into account to prevent discrimination against individuals because of their age, disability status, or expected length of life as the Affordable Care Act requires?
• What models should HHS consider in developing essential health benefits?
• What criteria should be used to update essential health benefits over time and what should the process be for their modification?

Events and Forums

Building a Healthy Georgia: Widening the Safety Net and Ensuring Greater Access to Care

On Wednesday, November 30^th, Georgians for a Healthy Future is hosting a Building a Healthy Georgia Event in Savannah.  The focus will be on widening the safety net and ensuring greater access to care for Georgians living in the Coastal Region. We’ll cover topics including:

• Local perspectives on the specific health care challenges facing the coastal region
• How the Affordable Care Act impacts the community and individuals; Georgia’s opportunity to customize
• Widening the safety net and expanding access to care
• Medicaid redesign and upcoming 2014 expansion

The event will take place at the Coastal Georgia Center from 4 PM to 6 PM. For more information and to register for the event, click here.

SAVE THE DATE: Healthcare Unscrambled 2012

What’s New in Georgia

Reforming Georgia’s Health Insurance Marketplace: All About Exchanges

Department of Community Health’s Medicaid Redesign Project Continues, Advocates Weigh In

Opportunity to Provide Input to HHS on Essential Health Benefits

Upcoming Georgia Health Agency Meetings

A New Resource Guide on Affordable Care Act Grants

Events and Forums

Building a Healthy Georgia: The Impact of Health Care Reform on Central Georgia’s 50+ Community

What’s New in Georgia

Health Insurance Exchange Advisory Committee Issues Interim Report
The Governor’s Health Insurance Exchange Advisory Committee, charged with determining whether Georgia should establish a state-based health insurance exchange, issuedan interim report on September 15^th, available here.  Georgians for a Healthy Future’s executive director is a member of the committee and is currently participating on the governance and insurance markets subcommittees. GHF has also released an issue brief about the potential benefits of a well-designed exchange for health care consumers in Georgia, and we welcome your input to help us best represent the consumer voice on the committee. The next full meeting of the committee will be held on October 27^th from 10am-2pm at the Department of Community Health (2 Peachtree St, 5^th floor). All meetings are open to the public. Final committee recommendations are due to the Governor on December 15^th per the Executive Order issued earlier this year.

New Department of Public Health Holds Initial Board Meeting
The newly-appointed nine-member Board of Public Health convened for the first time on September 26th. Over a period of nearly three hours, the members of the Board were provided a wide-ranging overview of the new Department of Public Health’s operations, including plans for trimming the FY2011 and FY2012 budgets. The new Department Of Public Health was established as a stand-alone state department on July 1, 2011, under legislation passed by the 2011 General Assembly.  To view the slides from the meeting, click here.

Children Eligible for State Health Benefits Plan Can Now Opt for PeachCare
Starting in October, parents of children eligible for the State Health Benefit Plan (SHBP) can now opt to enroll their kids in PeachCare for Kids™ during open enrollment—a move that is expected to save money for parents as well as the state.  The new option is expected to bring 40,000 Georgia children into the state’s PeachCare program.  Currently, 200,000 kids are covered under PeachCare.  To read a recent Georgia Health News article on the transition, click here.

Navigant Begins Stakeholder Focus Groups
As part of the environmental scan that consulting firm Navigant is tasked with undertaking as part of their Medicaid Redesign contract, in a few weeks they will begin convening stakeholder focus groups across the state.  To be invited to one of these sessions, interested stakeholders must have registered on the DCH website back in September.  For those not selected to attend the focus groups, Navigant has launched an online survey for consumers, patients, providers and vendors to weigh in on the process.  Click here to access the survey.

Events and Forums

Medicine and Society Lecture Series Event This Friday
On Friday, October 7^th, GHF executive director Cindy Zeldin will be presenting “The Affordable Care Act: Implications for Georgia” to attendees of the Medicine and Society Lecture Series at Grady Hospital.  Presented in collaboration with Emory’s Department of Medicine, the Urban Health Initiative, and Social Medicine Work Group, this event will inform future health professionals about the intricacies of the ACA, how it will unfold through the implementation process, and what it means for medical professionals.  For more information, contact Jada Bussey-Jones.

Interdisciplinary Care in Action: Meeting Tomorrow’s Health Care Needs
On Thursday, October 13^th, HealthSTAT is coordinating an interdisciplinary professional panel to discuss how today’s students can prepare themselves to be tomorrow’s interdisciplinary leaders.  Outreach and advocacy Director Amanda Ptashkin will be on the panel to discuss the important role of health professionals in helping to shape the future of our health care system.  To learn more about the event, click here.

State of Public Health Workforce
On Tuesday, October 25^th, Foothills Area Health Education Center (AHEC) is hosting a webinar, the “State of the Public Health Workforce in the State of Georgia.” This program will provide an overview of the challenges and strategies to increase the public health workforce and activities that support the professional development of the public health workforce in the State of Georgia.  For more information about the webinar, click here.  To register, click here.

What’s New in Georgia

Health Insurance Advisory Committee Recommends Creation of Georgia Exchange

Throughout the summer, the Governor’s Health Insurance Exchange Advisory Committee has been meeting regularly to study whether Georgia should develop a health insurance exchange. At the August meeting, the committee voted to recommend legislation for a Georgia exchange in 2012 and created subcommittees around governance, insurance markets, operations, and contingency plans to begin exploring design options for an exchange.  Minutes from this meeting are available here.

Authorized by the Affordable Care Act, health insurance exchanges are state-level competitive health insurance marketplaces that hold the potential to transform our broken health insurance system into one that is transparent, competitive, and that provides consumers with the information, tools, and access to tax credits that can make health insurance more understandable and affordable. But only if we get it right. As this process unfolds, we need your voice to build support for an exchange that will work for all of Georgia’s health care consumers and not one that will work just for the insurance industry.

You can learn more about this issue by downloading Georgians for a Healthy Future’s issue brief about how to build a consumer-friendly exchange here. You can also read additional news reports on the exchange here, here, and here. A list of subcommittee members is available here. The next meeting of the full exchange committee is scheduled for September 22^nd at 10am, location TBD. To see how Georgia’s progress compares to that of other states, click here for a spreadsheet describing progress across all states compiled by state refor(u)m.

New Information and Tools for Georgia Consumers Subject to Proposed Health Insurance Premium Increases

Georgia insurance companies proposing to increase health insurance premiums by 10 percent or more must now submit information to the Georgia Insurance Department, which will operate a rate review program to determine if the proposed rate increases are justified. The requirement, which went into effect on September 1^st, is part of the Affordable Care Act, and Georgia has chosen to implement a rate review program in compliance with this provision. Consumers will also have access to information about the proposed rate increases, including the rationale behind them, and an opportunity to file comments through a tool on healthcare.gov beginning in mid-September. A preview of this tool is available here. Information about Georgia’s decision to operate a rate review program is available here and here.

Medicaid Redesign Process: Upcoming Stakeholder Forums

At the end of July, the Department of Community Health (DCH) awarded the Medicaid redesign assessment contract to Navigant Consulting.  As part of the contract, Navigant will hold up to 30 stakeholder focus groups across the state, in cities yet to be announced.   Part of the state environmental scan, the intent of these focus groups is to provide a forum for Georgia-specific input from providers, other agencies, advocates, and others affected by Medicaid and PeachCare to provide useful information to both Navigant and DCH as this process unfolds.  If you or your organization wouldlike to participate in these focus groups, you can submit an application online here.  To learn more about DCH and Navigant’s plans, click here.  The deadline for submissions is September 13^th.

2012 and 2013 Budget Update

DCH announced last week that Georgia’s Medicaid and PeachCare programs are facing budget shortfalls of more than $200 million in the current fiscal year (FY 2012) and more than $350 million next year (FY 2013). The agency is not proposing any cuts to manage the shortfall; rather, the department is simply seeking new money from the Governor’s Office of Planning and Budget (OPB). Left unsaid is what would happen if new funding is not made available to DCH. Significant provider reimbursement rate cuts would likely be necessary.

In addition to the funding request, the DCH proposal includes provisions to allow (currently ineligible) state employees to enroll their children in Georgia’s PeachCare program (if they meet existing income-eligibility guidelines). This proposal would lead to higher state costs in the PeachCare program, though these costs would be more than offset by state savings in the State Health Benefit Program.

The DCH Board is expected to act on the department’s proposed budget in September, after which the request would be submitted to OPB.  To read the Georgia Budget & Policy Institute’s overview of the FY 2012 budget and budget trends, click here.

DCH Awarded Grants for PeachCare Outreach and Enrollment and Public Health Infrastructure Strengthening

Georgia’s Department of Community Health (DCH) recently received two federal grants from the Department of Health and Human Services to improve outreach and enrollment for Medicaid and PeachCare as well as improve the public health infrastructure in Georgia.  The first grant, worth $2.5 million, will allow DCH to use technology solutions to better coordinate enrollment and renewal in Medicaid and PeachCare programs.  The second grant, worth $499,738, will go to strengthening public health infrastructure for improved health outcomes and to help train and educate public health workers. To learn more about these grants, click here and here.

Events and Forums

Building a Healthy Georgia Started in Augusta and Continues in Butler

Last week, Georgians for a Healthy Future, Voices for Georgia’s Children and Health STAT kicked off our Building a Healthy Georgia campaign in Augusta. With a focus on children’s access to care and health care workforce issues, more than 60 local community leaders, key stakeholders, health care professionals and members of the academic community participated in the event and brought their expertise and passion to the conversation.  We are looking forward to working collaboratively to address our most pressing health care issues in Augusta and we look forward to continuing that dialogue in other cities across the state.   You can view the power point presentation from the forum here, and see photos from the event here.

Next Thursday, September 8^th from 3 PM to 5:30, Georgians for a Healthy Future, the Georgia Budget & Policy Institute and the Georgia Rural Health Association will be in Butler, Taylor county for Building a Healthy Georgia: Workforce Development and the Value of Ensuring Access to Quality Health Care.  The focus is on economic and workforce development issues, particularly as they relate to both local fiscal and physical health.  You can find out more about the Butler event by clicking here.

What’s New in Georgia

Georgia Department of Community Health Awards Medicaid Redesign Contract to Navigant

The Georgia Department of Community Health has announced that it has hired Navigant Consulting to conduct an assessment and present options for restructuring Georgia’s Medicaid and PeachCare for Kids (CHIP) programs. The assessment will address quality, access, and appropriate utilization of resources within these programs. It will include an environmental scan at both the state and national levels to identify what has worked well and what has not worked well and will be complemented by up to thirty stakeholder forums to gain Georgia-specific input from providers, other agencies, advocates, and members. The assessment phase begins immediately and runs through December. The Department has provided an e-mail address, Navigant@dch.ga.gov for anyone who wishes to directly weigh in with the Department about this process. A recent news article about this issue is available here.

Potential Good News for Consumers: Georgia Insurance Department to Review Proposed Health Insurance Premium Increases in Compliance with the Affordable Care Act

In recent years, Georgia consumers have seen their health insurance premiums increase more quickly than their earnings, placing a strain on household budgets. Meanwhile, insurance companies just posted a surge in profits for the second quarter of 2011. Georgia consumers historically haven’t had access to adequate information to know if premium rate hikes are justified based on underlying medical costs or if they are simply going towards profits. Thanks to requirements and resources available through the Affordable Care Act, Georgia’s Insurance Department has expressed its intent to operate a rate review program to scrutinize proposed insurance premium rate increases of ten percent or more in compliance with the law. Insurance companies will have to provide evidence that these proposed premium increases are based on reasonable factors like a change in medical costs, utilization, or benefits. This is an opportunity to spur insurers to operate more transparently and more fairly in the market. Georgians for a Healthy Future will continue to monitor this issue as the Insurance Department implements the new requirements. Georgia’s intention to operate rate review was first reported by Georgia Health News. The link is available here. The Atlanta-Journal Constitution also reported on this issue here.

Next Meeting of the Governor’s Health Insurance Exchange Advisory Committee is August 16^th

The Health Insurance Exchange Advisory Committee, charged with determining whether Georgia should establish a state-based health insurance exchange, will hold its third meeting on August 16^th from 12pm to 3pm in the 5^th floor of the Department of Community Health at 2 Peachtree St. The meetings are open to the public. More information about the work of the committee and upcoming meetings is available here.

New Issue Brief from Georgians for a Healthy Future: Building Georgia’s Health Insurance Exchange

Georgia is currently weighing options to determine whether it should establish a health insurance exchange.  Authorized by the Affordable Care Act, the goal behind these competitive health insurance marketplaces is to better facilitate competition and choice for health care consumers. Earlier this week, Georgians for a Healthy Future released an issue brief entitled Building Georgia’s Health Insurance Exchange that outlines how a health insurance exchange can benefit Georgia consumers and makes recommendations for our policymakers as they weigh design options for an exchange.
Building Georgia’s Health Insurance Exchange addresses the following questions:

• Who is eligible for the health insurance exchange?
• What types of insurance plans will be available on the exchange?
• How will consumers afford the products offered on the exchange?
• What will Georgia’s exchange look like?
• How will the exchange benefit Georgia consumers?
• What should policymakers focus on to build a successful exchange?
• What is the timeline for implementing an exchange?

Building Georgia’s Health Insurance Exchange recommends the following policy goals for an exchange:

• Create a governance structure that can transparently and effectively oversee the exchange without any conflict of interests; insurance companies or other businesses that have a direct financial stake should not serve on the governing body

• Provide structured choices that supply the information and tools consumers need to make optimal purchasing decisions, including quality and customer satisfaction ratings as well as information about price and benefits

• Create incentives for insurance companies to compete based on value rather than by selecting the healthiest applicants:  consider leveraging volume within the exchange to drive better deals with insurance companies; consider crafting exchange participation rules to allow the highest quality and value plans to participate; and align regulations inside and outside the exchange to eliminate incentives to steer consumers outside the exchange

• Serve as an easy-to-use, one-stop-shop and provide navigation assistance to programs like PeachCare for Kids^TM and Medicaid where appropriate to ensure that all individuals and families eligible for these programs enroll

• Develop a robust outreach and enrollment mechanism to ensure that low-income and minority communities that historically have had the highest rates of uninsurance are engaged and that consumers in rural areas, without internet access, or with limited English proficiency can still enroll in the plan that best meets their needs

The full issue brief is available here.

The Debt Crisis and What it Means for Health Care

The recent raising of the debt ceiling spared both Medicaid and Medicare from cuts, but that may be temporary.  With the formation of the bi-partisan “Super Committee” and both parties gearing up for an uphill battle, drastic decisions will be debated, and we must call, email or fax our Congressional delegation and explain how important it is to protect programs like Medicaid and Medicare that help and serve some of Georgia’s most vulnerable citizens.

To see a brief analysis on how the current budget deal will affect health care programs like Medicaid and Medicare, check out Community Catalyst’s blog on the topic.  For now, here is what you need to know:

• In the first stage, caps are immediately placed on discretionary spending, saving $917 billion over 10 years.
• For now, both Medicaid and Medicare have been spared from cuts.
• That may not be the case moving forward since the bill authorizes a bipartisan joint committee of 12 legislators to come up with an additional $1.2 trillion in cuts to be agreed on by the House and Senate or suffer a “trigger” that would institute across the board cuts.
• If the trigger is activated, Medicaid is still protected from cuts whereas Medicare would be susceptible to cuts to providers and insurers.
• As the committee makes its decisions, both Medicaid and Medicare are fair game and thus at risk.
• It is unclear if the committee will be able to reach a consensus but if they cannot or their efforts do not amount to the total reduction necessary, the trigger will be activated and across the board cuts will result.

Between now and November (the committee’s deadline to have a plan drafted) the health advocacy community must rally behind these important programs and spur outreach to our elected officials to remind them:

Don’t jeopardize Georgia’s fragile economic recovery and the health and economic security of seniors, people living with disabilities and low-income families by simply shifting costs onto individuals, families and the state.  Don’t cut Medicaid or Medicare.

If you don’t know who your member of Congress is, you can find out this information here.

As tough decisions are being made, we must continue to tout Medicaid’s value not only as a means to help low-income children, elderly, and disabled Georgians get health care services; but also one that invests in Georgia’s health care system and its local economies. For more specifics on the effect that cuts in Medicaid would mean for Georgia, you can download a fact sheet from Georgians for a Healthy Future and the Georgia Budget and Policy Institute here.  Families USA also has a Medicaid calculator which allows you to determine the economic impact of proposed cuts to Georgia’s program here.

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Action Alert

Tell Your Member of Congress and Georgia’s Senators:  Medicaid Matters!

As Congress debates deficit reduction proposals, Medicaid is under threat of being cut. The Ryan proposal, passed by the House of Representatives, would make drastic cuts to Medicaid, such that in 10 years Medicaid would be cut by 33%. To put this into context, if a cut of this size were put into effect today, it would translate to $1.9 billion in lost federal funding for Georgia and place $4.4 billion in Georgia business activity and more than 38,000 jobs related to our state’s health care economy at risk.

Medicaid cuts would not only threaten Georgia’s fragile economic recovery, but also threaten access to health care and health outcomes for low-income families, seniors, and people with disabilities. In fact, a landmark study released last week by a team of top-notch researchers led by Harvard and MIT using a randomized control design, the gold standard for health services research, has found that having Medicaid coverage results in improved access to care, improved financial security, and improved reported health status relative to being uninsured. More details about the study are available here and here, and the full report can be downloaded by clicking here.

Please contact your member of Congress and send the message:  Don’t jeopardize Georgia’s fragile economic recovery and the health and economic security of seniors, people living with disabilities and low-income families.  Don’t cut Medicaid. If you don’t know who your member of Congress is, you can find out this information along with contact information here.

What’s New in Georgia

Georgia Health Insurance Exchange Advisory Committee Work Continues

The Health Insurance Exchange Advisory Committee, charged with determining whether Georgia should establish a state-based health insurance exchange, held its second formal meeting on July 12^th. During the morning session, the committee heard from two existing small business exchanges, HealthPass in New York and Florida Health Choices, to help inform the committee’s work. In the afternoon session, the committee discussed potential pros and cons of developing a small business and/or individual health insurance exchange in Georgia. Committee meetings are open to the public, and the next committee meeting will be held on August 16^th (time and location TBD). There are also two upcoming small business listening sessions, one taking place in Albany on July 20^th and one in Dalton on 26^th of July.  For more information on these sessions, email Amanda Ptashkin.  The committee is to make preliminary recommendations to the Governor by September 15^th and final recommendations by December 15^th. Georgia Health News covered this week’s meeting (article here), and all meeting materials are posted on the state’s health reform website here. This week, the federal Department of Health and Human Services released a proposed rule on exchanges, providing additional flexibility for states as they move forward with their exchange planning. Information about the rule is available here, and a summary analysis from the Health Affairs blog is available here.

Medical Loss Ratio Update: Ensuring Value for Georgia’s Consumers

Health care consumer advocates in Georgia are on standby as the Center for Consumer Information & Oversight (CCIIO) reviews the Georgia Insurance Commissioner’s application for an adjustment to the new medical loss ratio (MLR) rules that require insurance companies to spend at least 80% of the premiums their customers pay on medical services and quality improvement activities, as compared to administrative expenses, or else provide rebates to consumers. Designed to spur insurance companies to operate more transparently and to provide value for the paid premium dollar, the new rules are a step forward for consumers. When Georgia’s application is complete, CCIIO will accept public comment. Georgians for a Healthy Future will be filing comments in collaboration with a range of other groups, and when the comment period opens, we will keep you updated as to sign-on opportunities on this important issue. Kaiser Health News has a video explaining MLR here, and Georgia Public Broadcasting has a story about Georgia’s adjustment request here.

Community Health Board Approves Provider Reimbursement Rate Cuts

The Georgia Department of Community Health Board met earlier this week and approved a .5 percent cut in reimbursement rates for providers participating in the Medicaid and PeachCare for Kids programs (final adoption of rules). The board also proposed increasing co-payments for Medicaid patients and adding co-payments for the first time for PeachCare for Kids patients ages 6 and older (initial adoption of rules). Both changes reflect decisions made by the General Assembly during the 2011 Legislative Session. However, there is concern among advocates and health care providers that these changes will diminish access to care. For more information about these changes, see a recent Georgia Health News article here and a recent AJC article here. For materials from the Department of Community Health board meeting and information about upcoming meetings, click here.

F as in Fat: Georgia Rankings

According to a new report released by the nonprofit Trust for America’s Health and Robert Wood Johnson Foundation shows that Georgia is the 17^th most obese state, with an adult obesity rate of 28.7% and a children’s obesity rate of 21.3%.  To read that report, click here.  To read a recent AJC article on the report, click here.

Events

What Health Care Reform Means for Small Businesses in Georgia

This week, Georgians for a Healthy Future and Small Business Majority held the first in a series of presentations focused on small business owners and how health care reform will affect them, their families and their bottom line.  From the tax credits that are already available for businesses who filed 2010 tax returns to the creation of the small business exchange, health care reform will have a positive impact on many of Georgia’s small businesses.

To learn about an upcoming webinar or educational forum, email Amanda Ptashkin.   To view the power point presentation from this week’s webinar, click here.

Building a Healthy Georgia: Augusta

If you live in the Augusta area and have an interest in policies and practices aimed at the obstacles to accessing care for children in the region, join Georgians for a Healthy Future, Voices for Georgia’s Children and Health STAT for our symposium, “Building a Healthy Georgia: Exploring Policies and Practices to Improve Children’s Access to Health Care Services.”

Event Details:

WHEN:             Thursday, August 25^th, 1:00 PM to 3:00 PM

WHERE:           The Salvation Army Ray and Joan Kroc Corps Community Center of Augusta

CONTACT:       For questions, please contact Amanda Ptashkin or at 404-890-5804.

While we request RSVP, please note that there is no cost

REGISTER HERE

For more information about the event, click here.  Don’t live in Augusta?  Think of at least one person who you know in the area who would be interesting in being involved in this conversation and tell them about it!  Stay tuned for more information about upcoming events in a town near you!

What’s New in Georgia

Georgia Health Insurance Exchange Advisory Committee Begins Work

The first meeting of the newly appointed Health Insurance Exchange Advisory Committee was held on June 6^th. The committee, consisting of 25 members, heard presentations from the Governor’s staff and was given its charge to determine whether Georgia should establish an exchange and whether there should be a single exchange for small businesses and individuals or whether there should be separate exchanges. Information about the committee and the committee meetings is housed on the state of Georgia website here.

State-based health insurance exchanges are a central feature of the Affordable Care Act (ACA) and will serve as the mechanism for restructuring the individual and small group health insurance marketplaces. If designed well, the exchange can facilitate apples-to-apples comparisons of health insurance options for consumers, make these choices more affordable by providing access to substantial tax credits authorized by the ACA, and navigate consumers who are eligible for the Medicaid or PeachCare for Kids programs to those options. Georgians for a Healthy Future’s Executive Director was appointed to the committee to represent the consumer voice. To see our priorities for the exchange, read our recent op-ed on this issue here.

Still, we want your input! Please share your priorities for the exchange with us. If you have questions about the exchange or would like to learn more, please also be in touch and we can brief you about the details.   To view other states’ progress on setting up exchanges, click here to view a Commonwealth Fund map.

Cuts to Medicaid Will Harm Georgia’s Economy

Congressional proposals to reduce federal Medicaid support to states and turn the program into a block grant would stunt the economic recovery in Georgia by placing business activity and thousands of jobs at risk while shifting new costs to Georgia at a time when the state can least afford it. According to a new report released this week from the national consumer health advocacy organization Families USA, here in Georgia the proposed cuts could translate to as much as $1.9 billion in lost federal funding and place $4.4 billion in business activity and 38,420 jobs at risk.

Please contact your member of Congress and send the message: Don’t jeopardize Georgia’s fragile economic recovery and the health and economic security of seniors, people living with disabilities and low-income families by simply shifting costs onto individuals, families and the state.  Don’t cut Medicaid. If you don’t know who your member of Congress is, you can find out this information here.

For more specifics on the Georgia data, you can download a new fact sheet from Georgians for a Healthy Future and the Georgia Budget and Policy Institute here.  You can also download the full report from Families USA here.

Pathways to Coverage
Figuring out how to purchase insurance for yourself or your family is a confusing process, particularly if you have a pre-existing condition or are unable to afford coverage.  To help consumers navigate the system, Georgians for a Healthy Future has a new fact sheet called Pathways to Coverage. It’s a basic one-page overview of where and how you can access health insurance in Georgia today, and provides you contact information for relevant resources. If you interact with patients and consumers, please share with them, or any other individuals or organizations who you think would find it useful. Click here to access the fact sheet.

Starting July 1^st, Insurance Companies Can Offer Stripped-Down Policies in Georgia
Throughout the 2011 Legislative Session, Georgians for a Healthy Future worked in coalition with a range of patient, consumer, and primary care advocacy groups to raise concerns about House Bill 47, which would allow Georgia insurance companies to sell individual health insurance products with benefit designs equivalent to those sold in other states, circumventing current Georgia standards for basic consumer protections and essential medical services that all insurers must cover today under Georgia law. Unfortunately, the legislation passed and was signed into the law by the Governor. It takes effect tomorrow. For a recent article on House Bill 47, click here.

New Changes to Take Effect July 1 for the Pre-Existing Condition Insurance Plan (PCIP)
The Pre-Existing Condition Insurance Plan, a new option for uninsured consumers who are locked out of the insurance market due to a pre-existing health condition, has had lower than anticipated enrollment since it became available in late 2010. To make the program more accessible, starting July 1^st premiums will be reduced by 15% in Georgia and applicants no longer have to produce a letter of denial from an insurance company but can instead supply documentation from their physician that they do have a pre-existing condition. The requirement to have been uninsured for six months has not been changed. To date, 608 people in Georgia have enrolled in the plan. To download our updated fact sheet on the PCIP, click here. To apply for the PCIP, click here. For a recent report from the Commonwealth Fund on how the program is working around the country, click here.

Forums and Events

Building a Healthy Georgia: Exploring Policies and Practices to Improve Children’s Access to Health Care Services

Georgians for a Healthy Future, along with partnering groups HealthSTAT and Voices for Georgia’s Children, invites you to participate in a community conversation centered around the barriers that children face when accessing vital health care services in Augusta.  With your active engagement, the goal of this symposium is to catalyze a statewide effort to advocate for policy and practice changes to remove existing access barriers and strengthen the overall health care delivery system in Georgia.  Please share this information with your contacts and partners in the Augusta area and encourage them to attend.

EVENT DETAILS:
WHEN:        Thursday, August 25^th, 1:00 PM to 3:00 PM
WHERE:      The Salvation Army Ray and Joan Kroc Corps Community Center of Augusta
CONTACT:  For questions, please contact Amanda Ptashkin.  To RSVP, click here.  While we request RSVP, please note that there is no cost to attend this event.

SPEAKERS:
Sandra Mobley,PhD, RN, Assistant Professor, Dept. of Obstetrics and Gynecology, Georgia Health Sciences University
Joann Yoon,JD, Assoc. Policy Director for Child Health, Voices for Georgia’s Children
Denise Kornegay,MSW, Program Director,AHEC Network
Michelle Putnam,MPH, Executive Director, HealthSTAT
Amanda Ptashkin,JD,Outreach and Advocacy Director, Georgians for a Healthy Future

To learn more about this event, click here.

Campaign for Better Care Advocates for Quality Reforms
The Campaign for Better Care is a new effort that aims to ensure that our health care system provides the comprehensive, coordinated, patient- and family-centered care that individuals want and need. Here in Atlanta, Georgians for a Healthy Future joined with coalition partners Georgia Watch, Piedmont Healthcare, Georgia Coalition for the People’s Agenda, The Center for Pan Asian Community Services, and the Urban League of Greater Atlanta in a town hall conversation about safely and effectively navigating healthcare today earlier this week to kick off the effort. To learn more about the campaign or to learn what you can do to support this effort, click here.

National News

6^th Circuit Appellate Court Upholds Individual Mandate
In a 2-1 ruling issued this week, the United States Court of Appeals for the 6^th Circuit upheld the constitutionality of the requirement to purchase health insurance in the Affordable Care Act. The 6^th circuit is the first appellate court to rule on the issue; cases are pending before the 4^th circuit and 11^th circuit court of appeals. Full coverage of the ruling is available here.

Building a Healthy Georgia

For nearly a year, we’ve been bringing the Peach Pulse to your inbox. Our hope is that it is interesting, informative, and equips you with the information and tools you need to be an effective advocate.

During the 2011 Legislative Session, we kept you updated on bills moving through the legislature that would impact health care consumers, developments with the nation’s new health care law, and other national issues affecting Georgia health care consumers.  We will continue to keep you updated on public policy developments happening in Georgia and nationally throughout the summer and fall, but also want to utilize this forum to highlight opportunities to engage on health care issues through Town Halls, Educational Forums and Health Fairs. Don’t worry–we will still have those other important updates in there!

Georgians for a Healthy Future, along with several coalition partners, is embarking on an exciting new project, the “Building a Healthy Georgia” Campaign. The effort will bring together community leaders, health care providers, consumers and small business owners to foster a dialogue on the most pressing health care issues in local communities, and we hope you’ll get involved.

Between now and October, we will hold forums in 9 cities: Alpharetta, Athens, Butler, Macon, Rome, Savannah, Gainesville, Augusta and Tifton.  Each event will have a different focus in order to address most pressing health care issues in these communities.  As these events are scheduled, we will be sure to share the details as well as an opportunity to participate.

Additionally, if you are planning an event of your own and would like to incorporate information from the health care consumer lens, we are always happy to come and speak to your group or to provide materials.  Please contact Amanda Ptashkin if you would like to include Georgians for a Healthy Future in your upcoming event!

Upcoming Events

AUGUSTA

Building a Healthy Georgia: Exploring Policies and Practices to Improve Children’s Access to Health Care Services

Georgians for a Healthy Future, along with partnering groups HealthSTAT and Voices for Georgia’s Children, invites you to participate in a community conversation centered around the barriers that children in your area face when accessing vital health care services.  With your active engagement, the goal of this symposium is to catalyze a statewide effort to advocate for policy and practice changes to remove existing access barriers and strengthen the overall health care delivery system in Georgia.

EVENT DETAILS:
WHEN: Thursday, August 25^th, 1:00 PM to 3:00 PM
WHERE: The Salvation Army Ray and Joan Kroc Corps Community Center of Augusta
CONTACT: For questions, please contact Amanda Ptashkin.  To RSVP, click here.  While we request RSVP, please note that there is no cost to attend this event.

SPEAKERS:
Sandra Mobley,PhD, RN, Assistant Professor, Dept. of Obstetrics and Gynecology, Georgia Health Sciences University
Joann Yoon,JD, Assoc. Policy Director for Child Health, Voices for Georgia’s Children
Denise Kornegay,MSW, Program Director, AHEC Network
Michelle Putnam,MPH, Executive Director, HealthSTAT
Amanda Ptashkin,JD,Outreach and Advocacy Director, Georgians for a Healthy Future

To learn more about this event, click here.

ATLANTA

Town Hall Conversation: Safely and Effectively Navigating Healthcare Today

Community leaders, civic organizations, healthcare providers and hospitals are collaborating to provide you with valuable healthcare information that everyone must have to safely and effectively navigate healthcare today.  The evening will feature discussion around patient safety as well as how healthcare reform might impact you and your family.  The event will include:

• Free health screenings
• Materials in various languages
• Food and beverages, and
• Opportunities to ask questions

EVENT DETAILS:
WHEN: Tuesday, June 28th, 6:00 PM to 8:00 PM
WHERE:  Atlanta Community Food Bank
732 Joseph E. Lowery Boulevard
Atlanta, GA 30318
CONTACT: To make a reservation or for more information, email hap@georgiawatch.org or call 404.525.1085

What’s New in Georgia

Building a Healthy Georgia Campaign

Georgians for a Healthy Future, along with many of our coalition partners is embarking on a series of educational forums across the state aimed at bringing together community leaders, health care providers, consumers and small business owners to foster a dialogue on the most pressing health care issues in local communities.  Between now and October, we will hold forums in 9 cities: Alpharetta, Athens, Butler, Macon, Rome, Savannah, Gainesville, Augusta and Tifton.

To learn more about the Building a Healthy Georgia campaign and ways to collaborate on the events, contact Amanda Ptashkin.

Governor Deal Establishes Advisory Committee on Health Insurance Exchange

Earlier this week, Governor Nathan Deal issued an Executive Order creating the Georgia Health Insurance Exchange Advisory Committee. The charge of the committee is to determine if Georgia should establish a state-based health care exchange as authorized by the Affordable Care Act. Georgians for a Healthy Future Executive Director Cindy Zeldin will serve on the committee, providing a seat at the table for the consumer voice. We will keep you updated throughout this process, and in turn please send us your thoughts and ideas for how to build a consumer-friendly exchange so we can bring the best ideas to the committee. The Executive Order, including the list of committee members, is available here.

House Bill 47 Signed Into Law

During the Legislative Session, Georgians for a Healthy Future worked in coalition with a range of patient and consumer advocacy groups to raise concerns about House Bill 47, which would allow Georgia insurance companies to sell individual health plans with benefit designs equivalent to those sold in other states, circumventing current Georgia standards for basic consumer protections and essential medical services that all insurers must cover today under Georgia law. Last month, Governor Deal signed House Bill 47 into law. We will monitor its implementation and keep you updated on advocacy opportunities.

Georgia Department of Community Health Looks at Medicaid Options

The Department of Community Health (DCH) recently announced that they would be undergoing a process to assess the most appropriate approach for providing services to Medicaid and PeachCare for Kids members. The Board of Community Health meets monthly, and the Board’s Policy Committee and Care Management Committee meet periodically as well. Information about upcoming DCH Board Meetings is available here. As we learn more information about potential changes to the Medicaid and PeachCare for Kids programs, we will pass along this information.

Opening Arguments to Start on June 8^th

The United States Court of Appeals for the 11^th Circuit will hear oral arguments in Atlanta on Wednesday, June 8, 2011, in the case State of Florida v. U.S. Department of Health and Human Services, the Florida Attorney General’s challenge to the Patient Protection and Affordable Care Act that has been joined by Attorneys General from a number of other states. Consumers and small businesses are already benefiting from the law through new tax credits, an insurance plan for people with pre-existing conditions, and additional consumer protections. Georgians for a Healthy Future is joining Families USA and several consumers who have been impacted by the law for a briefing prior to the oral arguments. The briefing will start at 8am on Wednesday morning at the corner of Forsyth St, NW and Walton St, NW outside the Elbert P. Tuttle United States Court of Appeals Building in Atlanta. Please join us to show your support!

National News

Premiums to Drop 15% for the Pre-Existing Condition Insurance Plan

Last week, the Department of Health and Humans Services announced that premium rates for the Pre-Existing Condition Insurance Plan (PCIP) would be lowered to encourage more people to enroll.  In Georgia, consumers will see a 15% reduction in premium costs and will no longer need to submit a formal denial letter from an insurer, but rather just send in a doctor’s note confirming the existence of a pre-existing condition.  Consumers hoping to join the PCIP will still need to show that they have been uninsured for six months.  This is a welcome change that should allow more of our state’s 1.9 million uninsured to find and enroll in health insurance.  To read a recent Georgia Health News article on the PCIP, click here.

Health Transformation Grants Now Available:

Through the Affordable Care Act, $100 million dollars is now available for up to 75 Community Transformation Grants across the country.  These grants are aimed at helping communities implement projects proven to reduce chronic diseases such as diabetes and heart disease. By promoting healthy lifestyles and communities, especially among population groups experiencing the greatest burden of chronic disease, these grants will help improve health, reduce health disparities, and lower health care costs.  State and local government agencies as well as state and local non-profit organizations are eligible to apply for the grants. Letters of interest are due on June 6 and applications are due to the CDC in July 2011, with awards expected to be announced near the end of summer. To learn more about the grant opportunity, click here.

600,000 Young Adults Get Coverage

Since September 23^rd, 2010, an estimated 600,000 young adults, up to age 26, have been able to remain on or rejoin a parent’s insurance plan through the dependent care provision of the Affordable Care Act.  The Department of Health and Human Services estimated that 1.2 million young adults would gain coverage through this provision in 2011 alone, but given the numbers to date, that figure should be much higher.  This provision is particularly popular because people in their 20’s have the highest uninsurance rate of any group, 30%.  To read more about the dependent care provision of the ACA, click here and here.

Have you been able to keep your children on your plan due to this provision? If so, let us know by emailing Amanda Ptashkin at aptashkin@healthyfuturega.org.

Georgians for a Healthy Future in the AJC: “Pro & Con: Is first year of health care reform law living up to promised claims?”

Georgians for a Healthy Future’s Cindy Zeldin and Voices for Georgia’s Children’s Joann Yoon marked the one-year anniversary of the new health care reform law by setting the record straight in the AJC on the benefits of the new law to Georgia consumers. The article is available here.

Second Annual Cocktail Reception

Thank you to everyone who came out for Georgians for a Healthy Future’s 2^nd Annual Cocktail Reception and Fundraiser!  We were delighted to see so many new and also familiar faces supporting the work of our organization.  Click here to view pictures from the event.  If you were unable to attend and would still like to support the important work of our organization, please click here.

What’s New in Georgia

Update on the 2011 Legislative Session

Thirty-three of the 40 legislative days are now complete. The Legislature is out of session for the remainder of this week; in session each day next week for legislative days 34 through 38, out of session the week of April 4^th; and in Session for the final two legislative days on April 12^th and April 14^th.  Georgians for a Healthy Future is monitoring several bills that would impact health care coverage and access in Georgia. If you’d like to weigh in on these bills, you can find your legislator’s contact information here.

Recent Action Was Taken on the Following Bills:

House Bill 47 would allow Georgia insurers to sell individual health insurance products with benefit designs equivalent to those sold in other states, circumventing current Georgia standards for basic consumer protections and essential medical services that all insurers must cover today under Georgia law. The bill was passed by the House and is now in the Senate Insurance Committee. For more information about the concerns this legislation raises for patients and consumers, click here. For more information about the legislation, click here.

House Bill 214 would move the Division of Public Health out of the Department of Community Health and establish a new, independent agency, the Department of Public Health, implementing the recommendation of the Public Health Commission. The new stand-alone agency would operate on the same budget as the Division of Public Health and provide Georgians a nimbler and more efficient public health agency with a clear focus on prevention and population-level health. The bill was passed by the House and passed through the Senate HHS Health Care Delivery Subcommittee on Wednesday. It now moves to the full Senate HHS Committee. For more information about the legislation, click here.

House Bill 229 would require that DCH process appeals requests and refer them for hearing before an Administrative Law Judge (ALJ) within 15 days. Currently, after the ALJ hears a case and renders an impartial decision, DCH may appeal the decision to itself.   HB 229 would remove DCH’s ability to overturn the ALJ’s decision. The bill did not pass by Crossover Day, which means that it is no longer viable this year unless attached to another piece of legislation. To learn more about the benefits of HB 229, click here. For more information on the legislation, click here.

House Bill 476 (pulled from the calendar on Crossover Day) would have established the Georgia Health Exchange Authority, the governance body for Georgia’s health insurance exchange. Under the Affordable Care Act, Georgia recently received a $1 million grant from the Department of Health and Human Services to begin planning for a health insurance exchange. HB 476 also would have created an Advisory Committee to make policy recommendations to the exchange governing board and the Governor by November 15, 2011 for next steps. The bill was pulled under pressure from tea party activists just prior to Crossover Day and is no longer viable this Session. Governor Deal has indicated he will move forward with an Advisory Committee. For the AJC article on HB 476 and the Georgia Exchange, click here.

Senate Bill 17 would establish a Special Advisory Commission on Mandated Health Insurance Benefits to study the social and financial impact of current and proposed health insurance benefit mandates and providers. The bill has passed the Senate and has passed through the House Insurance Committee.  To learn more about SB 17 and benefit mandates, click here for a recent AJC article. For more information about the legislation, click here.

Senate Bill 63 would enact a Georgia Medical Assistance Fraud Prevention Program utilizing smart card technology to verify identification of Medicaid recipients, first directing the Department of Community Health to develop and implement a pilot program. Implementing the bill could present barriers to accessing care, and the methodology proposed has not been proven to be a successful method to target fraud within the Medicaid system. Further, there has been some controversy over a vendor that has been lobbying for the bill. SB 63 has passed the Senate and has not yet had a hearing in the House.  To see the fiscal note on the bill as originally proposed, click here. For a recent AJC article on this issue, click here. For more information on the legislation, click here.

House Bill 461 and Senate Bill 177 would enter Georgia into an interstate “health care compact” to allow member states to opt out of any federal health care law. While interstate compacts are typically used to handle regional and multi-state problems such as transportation issues, water rights or environmental protection, they require approval from the U.S. Congress and the President of the United States. Thus, the compacts have no chance of becoming law. HB 461 passed the House and is in the Senate Insurance Committee. SB 177 passed the Senate and is in the House Insurance Committee. For a recent AJC article on this issue, click here.

Additional Analyses & Resources on Proposed Health Care Legislation in Georgia
You can also track the status of various health care related bills and download analyses and resources on these bills on our new legislative tracking page on the Georgians for a Healthy Future website. The page is available here.

Bump It Up a Buck Delivers Petitions and Rallies for an Increase in the Cigarette Tax

This week, the Georgia Coalition for Tobacco Prevention ran a 48-hour petition drive to raise awareness and support for the Bump It Up a Buck campaign—an effort to raise the state’s tobacco tax by a dollar.  Doubling expectations, at the end of the drive the coalition had collected over 1,000 names and on Wednesday, held a press conference with local physicians to highlight the momentum behind the movement and hand deliver the petitions to the Governor’s office.  Dr. Harry Heiman, a Professor at Morehouse School of Medicine and Board Member for Georgians for a Healthy Future explained that “tobacco has no redeeming quality.  There is nothing good that comes out of smoking tobacco.  We have the support—the only question is, do we have the political will?” To view coverage of the Press Conference, click here, and here and to read more, click here.

The Affordable Care Act and You

Insurance Commissioner Hudgens Requests Adjustment to Medical Loss Ratio Rules

Last week, Insurance Commissioner Ralph Hudgens submitted a request to the U.S. Department of Health and Human Services on behalf of the state of Georgia for an adjustment to the recently issued rules pertaining to medical loss ratio (MLR). The MLR rules are designed to ensure that consumers get value for their premium dollar by requiring insurers operating in the individual health insurance market to spend at least 80% of premiums they collect from consumers on medical care and health care quality improvement as compared to administrative expenses such as marketing and profits. The rules were developed by the National Association of Insurance Commissioners (NAIC) after a thorough process. States requesting waivers can propose a phase-in to the MLR requirements for the years 2011, 2012, and 2013 if they can demonstrate immediate implementation of the MLR standard would destabilize the individual health insurance market in their state. They cannot waive them entirely. Georgia thus proposed a phase-in period for the MLR Standard. The application detailing the adjustment request is available here. The data on Georgia insurers that the Insurance Department provided in support of its application is available here. A recent article on this issue from Georgia Health News is available here. The application is under review by the U.S. Department of Health and Human Services. Once deemed complete, public comments will be accepted. More information about how to file public comments is available here.

Focus on Primary Care

By 2014, more than a million uninsured Georgians will gain health insurance as a result of the Affordable Care Act, either through the Medicaid program (when it will be expanded to all Georgians at or below 133 percent of the federal poverty level) or through private insurance purchased through the exchange. Once these Georgians become insured, it is imperative that this coverage translates to access to the health care delivery system. A new state-by-state study of primary care physician supply projects that Georgia will need between 177 and 285 additional primary care physicians to meet the expected increase in primary care utilization resulting from the coverage expansion. In addition to sheer physician supply, an important policy priority will be to ensure that there is an adequate network of primary care physicians participating in the Medicaid program. Beginning in 2013, under the Affordable Care Act, there will be an increase in the Medicaid reimbursement rate for primary care providers such that it is at parity with Medicare reimbursement rates. This increase is funded entirely with federal dollars. Several new reports take an in-depth look at this issue. First, a study in the journal Milbank Quarterly provides state-specific projections of primary care utilization and necessary supply; second, a report by the Center for Studying Health System Change specifically examines primary care participation in the Medicaid program; and third, the Center for Health Care Strategies, Inc, provides a policy roadmap for states to implement the Medicaid primary care rate increase. Finally, a recent media article examines a renewed interest in primary care among medical students due to health reform. For more Georgia-specific information and policy recommendations on our state’s primary care supply, please see this recent presentation to the Georgia General Assembly made by the Georgia Area Health Education Centers.

One Year Later

This week marks the one year anniversary of the passage of the Affordable Care Act and advocates across the state and the country are evaluating the provisions that have already taken effect and seeing how far we have come in just one year.  On Monday, Georgians for a Healthy Future held a press teleconference with Terry Gardiner of the Small Business Majority and Alpharetta small business owner Julie Haley to detail the provisions of the law that help small businesses. These provisions include tax credits that offset the cost of providing insurance coverage for employees.  To read the press release, click here.  Beyond the benefits that small businesses see from the new law, young adults to seniors are also enjoying some new provisions.   The ability for a young adult to remain on a parent’s insurance plan up to age 26 will help get the next generation off on the right foot as they enter the job market in this sensitive economy.  The $250 donut hole checks for Medicare beneficiaries and free preventive services helps lower costs for seniors and allows them to better manage their care.  For more information about the impact of the ACA to date, check out our blog series, “One Year Later,” that explores these topics and more.

New Resources Available

The Consumers Union Guide to the Affordable Care Act was released this week and is a free, easy-to-use guide that walks the reader through parts of the ACA that have already been enacted.  It explores implications for people who currently have insurance, are uninsured, are a Medicare beneficiary, or own or work for a small business.  To access the guide, click here.  Additionally, Young Invincibles released a tool kit this week designed to help young adults figure out the best way to get covered.  To access the tool kit, click here.

March 15^th: Cocktail Reception and Fundraiser

If you haven’t done so already, please register for Georgians for a Healthy Future’s 2^nd Annual Cocktail Reception and Fundraiser.  Taking place at Ri Ra on Tuesday, March 15^th from 6:00pm to 8:00pm, the evening will include substantive updates on important issues facing the General Assembly as well as an opportunity to network and unwind before Cross-Over Day. We hope to see you there! Click here to purchase your ticket.

What’s New in Georgia

Update on the 2011 Legislative Session

Twenty-eight of the 40 legislative days are now complete. The Legislature is in session Monday and Wednesday of this week for legislative days 29 and 30. Day 30 is also known as crossover day, the deadline for bills to pass their chamber of origin to remain viable, unless attached to another piece of legislation as an amendment. Georgians for a Healthy Future is monitoring several bills that would impact health care coverage and access in Georgia. If you’d like to weigh in on these bills, you can find your legislator’s contact information here.

Recent Action Was Taken on the Following Bills:

House Bill 476 establishes the Georgia Health Exchange Authority, the governance body for Georgia’s health insurance exchange. Under the Affordable Care Act, Georgia recently received a $1 million grant from the Department of Health and Human Services to begin planning for a health insurance exchange. The exchange will be a structured marketplace where, beginning in 2014, individual consumers and small businesses can purchase health insurance plans from a range of private insurers, in many cases with tax credits to offset the cost of the premiums. HB 476 also creates an Advisory Committee to make policy recommendations to the exchange governing board and the Governor by November 15, 2011 for next steps. This is a constructive first step towards developing a better functioning, value-driven health insurance market for consumers in Georgia. The bill was favorably passed out the House Insurance Committee last week. For more information on HB 476, including several policy reports outlining policy choices for states, click here. For more information about the legislation, click here.

House Bill 47 would allow Georgia insurers to sell individual health insurance products with benefit designs equivalent to those sold in other states, circumventing current Georgia standards for basic consumer protections and essential medical services that all insurers must cover today under Georgia law. The bill was passed by the House last week and moves to the Senate Insurance Committee. For more information about the concerns this legislation raises for patients and consumers, click here. For more information about the legislation, click here.

House Bill 229 requires that DCH process appeals requests and refer them for hearing before an Administrative Law Judge (ALJ) within 15 days. Currently, after the ALJ hears a case and renders an impartial decision, DCH may appeal the decision to itself.   HB 229 removes DCH’s ability to overturn the ALJ’s decision, providing a fair and efficient administrative appeal process that protects the integrity and impartiality of the hearing before the Administrative Law Judge. The bill was favorably passed by the House Judiciary Committee last week and will be voted on by the House this week. To learn more about the benefits of HB 229, click here. For more information on the legislation, click here.

Senate Bill 63 would enact a Georgia Medical Assistance Fraud Prevention Program. The bill, as introduced, would have put in place a pilot program that would involve fingerprinting Medicaid patients at the point of service. A committee substitute bill stripped the biometric identification requirement and instead requires a pilot program utilizing smart card technology along with language that the Department may also implement a biometric verification process if it so chooses. Implementing the bill could present barriers to accessing care, and the methodology proposed has not been proven to be successful method to target fraud within the Medicaid system. To see the fiscal note on the bill as originally proposed, click here. For more information on the legislation, click here.

Additional Analyses & Resources on Proposed Health Care Legislation in Georgia
You can also track the status of various health care related bills and download analyses and resources on these bills on our new legislative tracking page on the Georgians for a Healthy Future website. The page is available here.

Budget Update

Last week, the House of Representatives passed the FY 2012 budget.  For the Department of Community Health, the House version of the budget restored proposed funding cuts to dental, vision, and podiatry services for adults on Medicaid; partially restored Medicaid reimbursement cuts to providers; and partially restored funding for the Children 1^st program which provides screening services for newborns and other at-risk children and links children to services to address developmental and other health needs.  To learn more about the health care budget, click here to read Georgia Budget and Policy Institute’s latest report.

Bump It Up a Buck Campaign Launches

On March 3^rd, the Georgia Alliance for Tobacco Prevention (American Cancer Society, American Lung Association, American Heart Association, ACS CAN, GASCO, Georgians For A Healthy Future, Georgia Public Health Association) launched the “Bump It Up a Buck” campaign, aimed at increasing the state’s tobacco tax by a dollar.  The bump of $1 will generate an estimated $350 million per year in revenue at a time when the state is facing a $2 billion deficit, and will help save critical programs and services, save kids from addiction to tobacco and encourage current smokers to quit.  To learn more about the campaign and to see useful fact sheets on the issue, visit www.bumpitupabuck.org and find them on Facebook and Twitter.

The Affordable Care Act and You

Early Retiree Reinsurance Program Provides Financial Relief to Georgia Health Plan Sponsors, Including State Health Benefit Plan

The Early Retiree Reinsurance Program (ERRP) was established by the Affordable Care Act to assist businesses, state and local governments, non-profit organizations, and other plan sponsors that provide health insurance to early retirees with the cost of that coverage. The ERRP is intended to help stabilize plans that provide insurance to early retirees. Without such coverage, early retirees between the ages of 55 and 64 face difficulties securing an affordable health insurance policy in the individual market because of their age or pre-existing health conditions. As of December 31, 2010, over 5,000 plan sponsors were approved for participation in ERRP, including 74 Georgia-based plans. The Georgia Department of Community Health was among the approved applicants, receiving $34.9 million for the State Health Benefit Plan. More information about the ERRP and the funds directed to Georgia employers is available here. For a full report on the ERRP in 2010, click here.

New Report Finds Full Implementation of the Affordable Care Act Will Reduce Georgia’s Rate of Uninsured by 12.6 Percentage Points

A new report by the Robert Wood Johnson Foundation estimates the effects of the Affordable Care Act on states, in particular the increases in insurance coverage, subsidies in the exchanges, Medicaid enrollment and federal spending.  Nationally, full implementation will lead to a 10.3 percentage point decrease in uninsurance for the non-elderly—in Georgia that reduction is 12.6 percentage points. In terms of the Medicaid program, upon full implementation, 1.8 million Georgians will be enrolled in Medicaid. Among this group, 29% will be newly eligible and newly enrolled.  For more data on the effects of full implementation and to read the full report, click here.

Progress Continues on Health Insurance Exchanges

Georgia’s planning work on a state health insurance exchange continued with the introduction of HB 476, and progress continues in states around the country. For primers on how exchanges will work, what points of flexibility states have, and resources for how to ensure the exchanges are consumer friendly, see Families USA’s Health Insurance Exchange Resources. For a recent AJC article on Georgia’s progress, click here.

National News

New Flexibility

President Obama outlined a proposal to move up the date from 2017 to 2014 in which states wishing to innovate to achieve the same coverage and affordability goals as will be met under the Affordable Care Act can apply for a waiver to pursue these strategies. As Georgians for a Healthy Future discussed in media interviews (here and here) on this topic, the provision is intended for states that are already at near-universal coverage and it is unlikely that Georgia would be able to shift course and set up a separate system that would meet the coverage and affordability benchmarks without doing it under the framework in the Affordable Care Act.

Employers and Health Care Reform

A new policy brief issued by the Robert Wood Johnson Foundation examines the issues surrounding the effects of health care reform on employers.  To expand access and strengthen the employment-based health system, the ACA requires midsize and large companies to make payments to the federal government if they do not offer health insurance to their employees and dependents starting in 2014. The brief explores the current state of employer-sponsored coverage and what the likely impact is of implementation.  To read the brief, click here.

Small Business: A Year Later

A new fact sheet from Small Business Majority details how provisions of the new health law address concerns with rising health care costs and ultimately affect small businesses across the country.   A recent study found that nationally 87% of small businesses are eligible for tax credits to help offset the cost of health care for employees.  Additionally, small businesses benefit from access to the Pre-Existing Condition Insurance Plan and free preventive care now available through health plans.  To learn more about the effects of the law on small business, click here.

What’s New in Georgia

Update on the 2011 Legislative Session

Nineteen of the 40 legislative days are now complete. The Legislature will be in session every day next week for legislative days 20 through 24. Georgians for a Healthy Future is monitoring several bills that would impact health care coverage and access in Georgia. If you’d like to weigh in on these bills, you can find your legislator’s contact information here.

Action was taken on the following bills this week:
House Bill 47would allow Georgia insurers to sell individual health insurance products with benefit designs equivalent to those sold in other states, circumventing current Georgia standards for basic consumer protections and essential medical services that all insurers must cover today under Georgia law. The bill was favorably passed out of the House Insurance Committee this week. For more information about the concerns this legislation raises for patients and consumers, click here. For more information about the legislation, click here.

House Bill 214would move the Division of Public Health out of the Department of Community Health and establish a new, independent agency, the Department of Public Health, implementing the recommendation of the Public Health Commission. The new stand-alone agency would operate on the same budget as the Division of Public Health and provide Georgians a nimbler and more efficient public health agency with a clear focus on prevention and population-level health. On Wednesday, the bill was favorably reported out of the House Health and Human Services Committee. Clickhere to read a release from Partner Up! for Public Health Campaign on this legislation. For more information about the legislation, click here.

House Bill 229 requires that DCH process appeals requests and refer them for hearing before an Administrative Law Judge (ALJ) within 15 days. Currently, after the ALJ hears a case and renders an impartial decision, DCH may appeal the decision to itself.   HB 229 removes DCH’s ability to overturn the ALJ’s decision, providing a fair and efficient administrative appeal process that protects the integrity and impartiality of the hearing before the Administrative Law Judge. This week, the bill was recommitted to subcommittee to incorporate amendments suggested by members after subcommittee approval. It will be heard again next week. To learn more about the benefits of HB 229, click here. For more information on the legislation, click here.

Senate Bill 17would establish a Special Advisory Commission on Mandated Health Insurance Benefits to study the social and financial impact of current and proposed health insurance benefit mandates and providers. The Senate passed the bill this week. However, because the Affordable Care Act will establish an essential benefits package—a federal floor—for all new health plans beginning in 2014, the impact of the proposed Commission is unclear. To learn more about SB 17 and benefit mandates, click here for a recent AJC article. For more information about the legislation, clickhere.

Additional Analyses & Resources on Proposed Health Care Legislation in Georgia
You can also track the status of various health care related bills and download analyses and resources on these bills on our new legislative tracking page on the Georgians for a Healthy Future website. The page is available here.

Health Care & The State Budget

On Thursday, the House Appropriations Health Subcommittee held a public hearing on the FY 2012 Department of Community Health (DCH) budget. The Medicaid and PeachCare for Kids programs, administered by DCH, are a critical source of health insurance for our state’s most vulnerable children and families. Due to stability protections in federal law, eligibility levels for these vital programs are maintained in the proposed budget. Still, three proposed changes to these programs raise concerns about access to care:  the proposed FY 2012 budget places additional co-payments on low-income patients; eliminates adult dental, vision, and podiatry services; and reduces provider reimbursement rates. Each of these provisions would have a negative impact on access to care by creating financial barriers for patients, shifting care to inappropriate settings, or discouraging provider participation in these programs.

If your legislator sits on the Appropriations Committee, please ask them to protect Medicaid and PeachCare for Kids. Members of the appropriations committee can be found here. You can find your legislator’s contact information here. To learn more about the Governor’s Proposed Health Budgets, click here for a recent analysis from the Georgia Budget and Policy Institute.

Primary Care in Georgia

On Monday, the House Appropriations Health Subcommittee heard invited testimony on Georgia’s primary care workforce. Georgia is below the national average on overall physician supply and primary care physician supply, and our primary care trends are getting worse. For more information about this important issue, click here.

A Statewide Screening Program for Children is At Risk

Children 1st is a statewide program that identifies and screens at-risk children ages birth to five and connects them to appropriate health care services.  The proposed FY 2012 budget cuts $2.9 million from this program, making it impossible for the program to continue to operate as a statewide program.  For more information or to raise your concerns about this cut, please contactHealthy Mothers, Healthy Babies Coalition of Georgia, which has been closely monitoring this issue.

Georgia Alliance for Tobacco Prevention

Georgians for a Healthy Future continues to work with the Georgia Alliance for Tobacco Prevention to increase the tobacco tax from $.37 to $1.37.  This dollar increase would bring us closer to the national average of $1.45 and bring in an estimated $400 million in new revenue to help balance the state budget.  If you would like to learn more about the Alliance or ways to get involved, please email Eric Bailey at the American Cancer Society.

The Affordable Care Act and You

The Pre-Existing Condition Insurance Plan:  New Resources & Information

The Pre-Existing Condition Insurance Plan (PCIP), authorized by the Affordable Care Act, is a new health insurance option for uninsured Georgians who are locked out of the insurance market due to a pre-existing condition. The PCIP covers a range of benefits, including the applicant’s pre-existing condition, and does not base eligibility for the program on income or any other factors aside from having been uninsured for 6 months, having been denied coverage for a pre-existing condition, and meeting U.S. citizenship requirements. Premiums for the plan are based on a standard population and vary only by age. As of February 1stof this year, 399 Georgia consumers gained coverage through the PCIP. The premiums are subsidized entirely with federal dollars and no state funds are associated with the program. In fact, the Governor’s FY 2012 budget proposal realizes savings of $680,263 from the movement of previously uninsured hemophilia patients who had been accessing life-saving drugs through a state program into the PCIP, where those drugs are now covered. For more information about the PCIP, click here to download our new fact sheet. If you think you are eligible for the program, you can apply here. If you work with consumers, patients, or volunteers and want additional resources to raise awareness of the program, including a downloadable widget to add to your website, click here.

Progress on the Health Insurance Exchange

This week, the Atlanta Journal-Constitution reported that Insurance Commission Ralph Hudgens said Georgia should move forward with creating and running its own insurance exchange.  The state health insurance exchanges, which must be operational by 2014, will be new marketplaces where most individuals and small businesses will buy insurance.  States are given the option of operating their own exchange or allowing their citizens to access a federal exchange.  Over the past few months, with a $1 million grant from the U.S. Department of Health and Human Services, the Governor’s Office of Planning Budget has been convening stakeholders and advocates to gather input on the feasibility of establishing a health insurance exchange in Georgia.  This week, Georgia PIRG released a new policy brief entitled, “Building a Better Health Care Marketplace” that discusses the key components of creating a strong exchange.  To read that brief, click here.

Medical Loss Ratio Update:  Consumer-Friendly Rules on Insurance Premiums May be at Risk in Georgia

Under a provision of the Affordable Care Act known as medical loss ratio, insurers operating in the individual health insurance market are required to spend at least 80% of premiums on medical services, improving value for consumers by limiting the amount of consumers’ premiums that can go towards administrative costs such as marketing and profits. This standard was developed through a transparent, fair, and methodical process undertaken by the National Association of Insurance Commissioners (NAIC). The rules are good for consumers, they promote value, and they hold insurers accountable for how premium dollars are spent. If states can demonstrate that these rules would have a destabilizing effect on the individual health insurance market, however, a state’s Insurance Commissioner can apply for an adjustment to the rules. Although there may be instances in which insurers genuinely cannot meet the new MLR standard and would be forced to leave a state’s market unless an adjustment is granted, most individual market insurers should be able—and expected—to spend no more than 20 percent of the premium dollars they collect on non-medical costs. Georgia’s Insurance Department is currently collecting information from insurers and will likely file a request for adjustment. Once the request is filed, there will be a 10-day window for public comment. To ensure that the insurance industry voice is not the only perspective heard, we encourage our partner groups to join us in filing public comments from the consumer perspective at the appropriate time. We will continue to provide information and updates on this issue as we learn more. If you or your organization would like to assist with preparing public comments, please contact us.

National News

D.C. Federal Court Ruling in Favor of ACA

On Tuesday, D.C. Federal Court Judge Gladys Kessler upheld the Affordable Care Act.  This is the third time that a court has reviewed the health reform law on its merits and found it constitutional.  Two rulings have struck down all or parts of the law and 12 cases have been dismissed outright. This ruling reinforces that the individual responsibility provision of the law was a reasonable measure for Congress to take and is in line with the Commerce Clause of the Constitution.  While the issue continues to be litigated by district, appellate and most likely the Supreme courts, it is clear that states must continue the work of implementation while these issues are being resolved to ensure that all Americans are able to access the benefits of the new law.

The CLASS Program

Last week, the Department of Health and Human Services released a new implementation brief on the Community Living Assistance Services and Supports (CLASS) Program.  The CLASS Program was created by the Affordable Care act to be a federally administered health insurance program designed to assist eligible individuals in purchasing long-term community living services and support.  Approximately 10 million seniors and people with disabilities need long-term services and supports and current options in place are insufficient to adequately provide for these citizens.  The CLASS Program will offer eligible beneficiaries:  advocacy services, advice and assistance counseling, and cash benefit. To learn more about the Class Program and its implementation timelines, click here.

What’s New in Georgia

Update on the 2011 Legislative Session

With thirteen Legislative days complete, several bills have been introduced that could impact health care consumers in Georgia.

House Bill 47 would allow Georgia insurers to sell individual health insurance products with benefits equivalent to those sold in other states. This could circumvent current Georgia standards for basic consumer protections and essential medical services that all insurers must cover today under Georgia law. The Health and Life Subcommittee of the House Insurance Committee heard testimony on this legislation on Wednesday. Georgians for a Healthy Future expressed our concerns to the subcommittee. The subcommittee plans to vote on the legislation next week.

House Bill 214 would create a separate public health agency, the Department of Public Health. On December 1, 2010, The Public Health Commission issued its final report to the Governor, Speaker, and Lieutenant Governor recommending that the Division of Public Health become an independent, cabinet-level state agency, with the Commissioner reporting directly to the Governor and serving as the state’s chief health officer.
This legislation implements the recommendation of the Public Health Commission. The bill is assigned to the House Health and Human Services Committee.  To read a recent Georgia Health News Article on HB 214, click here.

Senate Bill 17 would create a special advisory commission on mandated health insurance benefits in Georgia. The purpose of the commission would be to assess the impact of mandated health benefits and providers and advise the Department of Insurance on these issues, among other responsibilities. The bill was unanimously passed out of the Insurance and Labor Committee on Thursday.

Senate Resolution 140 seeks to dedicate funds for trauma care from existing vehicle registration fees that are already being paid to the state.  Trauma care is a significant problem in Georgia since there are only 16 trauma centers for the state’s 159 counties and particular lack of access in rural areas.  To read recent articles on trauma funding, click here and here.

We will continue to monitor these and other health-related bills throughout the Legislative Session.

Progress Continues on Health Insurance Exchange Feasibility Study

Over the past few months, with a $1 million grant from the U.S. Department of Health and Human Services, the Governor’s Office of Planning Budget has been convening stakeholders and advocates to gather input on the feasibility of establishing a health insurance exchange in Georgia. As policymakers consider options for how to structure an insurance exchange, Georgians for a Healthy Future will continue to weigh in on behalf of Georgia consumers. Our top priorities for the exchange are that the governing body be transparent and free of conflicts of interest and that the exchange will seamlessly facilitate enrollment into private health plans as well as Medicaid and Peach Care and that it will provide a robust mechanism for consumers to make true apples-to-apples plan comparisons based on value. The U.S. Department of Health and Human Services has announced a new round of exchange establishment grants. We do not yet know if or when Georgia will apply for the grants, but we will keep you updated as we learn more.  To read a recent article on the exchange feasibility study, click here.

Georgia Alliance for Tobacco Prevention Works for $1 Increase

Georgians for a Healthy Future has joined with a range of health care focused organizations to support a $1 increase in Georgia’s tobacco tax. Our current tobacco tax is only 37 cents per pack, well below the national average of $1.45. Increasing a state’s tobacco tax has demonstrable public health benefits: it reduces smoking and related death and disease; keeps kids from starting to use tobacco products; and reduces the long-term health care costs associated with treating illnesses attributed to tobacco use. A $1 increase will also generate an estimated $400 million in new revenue to mitigate cuts to other vital health care programs in the state budget. As the Special Joint Committee on Georgia Revenue Structure considers the recommendations of the Special Council on Tax Reform and Fairness for Georgians, we will alert you for opportunities to support a $1 increase in the tobacco tax.

The Affordable Care Act and You

Small Businesses and the Economy

A recent survey of 619 small business owners revealed that 1/3 of employers who do not offer health insurance said they would be more likely to do so because of the small business tax credits—credits which are available to 84% of small businesses here in Georgia because of the Affordable Care Act.  Additionally, the report explained that there is still a gap in education about the new law to small businesses—only 43% are familiar with the new tax credits available to them.  To read the full report, click here.  Small Business Majority has a tax credit calculator to help small business owners to determine what their credits might be.  Additionally, the National Women’s Law Center has a handy tool for non-profits to determine if they too qualify for the small business tax credits.  That can be accessed here.  In addition to the tax credits available through the new law, a recent report by Small Business Majority showed that the Affordable Care Act is helping to stimulate the economy and since its enactment, job growth has consistently grown and will continue to do so in the future.   To learn more about health reform and the economy, click here.

To those of you in the small business community or to those who work with them, Small Business Majority is holding a webinar on Thursday February 17^th at 3pm that will focus on what the new healthcare law means for small business.  It will focus on both federal and state provisions to help local small business owners understand how the law will affect them. Topics being discussed include: Small business tax credits— who’s eligible for them and how to claim them; State insurance exchanges; High-risk pools; Shared responsibility; Cost containment and; Tools and resources available for small businesses interested in learning more about the law. To RSVP for the webinar, click here.

Additionally, as we gear up to celebrate the 1^st Birthday of the Affordable Care Act, we are looking for small businesses that have benefitted from the new law and would love to hear your story.  Please contact Amanda Ptashkin to learn how to get involved.

New Proposed Rules Benefit Students

This week, the Department of Health and Human Services released proposed rules that would apply the Affordable Care Act’s consumer protections to college health plans starting in 2012, meaning college students will be guaranteed the same consumer protections and benefits as all Americans under the new law.  To read the proposed rules, click here.

National News

The Florida Ruling and Its Implications

On January 31^st, U.S. District Judge Roger Vinson of Florida was the first in the nation to strike down the entire health care reform law—a suit to which Georgia was a party. To date, 25 challenges to the law have been filed and 4 have been decided: 2 upholding the law and 2 finding all or part of the law unconstitutional.  Twelve cases were dismissed outright.  This ruling will have little impact on what is happening on the ground where many states are already moving ahead with implementation of the ACA.

This week, Gov. Deal, along with 28 other governors, sent a letter to President Obama urging him to direct the U.S. Department of Justice to expedite the appeals process in the multistate litigation against the new law before states begin implementing portions of it.  To read the letter sent to the President, click here.

Georgia consumers cannot afford to lose the benefits of the Affordable Care Act, including discounts for seniors struggling with the cost of lifesaving prescriptions, protections for children due to pre-existing conditions, and coverage for young adults up to age 26. To read a recent Georgia Health News article on the ruling, click here.

Medicaid Stability Protections May be at Risk

Stability protections, also known as “maintenance of effort” requirements, ensure that states do not adopt more restrictive eligibility levels or enrollment procedures in their Medicaid and Peach Care programs so that children and families can maintain stable health coverage. Several states have asked Congress to eliminate these federal stability protections so that they have flexibility to roll back eligibility for populations they cover at state option. While we recognize that states, including Georgia, are facing difficult budgetary climates, cutting health care coverage would make it harder for consumers to access primary care and manage conditions, resulting in poorer health outcomes and higher costs down the line. Cutting Medicaid would also have a negative impact on the doctors, pharmacies, and hospitals in Georgia who rely on Medicaid reimbursement funds. Please urge your Member of Congress in Washington to preserve stability protections in Medicaid and CHIP. For more information, click here.

What’s New in Georgia

The 2011 Legislative Session is Underway

Last week, the Georgia General Assembly briefly convened amid the ice and snow to begin the 40-day Legislative Session. Both the House and the Senate leadership have released committee assignments. In the House, the key committees for health care-related legislation are Insurance (Chair:  Representative Richard Smith), Health and Human Services (Chair:  Representative Sharon Cooper), and Appropriations (Chair:  Representative Terry England). On the Senate side, they are Insurance and Labor (Chair: Senator Greg Goggans), Health and Human Services (Chair:  Senator Renee Unterman), and Appropriations (Chair:  Senator Jack Hill). Information on the House Committee assignments is available here. Information on the Senate Committee assignments is available here. The Legislature is in adjournment this week for budget hearings. The Department of Community Health budget briefing is scheduled for this Thursday, January 20^th, at 10am in Room 341 of the State Capitol. Other budget briefings of interest on Thursday include the Department of Human Services budget briefing at 9am and the Department of Behavioral Health & Developmental Disabilities briefing at 11am.

Georgians for a Healthy Future will be monitoring health care-related developments throughout the 2011 Legislative Session. Click here to learn about our 2011 policy priorities and here to identify your state legislators. We also now have a calendar featuring a range of health care advocacy events associated with the 2011 Legislative Session available on our site. If you’d like to get involved with a lobby day or deepen your engagement in health care advocacy, please contact Amanda Ptashkin, our Outreach & Advocacy Director.

Georgians for a Healthy Future Calls for Transparent and Systematic Health Reform Implementation in the Atlanta Journal-Constitution

To make the most of the Affordable Care Act, Georgia should move swiftly to establish a commission to proactively coordinate the pieces of the law our state is required to put into place, such as an expansion of Medicaid, design elements that we can tailor for our state’s needs, such as the new health insurance exchanges, and maximize grants to strengthen our public health system and our health care workforce. A commission or task force could offer diverse input, including from the consumer, who is often overlooked. Some of this work is already happening informally within state agencies, but a systematic and transparent process accessible to consumers and stakeholders will ensure opportunities aren’t missed, all pertinent perspectives are heard and cross-cutting issues are handled efficiently. For the full article, click here.

Governor Deal Releases Budget Proposals

On Wednesday, Governor Deal released his budget proposals. The FY 2012 budget proposal for the Department of Community Health features a one percent Medicaid and PeachCare for Kids provider rate cut; the elimination of vision, dental, and podiatry services for adults within the Medicaid program; additional co-pays for patients within Medicaid and PeachCare for Kids; and reductions in funding for public health programs, among other provisions. While larger provider rate cuts had been anticipated, taken together, these budget cuts stand to negatively impact access to care for some of our state’s most vulnerable citizens.  For more information on the Governor’s health care budget proposals, click here. Additional details about the proposed budget will become available during the budget hearings on Thursday and at the February Department of Community Health Board Meeting. For more information on the state budget, see the Georgia Budget & Policy Institute’s budget primer. For information on the budget process, see the Governor’s Office of Planning and Budget.

Health Insurance Exchange Planning Continues

Georgians for a Healthy Future is actively engaged in the Health Insurance Exchange Feasibility Study currently underway. Under the Affordable Care Act, an exchange, or structured health insurance marketplace, must be up and running in each state by 2014. While most of the participants in the workgroups are representing the insurance industry, Georgians for a Healthy Future is representing the consumer voice in these meetings. As one of the central elements of implementation of the new health law, making the exchange work for consumers is critical. The next full meeting is this Friday, January 21^st. For more information about the exchange concept and the key benchmarks to build an effective exchange, click here.

Special Council on Tax Reform and Fairness Issues Final Report

The Special Council on Tax Reform and Fairness has released its final recommendations to the Legislature. While there is a recommendation within the final report to increase the tobacco tax to the regional average, Georgians for a Healthy Future has joined with other advocates to oppose this 31 cent increase and instead call for at least a $1 per pack increase in the tobacco tax. A 31 cent increase still places Georgia’s tobacco tax well below the national average and is insufficient to have a quantifiable impact on deterring youth smoking rates (keeping kids from starting to use tobacco and getting others to quit). A $1 per pack increase, by contrast, has clear health benefits and would bring much needed revenue to our state at a time when other vital health care programs within the state budget are being cut.

The Affordable Care Act and You

Health Reform Implementation Grant Opportunities for States in 2011

As states, medical providers, and community health centers, among others, prepare for full implementation of the Affordable Care Act, the new law provides a range of grant opportunities to improve access to quality health care. Last month, Families USA released a compilation of selected grant opportunities that pertain to health care coverage and access, “The Patient Protection and Affordable Care Act: Grants, Demonstration Projects, and Enhanced Federal Funding Opportunities Available in 2011.”  While not exhaustive, it is a useful document to determine the types of opportunities currently available in 2011.  To access the report, click here.

National News

Repeal Efforts Renewed This Week

Though the 112^th Congress is only a few days old, a major issue is already taking center stage: repeal of the new health law.  This Wednesday, January 19, the U.S. House of Representatives will vote on HR 2, a bill to repeal the Affordable Care Act. On Wednesday, January 19, please take a moment to let your Representative know that Georgians do not want our new health care protections taken away. Call 1-888-876-6242 and tell Congress to vote NO on the HR 2.

The cost of repeal is just too great.  Approximately 43,500 young adults would lose their insurance coverage through their parents’ health plans.  An estimated 80,400 on Medicare would see significantly higher prescription drug costs.  Repeal would also strip tax credits from 120,300 Georgia small businesses.  Beyond these setbacks, the financial burden is also overwhelming.  The Congressional Budget Office has estimated that repeal of the law will add $230 billion to the deficit over the next 10 years.  To read recent reports on the cost of repeal, click here and here.

On Wednesday, January 19, please take a moment to tell your Representative that Georgians have already started seeing the benefits of the law and what reform means to you.  Call 1-888-876-6242 and tell Congress to vote NO on the HR 2.

HAPPY HOLIDAYS!

Here at Georgians for a Healthy Future, we wish you and your families and happy and healthy Holiday Season and New Year!  The Peach Pulse will return to its every-other-week format in the New Year.  Happy Holidays!

What’s New in Georgia

Georgians for a Healthy Future Unveils Our 2011 Policy Priorities

Georgians for a Healthy Future formally unveiled our 2011 policy priorities last week. The priorities were developed with broad input from community stakeholders, and we look forward to working with our coalition partners to advance them in the coming year. Our advocacy efforts will be focused on five core issues:

1)    Support Consumer-Friendly Implementation of the Affordable Care Act

2)    Protect and Strengthen Quality Care for Medicaid and PeachCare Beneficiaries

3)    Preserve Consumer Protections for Georgians in Private Health Insurance Plans

4)    Strengthen Georgia’s Public Health System

5)    Support a More Sustainable Revenue Structure, Including an Increase in the Tobacco Tax

For more details about each of these policy priority areas, please visit the Georgians for a Healthy Future website. If you’d like to work with us to advance them, please contact us.

Health Care Unscrambled: Recap

Last week, Georgians for a Healthy Future held our first annual policy breakfast, Health Care Unscrambled, to discuss the challenges and opportunities that lie ahead in 2011 for health care policy. Anton Gunn, Regional Director for the US Department of Health and Human Services (HHS), spoke about the Affordable Care Act and opportunities for collaboration and partnership between stakeholders and HHS as implementation of the law moves forward. Alan Weil, Executive Director of the National Academy for State Health Policy, spoke about key decision points facing states around implementation of the new law. Dr. Phaedra Corso from the College of Public Health at the University of Georgia presented Georgia-specific demographic and political information that policymakers and advocates should consider as they move forward on health reform. All three presentations are now available on our website. Our Executive Director, Cindy Zeldin, rounded out the breakfast by presenting Georgians for a Healthy Future’s 2011 policy priorities. We look forward to working with you in 2011 to advance these priorities, and we’ll keep you informed on developments and advocacy opportunities around these issues. Finally, we’d like to issue a special thank you to our sponsors as well as to all in attendance. We hope you will join us again next year!

Public Health Commission Releases Final Report and Recommendations

The Public Health Commission, charged by the Georgia Legislature to determine the most appropriate structure for the Division of Public Health, issued its final report to the Governor, Speaker, and Lieutenant Governor on December 1, 2010. The unanimous recommendation of the Commission is for the Division of Public Health to become an independent, cabinet-level state agency, with the Commissioner reporting directly to the Governor and serving as the state’s chief health officer. To download the Commission’s full report, click here. To learn more about how to become an advocate for public health, visit the Partner Up for Public Health campaign website.

New Department of Community Health Commissioner Named

Governor-Elect Deal has named David Cook, Executive Director of the Medical Association of Georgia, as the incoming Commissioner for the Department of Community Health. In January, he will replace Clyde Reese, who will transition to the role of Commissioner of the Department of Human Services. For more information, click here.

2011 Legislative Session Calendar

The 2011 Legislative Session is shaping up to be a busy one.  With only 40 short days to get everything done, advocates needs to be well prepared and informed of important events and issues as they occur throughout the session.  To that end, Georgians for a Healthy Future has created the 2011 Legislative Session Calendar.  This calendar is a storehouse for upcoming advocacy events that impact the health and well being of Georgians.  Check back often to see what’s happening and how to get involved.  To have your event added to the calendar, please email Amanda Ptashkin.

Georgia Budget & Policy Institute Release 4 New Reports

Last week, the Georgia Budget & Policy Institute released four new reports that explore health and tax reform and what it means to the state and its residents.  The first report, Tax Reform Facts: Sales Tax Exemption on Groceries, discusses alternatives for raising revenues other than shifting the burden to middle to low-income Georgians through a regressive grocery tax—a tactic that is feared to gain traction once session starts.  The second report, Medicaid Expansion Facts: What’s in Store for Georgia’s Medicaid Enrollment?, explains how the new health law increases eligibility for Medicaid and provides states significant new funding to pay for the expansion and how the billions in new federal funding will help increase health coverage for nearly 500,000 Georgians without insurance. The third report, Georgia and the Federal Government Ensure Elderly and Newborns Have a Safety Net, explains how the Georgia works to protect its most vulnerable residents. This fact sheet provides an overview about who is served by the Medicaid program, how costs vary by population, and the income-eligibility criteria for Georgia’s Medicaid and PeachCare programs.  The last report, New Federal Tax Credit Benefits 84% of Small Businesses in Georgia, examines the new tax credits that rise from the new health law and how they could help nearly 120,000 small businesses in Georgia better afford health coverage for their employees.  For more information, visit the Georgia Budget & Policy Institute website.

The Affordable Care Act and You

State of Georgia Begins Work on Health Insurance Exchange Feasibility Study

Recently, the Governor’s Office of Planning and Budget (OPB) was awarded a $1 million grant from the U.S. Department of Health and Human Services to assess the feasibility of establishing a state run health benefit exchange. Under the Affordable Care Act, a health insurance exchange, or structured marketplace where individuals and small businesses can purchase affordable health insurance with federal tax credits, must be up and running in every state by 2014. States may set up their own exchange (either a single exchange for individuals and small groups or two separate exchanges) or rely on a federal fallback exchange that the Department of Health and Human Services would set up. With technical assistance from Georgia State University and the University of Georgia, OPB has been convening stakeholders over the past two months to examine these issues. Georgians for a Healthy Future and our coalition partners have been participating in these workgroups to ensure that the consumer and patient voice is at the table. The workgroups have been tasked with identifying the factors to consider, potential approaches, and the data needed for decision-making around several structural features of the exchange.  The next meeting is January 14th.  To get involved with one of the workgroups and for more information about upcoming meetings, click here. To learn more about health reform implementation in Georgia, see OPB’s new website at www.healthcarereform.ga.gov. For a detailed look through the consumer lens at the choices states face as they set up an exchange, click here. For a closer look at the population that would utilize the exchange, click here.

Update on Medical Loss Ratio Rules in Georgia

In November, the U.S. Department of Health and Human Services (HHS) issued interim final rules around medical loss ratio requirements. These rules require insurers operating in the individual health insurance market to spend 80 percent of premiums on medical services and were issued following a deliberative process by the National Association of Insurance Commissioners (NAIC), which developed the model regulation, as charged to do under the health law. These requirements will encourage transparency and facilitate better value for consumers. However, this win for consumers is at risk in Georgia. Our Insurance Department has indicated it will seek an adjustment for Georgia insurers under a process laid out within the federal rules. States may apply for an adjustment if the rules will destabilize their insurance marketplace. To determine this, HHS will weigh five factors when considering adjustment requests:  number of insurers likely to leave the market, number of individuals affected, availability of other coverage options, impact on premiums, and availability of brokers and agents. Once a request is made, public comment will be accepted for 10 days, and HHS has 30 days to consider the request. If you would like to join with Georgians for a Healthy Future as we develop our written comments, please contact us. For more information on this issue, click here.

New Resources Available

New Resources are being released daily to help states and consumers understand the new health law.  Families USA has a new report dedicated to best practices states can take in implementing state health insurance exchanges and a new report on how health reform aims at improving the lives of seniors and people with disabilities. The Commonwealth Fund released a report examining how baby boomers will be impacted by the new law and found that boomers in Southern and Western states in particular will benefit from provisions in the law.

The National Academy for State Health Policy has updated their new State Refo(u)rum website with useful information on implementing the new health law from work plans and timelines to state-specific analyses.  The Kaiser Family Foundation has also released a new issue brief entitled the Impact of Health Reform on Women’s Access to Coverage and Care. The issue brief reviews how the new law is expected to affect access to care and affordability of health coverage for women and explains the provisions in the new law related to preventive screening services, reproductive health, maternity care and women on Medicare.

National News

Child Nutrition Bill Signed by President

This week, President Obama signed the The Healthy, Hunger-Free Kids Act.  The passage of this bill marks an important success in the fight against child hunger and childhood obesity, as it will expand access to healthy school meals and will establish higher nutritional standards for school lunches. A summary of the Act’s key provisions, prepared by the Food Research and Action Center, can be found here.  To read a recent Washington Post article highlighting 12 of the key changes in the new law, click here.

What’s New in Georgia:

Georgia Elects New Statewide Officers, Governor-Elect Deal Names Transition Team

Last Tuesday, Georgia elected new statewide officials, including Governor-elect Nathan Deal, Insurance Commissioner-elect Ralph Hudgens, and several other constitutional officers. Governor Deal named his full transition team today. The list of members is available here.  To find out where the incoming Governor stands on health care issues, see the recent candidate questionnaire from the Healthcare Georgia Foundation. Also, while the role of the Insurance Commissioner on health care issues is less well known than that of the Governor, the new Insurance Commissioner is responsible for regulating health insurance in Georgia and enforcing consumer protections in health insurance. To learn more about how the incoming Insurance Commissioner plans to approach health care issues, see the results of our candidate survey. In addition, several new legislators were elected to the Georgia General Assembly.  To see the election results, click here.

Trauma Funding Referendum Fails on Election Day

The Yes 2 Save Lives Campaign was delivered a fatal blow on Tuesday when 53% of Georgians failed to approve Amendment 2, which asked voters to approve a $10 motor vehicle tag fee to fund a trauma care system, which would have generated approximately $80 million in revenue dedicated specifically to fund trauma care throughout the state. As such, Georgia missed an opportunity to secure a dedicated funding source for:  training 911 professionals, paramedics, critical care nurses and physicians; increasing rapid transport; providing the latest life-saving equipment and technology; and upgrading more emergency rooms to trauma centers.  Currently, there are only four level-1 Trauma Centers to serve 9.8 million Georgians.  Incidentally, deaths from trauma injuries in Georgia are 20 percent higher than the national average because access to trauma care is severely limited.  Despite the failure of the amendment to gain approval by the voters, groups like Georgians for a Healthy Future, Health STAT and others will continue to stress the need and urgency for trauma funding.  To read a recent AJC article on Amendment 2, click here.

161 Georgians Enrolled in Pre-Existing Condition Insurance Plan Since July

One of the early provisions of the new health law that went into effect this year was the creation of the Pre-Existing Condition Insurance Plan (PCIP) which provides people with pre-existing conditions an opportunity to purchase insurance without exclusions or higher premiums because of their conditions.  The PCIP, often referred to as a high-risk pool, is a bridge measure until 2014 when the health insurance exchanges will be up and operational and prohibit exclusions based on pre-existing conditions.  Back in July, many states opted to implement and operate their own high-risk pools, but Georgia instead allowed the Federal Government to operate the plan.  Figures released last week show that so far, 161 Georgians have already enrolled in the PCIP, part of the 8011 across the nation reported to have enrolled.  To view the data across the country, click here.  An estimated one in five Georgians has a pre-existing condition which could prevent them from securing private health insurance coverage.  Given that statistic, it would appear that enrollment for the PCIP is lower than expected given the need for such coverage.  It is important to remember that this is still a new program which has only been operational since July and there are procedural requirements that may be hampering enrollment. For example, for anyone applying, they must have been without insurance for six months and have been denied coverage, in writing, because of their condition.  As such, it is far too early to judge the merits of the program, but as the months go on and enrollment continues, we will see how Georgians with pre-existing conditions fare.  To read a recent AJC article on this issue, click here.

New Resource:  Georgia Health News Launched

This week, longtime health journalist Andy Miller launched Georgia Health News, an independent, nonprofit news organization that provides crucial, substantive information about health care in Georgia, including original reporting, consumer resources, and a blog. Visit the site here.

AIDS Drug Assistance Program Faces Funding Crisis:  Advocacy Opportunity

Georgia is one of nine states currently facing a funding crisis for the AIDS Drug Assistance Program (ADAP), which provides life-saving medications for low-income people living with HIV/AIDS. A waiting list was established for the program on July 1, and as of the end of October, there were 676 people on that list here in Georgia. The current funding gap is over $14 million. Advocates for people living with HIV/AIDS are seeking organizational sign-ons for a letter to President Obama and Members of Congress urging them to address this funding crisis with increased federal support. To learn more about the ADAP program, the consequences of this funding shortage for low-income people living with HIV/AIDS, and how to support the call for adequate funding of the program, please see Georgia Equality and the ADAP Advocacy Association.

The Affordable Care Act and You

State Health Refor(u)m

The National Academy for State Health Policy (NASHP) has devoted a section of its website to organizing and sharing resources developed by states to implement the new health law, including information about state legislation, coordinating councils, work plans, and timelines from across the country. The State Health Refor(u)m site is here. While there is no Georgia-specific information on the site at this time, the documents housed there are a helpful resource for advocates and policymakers working on implementation here in Georgia. We will hear from NASHP Executive Director Alan Weil about key decision points for states to consider at the Georgians for a Healthy Future policy breakfast on December 7^th. If you haven’t yet purchased your ticket for Health Care Unscrambled, you can do so here.

New Resource Available for Cancer Patients and Their Loved Ones

The American Cancer Society released a new consumer-friendly guide to help explain how the new health law will affect cancer patients and their loved ones.  The guide, entitled, “The Affordable Care Act: How it Helps People with Cancer and Their Families,”  describes how provisions of the law improve the quality of care and make health care more affordable, available and easier for patients to understand.  The guide also shares personal stories to illustrate exactly what the new law means for families affected by cancer.  To read the guide, click here.

New Resource:  The New Health Law and Free Clinics

The Georgia Free Clinic Network has released a new guide for charitable and free clinics and their management to help navigate the changing health care safety net landscape in light of the new health care law. This is the nation’s first comprehensive manual aimed at assisting free and charitable clinics to understand the new health law and make informed decisions. For more information, see the Georgia Free Clinic Network’s website.

HHS Announces New Federal Support for States to Develop and Upgrade Medicaid IT Systems

Under the new health law, beginning in 2014 health insurance exchanges will be a one-stop shop for consumers to review and purchase insurance coverage, including those eligible for Medicaid.  With the new law, there will be a large increase in the number of people eligible for the Medicaid program, and it will be critical that infrastructure and Information Technology (IT) is in place to meet this new demand.  Last week, the Department of Health and Human Services (HHS) announced new federal funding for states to streamline and upgrade their Medicaid eligibility systems in preparation for the changes.  Additionally, HHS announced guidance to help states design and implement the IT needed to establish exchanges.  These systems will help enroll people who qualify for Medicaid or PeachCare.  To read the HHS Press Release, click here.  This is different than a recent announcement regarding “Early Innovator” grants for IT Systems for the Exchange.  To learn more about that opportunity, click here.

New Funds Available to Support Community Health Centers

Last week, HHS Secretary Sebelius announced $335 million for existing community health centers across the country under the Expanded Services (ES) initiative. As part of the new health law, these funds will increase access to preventive and primary health care, including dental health, behavioral health, pharmacy, vision, and/or enabling services, at existing health center sites. Health centers requesting funds must demonstrate how the money will be used to expand medical capacity and services to underserved populations in their service areas. For more information and to view the grant application, click here.  Applications are due January 6, 2011 at 8 pm.  Currently, there are 26 Community Health Centers in Georgia that serve the needs of 76 counties.  They serve inner city neighborhoods, small towns and rural communities and make a difference in the lives of over 238,000 Georgians each year. To learn more about these Community Health Centers, visit the Georgia Association for Primary Health Care’s website.

What’s New in Georgia

Insurance Commissioner Candidate Survey Released

To educate Georgia voters on the role of the Insurance Commissioner with respect to health care issues, Georgians for a Healthy Future and Voices for Georgia’s Children surveyed all three candidates for Insurance Commissioner. Each candidate provided responses to eight questions about how they would approach the health insurance issues that fall under the purview of the office they are seeking. Today, our organizations are releasing a Voter Guide featuring those responses. Download the guide here.

On Election Day, Georgia voters will head to the polls to elect our state’s policymakers. Most voters are familiar with certain elected offices, like that of Governor, but many Georgians may be unaware of the importance, or perhaps even the existence, of the Office of State Insurance Commissioner.

The Insurance Commissioner runs the Georgia Department of Insurance and is elected every four years in a statewide vote. Among the core functions the Department of Insurance performs is the regulation of health insurance in Georgia. The Insurance Commissioner ensures that companies selling individual and small group policies in Georgia are financially solvent and enforces consumer protections and state laws regarding benefits that private insurers must include in policies sold in Georgia.

With the recent enactment of the Affordable Care Act, the new health care law, the role of the Insurance Commissioner has expanded. Our next Insurance Commissioner’s decisions will play an important role in shaping Georgia’s health insurance system for consumers in 2011 and well into the future.

Quality, affordable health coverage optimizes the health and wellbeing of Georgia’s children and families and ensures a healthy, productive workforce to grow our state’s economy. While the Insurance Commissioner alone is not responsible for the health of Georgia constituents, he or she will be one of a key group of elected and appointed state officials who together will implement different components of the new health law to maximize benefits for Georgians.

Georgia Receives Grant for Consumer Assistance Program

As part of the Affordable Care Act, the new health law, Georgia’s Department of Insurance applied for and received a grant for $822,156 on Tuesday to:

• Expand and enhance ability to provide assistance to consumers with health insurance issues, including ability to assist consumers wishing to formally appeal decisions made by their health insurer
• Improve capability to receive and track telephone calls from consumers seeking assistance by implementing calls center functionality
• Upgrade existing database systems to enhance the security of personally identifiable information and to obtain the ability to collect, track, and report data requested by Department of Health and Human Services

While these resources are needed to bolster existing capacity within the Department of Insurance, Georgia has not funded and has left vacant the role of independent consumer advocate since 2003. The Affordable Care Act includes stronger regulations on private health insurers and a range of new consumer protections. As these new provisions take effect, there will be a commensurate increase in the need for consumer navigation and assistance. An independent consumer advocate accountable only to consumers would be a welcome first step to meeting this increased need.

A number of other states receiving grant awards used their funds to create this sort of position or department, including North Carolina and Tennessee. To learn how other states are utilizing the Consumer Assistance Program grants, click here.

New Report Shows that 934K Georgians to Receive Premium Health Care Tax Credits in 2014

A new report released by Georgians for a Healthy Future and Families USA shows that 933,900 Georgians will be eligible for new tax credits beginning in 2014 that will significantly reduce the cost of private health insurance for individuals and families. The tax credits will offset a portion of the cost of health insurance premiums, and Georgians’ tax reductions will approximate $3.6 billion in that year.

Some key findings of the report show that working families will benefit the most:

• Approximately 823,700 Georgians will be in families with a worker who is employed full-time
• Another 71,500 people will be in families with a worker who is employed part-time

The tax credits will benefit both Georgians who are currently uninsured , who will utilize the tax credit to help purchase health insurance and Georgians who are currently insured who will use the tax credit to relieve some of the burden of health costs by making premiums more affordable.

• Approximately 466,400 uninsured Georgians will be eligible for a premium tax credit to purchase insurance
• Another 467,600 insured Georgians will be eligible for a premium tax credit to help with the cost of insurance

These tax credits will be financed entirely with federal dollars and will be available to Georgians purchasing insurance through the new health insurance exchanges. The state of Georgia was just awarded a grant from the Department of Health and Human Services to begin planning for an exchange here in Georgia. This is an opportunity for our state to ensure this marketplace navigates consumers to the appropriate health insurance option, whether that be Medicaid, PeachCare for Kids, or private insurance that will now be made affordable through these hefty tax credits.

To read the report, Lower Taxes, Lower Premiums, in its entirety, click here.

Mental Health Care in Georgia to Improve with Recent Court Decision

This week, the State of Georgia and the United States Department of Justice settled the Justice Department’s litigation against the state based on both conditions in the state’s seven psychiatric hospitals and the lack of community services for people with mental illness and developmental disabilities.  Olmstead was at the heart of the lawsuit and is central to the settlement agreement.  In Olmstead, the U.S. Supreme Court held that people with disabilities have the right to receive services in the community rather than in institutions.

Highlights of the settlement include:

• 9000 people with mental illnesses will receive services
• Increased funding for individuals with mental illnesses and developmental disabilities by approximately 59 million over next year and a half.
• 150 – 250 additional people with developmental disabilities will obtain Medicaid vouchers each year over next five years
• Increased family supports to 2350 additional people with developmental disabilities by 2015
• Housing subsidies for 2000 people with severe and persistent mental illness by 2015
• 22 Assertive Community Treatment Teams that will serve 100 people each that will be brought to fidelity by 2015
• New case management, peer support, crisis stabilization, and supports for individuals with disabilities.

The settlement, over a decade in the making, is a success for the mental health and developmental disability community and will make great strides to ensuring that these populations receive the care they need in the setting that is right for them. To learn more, click here for a recent AJC article and to read the Department of Justice press release, click here.

Public Health Commission Meeting

The Public Health Commission met for the fourth time on Monday, October 18.

The Commissioners voted to instruct their contract consultant to draft a report for their review that recommends Public Health become an independent agency, with an “attached” agency being the back-up preference. The next meeting of the Public Health Commission is scheduled for November 15 and its final report is due on December 1, 2010. For more information about the Public Health Commission, click here.

The Affordable Care Act and You

New Interactive Timeline for Implementation

The Kaiser Family Foundation has updated their Health Reform Source to include an interactive implementation timeline. The timeline is designed to explain how and when the provisions of the health reform law will be implemented over the next several years. You can show or hide all the changes occurring in a year by clicking on that year. Click on a provision to get more information about it.  To view the timeline, click here.  Additionally, if you have not done so already, be sure to check out KFF’s video Health Reform Hits Main Street here.

National News

Child-only Health Plans

Among the provisions of the Affordable Care Act that went into effect on September 23^rd was a requirement that insurers no longer deny coverage to children with pre-existing conditions. While only a small number of children are impacted by this change, they tend to be particularly vulnerable (without access to employment-based health insurance through a parent and ineligible for Medicaid or CHIP). In a controversial response to the new requirement, several insurance companies announced that they would stop selling child-only policies due to concerns that families would apply for these plans only after a child became sick. On October 13^th, U.S. Department of Health and Human Services (HHS) Secretary Sebelius sent a letter to the National Association of Insurance Commissioners clarifying the HHS regulation and outlining options for insurers and states. To read the letter, click here. For additional information on this issue from the Georgetown Center for Children and Families, click here.

Health Care Lawsuit Moves Forward in Florida

Last week, the U.S. District Court in Pensacola, Florida permitted a lawsuit against the Affordable Care Act to move forward.  Dismissing four other claims, Judge Vinson allowed the case to proceed to address the constitutionality of two main issues: the individual mandate and the Medicaid expansion.  Georgia is one of twenty states involved in the suit.  Despite this ruling in Florida, judges in Maryland, California, and recently Michigan have dismissed cases challenging the constitutionality of the Affordable Care Act.  Additionally, despite the legal challenges to the law, many provisions have already gone in to effect and will continue to do so while the issue is litigated.  Already, this law has:

• Ensured that kids with pre-existing condition have access to coverage;
• Given tax-credits to small-businesses that provide insurance to their workers;
• Allowed recent college graduates looking for jobs to stay on their parents plans;
• Sent checks to seniors to help pay for their prescriptions; and
• Protected consumers from insurance company abuses.

To read more about the lawsuit, click here and here.

What’s New in Georgia:

New Medicaid Figures in Georgia

In December 2009, nearly 1.5 million Georgians (874,000 children and 573,000 adults) were enrolled in the Medicaid program, an increase of 8.8 percent over December 2008 figures, according to the Kaiser Family Foundation. In the wake of the 2009 recession and unprecedented declines in employment-based coverage, Medicaid programs across the country saw the largest leaps in enrollment since the 1960s. While the Medicaid program provided coverage to many Georgians who lost workplace health insurance and would have otherwise gone uninsured, the number of Georgians without health insurance still leapt to nearly 2 million in 2009.

The Kaiser Family Foundation (KFF) release provides state-by-state data on Medicaid enrollment in 2009 as well as figures on FY 2010 Medicaid spending from a 50-state survey of Medicaid officials. For more state figures, visit the snapshot here.  For the survey of Medicaid officials, click here. For a recent AJC article discussing this topic, click here.

Georgia Community Health Centers receive more than $8 million in federal funds through the Affordable Care Act

On October 8^th, the Department of Health and Human Services announced $727 million in awards to 143 community health centers across the country. Over the next five years, under the Affordable Care Act, $11 billion in funding for the operation, expansion, and construction of community health centers will be available, nearly doubling the capacity of these centers to provide primary care services to patients regardless of insurance status or ability to pay. Two community health centers in Georgia received grants totaling more than $8 million. The full list of grantees is available here. For more information about community health centers in Georgia, see the Georgia Association for Primary Health Care.

Step up for Kids Day

On Monday, October 4, Voices for Georgia’s Children, in partnership with Every Child Matters, held their annual Step Up for Kids Day at the Sheltering Arms Early Education and Family Center.  The speakers discussed the importance of investing in children from birth to age five, thus providing a strong foundation for their future success. Parents, teachers and legislative leaders powerfully described the need to invest in the early years of children’s lives and urged those in attendance to get involved and speak up for children’s issues.  To learn more about the event and ways you can get involved, visit the Voices for Georgia’s Children website.

Yes 2 Save Lives

With less than a month to go until the general election, efforts to improve the state of Georgia’s trauma system are in full swing.  The Yes 2 Save Lives campaign was formed to educate Georgians about the current status of trauma care across the state and to build support for a constitutional amendment to allow for an annual $10 car registration fee. Funds would be directly used to provide a dedicated funding source to improve and expand the trauma care system across the state.  Deaths from trauma injuries in Georgia are 20 percent higher than the national average.  It is estimated that funds collected will generate $80 million a year and go directly toward improving our statewide trauma care system.  To check out the latest ads from the Yes2SaveLives campaign, click here.

HealthSTAT will feature a panel of experts on trauma care at their next meeting, Wednesday, October 20, at 8:00pm at Manuel’s Tavern.  They will also have campaign materials and yard signs available.  Contact Michelle Putnam at HealthSTAT if you are interested in learning more about the campaign or need any campaign materials.

Revenues Continue to Rise in September

State revenues in September increased by 5.7 percent over September 2009 revenues, according to data released by the Georgia Department of Revenue. While this increase is good news, vital services are still at risk as the long road to recovery continues. For more information about what the revenue numbers mean and the impact on the state budget, see the Georgia Budget & Policy Institute.

Special Council on Tax Reform and Fairness Continues its Important Work

At a September 29^th meeting, the Special Council on Tax Reform and Fairness for Georgians which is charged with studying the state’s revenue structure and making recommendations for legislation, heard presentations from a variety of business industries, learned how city and county taxes work, and dedicated the last hour of the meeting to presentations from emerging industries in Georgia. The meeting minutes are available here.

The Affordable Care Act and You:

Georgia Preparing for Health Insurance Exchanges

Georgia has been awarded a $1 million planning grant for the development of a health insurance exchange where consumers can shop for coverage.  The Governor’s Office of Planning and Budget will administer the grant and use it do the following:

• Form an Exchange Work Group to carry out the activities of the Georgia Health Benefit Exchange Feasibility Study. An Exchange Advisory Committee will also be formed with broader representation from key State agencies and stakeholder groups.
• Gather stakeholder input through an advisory committee, large group meetings to educate and inform stakeholders, focus groups, and web-based surveys. Website and email notices will be used to keep stakeholders and the general public informed.
• Determine whether or not Georgia should establish an Exchange and the implications of doing so on insurance markets both in Georgia and nationally.
• Provide recommendations on governance structure and regulatory changes required to establish as Exchange to decision makers.

Healthcare.gov Gets an Upgrade:

In an on-going effort to provide health care consumers with the most up-to-date and useful information about the new health care law, the web portal, www.healthcare.gov, has added more information aimed at helping people navigate the health care waters.  On October 1, they added important new pricing and benefits information for private insurance plans offered to individuals and families, giving consumers the power to compare costs and the protections offered by different plans.  In addition, information about preventive care has been updated to reflect services that insurers are now required to cover at no cost.  To learn more about new additions to the web portal, watch this video.

New Resources Available

New resources are now available, courtesy of AARP, to help people understand the implications of the new health care law.  The first is a fact sheet that is aimed at helping people in rural areas understand what the new law means for them.  Click here to learn more. Second, AARP has held and will continue to hold a series of webinars aimed at explaining the law and what it means for different populations.  Click here to access the archived webinars or to sign up for one in the future.  Lastly, there is a helpful question and answer document aimed at highlighting and dispelling Medicare and Medicaid scams.  Click here to access that document.

Missed Opportunity: Rate Review Grant Funding

The Affordable Care made significant changes to the purchase and regulation of health insurance, including the allocation of funds for states to improve accountability and oversight over insurance industry premium increases — a rate review process open to the public. On August 16, the Department of Health and Human Services announced grant awards of $1 million apiece to forty-five states and the District of Columbia; Georgia did not apply for the funding.  Georgia was one of only five states that did not apply for the rate review funds (the other four being Alaska, Wyoming, Iowa, and Minnesota).  The application process was reopened for the five states who had not applied for the funding but Georgia has no immediate plans to apply for those funds.

Pre-Existing Condition Insurance Plan Briefing Now Available:

One of the earliest elements of the Affordable Care Act, the Pre-Existing Condition Insurance Plan (PCIP) went into effect over the summer. In Georgia, there are an estimated 224,658 individuals who are potentially eligible for the PCIP, according to a new issue brief from the Commonwealth Fund. Georgia was one of 24 states that opted not to establish its own plan; however, uninsured Georgia consumers with pre-existing conditions can sign up for the federal PCIP. The new Commonwealth Fund report examines eligibility, benefits, premiums, cost-sharing, and oversight of the PCIP programs, as well as variation of the plans from state to state. The issue brief is available here.

National News:

On the national level, there have been many issues our partner organizations have been following. Here is an update on some of these pieces of legislation.

School Nutrition Bill Fails

The Child Nutrition and WIC Reauthorization Act expired on September 30, 2010 without a vote by the House of Representatives. In August, the U.S. Senate passed the Healthy, Hunger-Free Kids Act (S. 3307), which in part expands access to healthy school meals, establishes higher health standards for school lunches, and regulates the food available in school vending machines. On the House side, the House Education and Labor Committee passed the Improving Nutrition for America’s Children Act (H.R. 5504), but the full U.S. House of Representatives had not yet voted on that legislation. Though authorization of the child nutrition programs, including school meals, the special nutrition programs for women, infants and children known as WIC and other feeding programs, expired Sept. 30, they were extended by the resolution that will fund the government until Congress returns.  Despite the setback, advocates will continue to work on this issue.  It is speculated that the issue may be taken up after the November election.

The National Neurological Diseases Surveillance System Act Passes House

The National Neurological Diseases Surveillance System Act (H.R. 1362) would direct the Centers for Disease Control and Prevention (CDC) to create a national surveillance program on neurological diseases, such as MS and Parkinson’s. This legislation will establish a national data surveillance system that will track and collect data on the epidemiology, incidence, prevalence, and other factors of neurological diseases, including multiple sclerosis and Parkinson’s. Currently, such a national coordinated system does not exist to collect data on MS. The development of a surveillance system will address this gap by gathering all existing data on the incidence and prevalence of MS in one location. As a result, this system could help uncover and inform promising areas of MS research such as: genetic and environmental risk factors, and support the discovery of disease therapies, treatments, and one day—a cure.

What’s New in Georgia

Care Beyond College

September 23rd marked the 6-month anniversary of the signing of the Affordable Care Act.  On the 23^rd, several key provisions impacting children and families took effect.  To highlight these new provisions and what they mean for Georgia families, Georgians for a Healthy Future hosted a public forum at Emory University entitled “Care Beyond College.”  Among the elements of the law now in effect is a provision allowing young adults up to age 26 to remain on a parent’s insurance plan regardless of school status. Other pieces of the Affordable Care Act that went into effect this week include the elimination of lifetime benefit caps, a requirement that there be no cost sharing tied to preventive services in private health plans, the elimination of pre-existing condition exclusions for children, among others. A summary of the new provisions now in effect can be found here.

At Thursday’s “Care Beyond College” event, a line-up of speakers shared their unique perspectives on the health law and the new provisions.  Joann Yoon, Associate Policy Director of Child Health for Voices for Georgia’s Children, explained how the new provisions will work and shared a personal story about her experience trying to maintain coverage when she graduated from law school. Dr. Minesh Shah, a Primary Care Internal Medicine Physician at Grady Health System, shared his experiences in serving young adults who often go without coverage to the detriment of their health and often times their academics.  Dr. Michael Huey, Executive Director of the Emory Student Health and Counseling Services, was on hand to speak specifically to the Emory community and how changes in the Affordable Care Act will affect the student plan on campus.  Vicky Kimbrell, a parent and legal services attorney, shared her personal story of being a health care attorney with an uninsurable 22-year old who will now benefit from the dependent care provision of the law.  To round out the forum, Representative Pat Gardner shared her thoughts on the legislature’s role in making sure implementation goes smoothly and works for Georgia’s families.

Several resources and information sheets were shared to further explain the new provisions of the law.  For the U.S. PIRG “The Young Person’s Guide to Health Insurance,” click here.  For the Center for Children and Families briefing, “September 23 Health Care Reforms: Making Insurance Work for Children and Families,” click here.  For the Georgia “Getting Covered” fact sheet, click here.

Nearly Two Million Georgians Uninsured in 2009

On September 16^th, the Census Bureau released new figures on health insurance in the United States. In 2009, the number of uninsured Americans topped 50 million, propelled by unprecedented declines in employer-sponsored coverage during the recession. Here in Georgia, there were 1.9 million individuals without health insurance, or one in five Georgians. The Affordable Care Act will extend coverage to most of these uninsured Georgians by 2014, when the law is fully implemented. To read the Census Bureau’s report on the new health insurance figures, click here. To read more about the implications for Georgia, click here.

Health Care 2010 and Beyond: A Symposium Exploring the Health Care Law and What it Means for Georgia

During the month of September, Georgians for a Healthy Future partnered with the Georgia Budget and Policy Institute, Voices for Georgia’s Children, and AARP to engage community leaders, public health professionals, medical providers, and other stakeholders in six cities throughout the state of Georgia in a discussion about the Affordable Care Act and what it means for Georgia. We visited Athens, Rome, Butler, Tifton, Macon, and Savannah. If you are interested in copies of the power point presentations that the speakers gave or in the materials we distributed, please e-mail us. You can also view our photos from the symposia here.

Public Health Commission Meeting Underscores Need to Highlight Importance of Public Health

The Public Health Commission, charged by the Georgia Legislature with identifying and recommending an appropriate organizational structure for the Division of Public Health, held its third meeting in Atlanta on September 13th.  The Commission heard from legislators, state officials, and policy experts. The legislators highlighted the need for clearer communication between the Division of Public Health and legislators about the mission and function of public health in Georgia. According to the testimony, creating a new state agency in the current budgetary climate is a challenge compounded by a lack of overall confusion within the Legislature about the role of public health. More information about the Commission is available here. A presentation given by the Georgia Budget & Policy Institute at the September 13^th meeting explaining public health and the state budget is available for download here. The next meeting of the Commission is scheduled for October 18^th.

Next Meeting of the Special Council on Tax Reform and Fairness

The next meeting of the Special Council on Tax Reform and Fairness will be held on Wednesday, September 29th at 1:00 PM in the auditorium of Cecil B. Day Hall at Mercer University’s Cecil B. Day Graduate and Professional Campus in Atlanta. The purpose of the council is to study the state’s revenue structure and make recommendations for legislation by January 10, 2011. Georgians for a Healthy Future is monitoring the work of the council because we want to ensure that our state has adequate revenues to meet the essential health care needs of Georgia’s most vulnerable children and families. More information about the council, including meeting minutes and background materials from previous meetings, is available here.

National News

Update on the Prevention and Public Health Fund

The Prevention and Public Health Fund, a $15 billion fund designated by the Affordable Care Act for use in communities across the country to target key public health issues such as tobacco cessation and obesity prevention and to strengthen local and state public health infrastructures was at risk of being gutted through an amendment under consideration in the United States Senate last week. In a 52-46 vote, the amendment failed and this vital fund was preserved. More information about the fund is available on the website of the Trust for America’s Health. Information about last week’s Senate vote is available here.

HHS Reopens Application Process for Rate Review Grants

On September 1^st, the Department of Health and Human Services reopened the application process for states to apply for federal grants of $1 million per state to review proposed health insurance premium increases and take action against unreasonable rate hikes. In the first round of applications, Georgia was one of only five states that did not apply for the grant. Only those 5 states are eligible to apply for the second round of grants, and applications are due to HHS by September 30, 2010. Should Georgia apply, this grant opportunity would enable our policymakers to develop strategies to protect consumers against unfair premium increases. More information is available here and here.

The Affordable Care Act and You

New Provisions Go in to Effect: New Resources Available

September 23 marked the 6-month anniversary of the signing of the Affordable Care Act and with it came many new provisions that will benefit families all across Georgia.  A number of new resources are now available to explain these new provisions and help health care consumers understand exactly how they can benefit from the new changes.  Consumers Union released a consumer’s guide to health reform, available for download here. Community Catalyst has a publication, entitled “Six Months In: Who is the Affordable Care Act Benefiting in your community?”  You can read that publication here.  Additionally, Families USA has compiled several useful fact sheets, publications, videos and other useful resources describing, in detail, the new protections.   You can access that information here.

Health Reform Hits Main Street

Got a few minutes to be entertained and educated at the same time? This new animated video from the Kaiser Family Foundation hits the highlights of the Affordable Care Act in a fun-to-watch and easy-to-digest format. Share it with all of your friends! A new health reform gateway from the Kaiser Family Foundation also features a customizable health reform implementation timeline and an interactive map of the United States containing state-by-state health care data and news.

Health Reform and Rural Communities

Rural communities in Georgia face a unique set of health care challenges, particularly in the area of access to medical care. Several provisions of the Affordable Care Act aim to increase the number of physicians and health care providers practicing in rural communities. The Center for Rural Affairs analyzed the elements of the new law that target an expansion of the rural provider workforce in a new issue brief entitled “Health Care Reform, What’s In it:  Rural Communities and Rural Medical Care.” The report is available here.  Earlier this week, the Georgia Rural Health Association held its annual meeting in Young Harris, Georgia. The meeting featured a strong line up of presentations and break-out sessions.  Visit the GRHA website for more information and to obtain copies of the presentations.

WHAT’S NEW IN GEORGIA:

Young and Insured:

On September 23, 2010, the dependent care provision of the Affordable Care Act goes into effect, allowing young adults up to age 26 to remain on their parents’ health insurance plans regardless of their school status.  To raise awareness about this new coverage option and to provide information about how it will work, Georgians for a Healthy Future will be holding an event on the Georgia State University Campus on Thursday, September 23^rd.  Speaking at the event are students as well as parents affected by the new provision, a physician to illustrate the provider-perspective, and others with a stake in this new insurance option.  We encourage all those in the Atlanta area with an interest in learning more about this new coverage option for young adults to attend this event and encourage young adults and parents to attend.  For more information, email Amanda Ptashkin.  Additionally, the national group Young Invincibles has launched a new website to help those that will now be eligible for dependent care to learn more about it.  Visit www.gettingcovered.org for more information.

Is it Worth $10 to Save a Life?

Only 15 designated trauma centers serve the state’s 9.3 million people–an inadequate number leaving too many Georgians without rapid access to life-saving trauma care. As a result, of the 40,000 cases of major trauma each year in Georgia, only 10,000 are treated at one of these designated trauma centers.  In November, Georgia voters will be asked to approve a constitutional amendment for an annual $10 car registration fee.  The $10 vehicle registration fee will dedicate funding for specialized medical services that help people survive serious injuries across the state.

Trauma care in Georgia is far from what it needs to be to address the needs of the state’s population.  Only four hospitals in the state are equipped to deal with the most critical injuries. Dedicated funding will help open new trauma centers, and keep those that exist from closing.  To learn more about the campaign to pass the ballot initiative and what you can do to get involved, visit www.yes2savelives.com or contact Howard Franklin to have your organization join the advocacy efforts.

Tax Revenues Continue to Rise in August:

On Wednesday, Governor Perdue announced that tax collections for August 2010 were up by almost 13 percent over August 2009 collections, marking the third consecutive month of gains over the previous year’s month. As a result, Fiscal Year 2011 tax collections are up 8.6 percent over last year’s numbers at this point in the FY 2010 Fiscal Year. The FY 2011 assumes 4 percent growth over FY 2010 for the entire year; for now, the budget cuts that Governor Perdue ordered earlier this summer remain in effect. For more information, click here. For additional state budget analysis and information, see the Georgia Budget & Policy Institute.

NATIONAL NEWS:

Public Health and Prevention Trust Fund at Risk:

The Affordable Care Act includes a major new investment in prevention and public health:  The Prevention and Public Health Fund is designated for use in communities across the country to target key public health issues such as tobacco cessation and efforts to reduce obesity by encouraging better nutrition and increased physical activity. The funding will also be used to strengthen state and local public health infrastructure, support data collection and analysis for community-based and clinical-based prevention activities and to expand and improve training for the public health workforce. Here in Georgia, these funds will be critical to strengthen our public health system. The fund, however, is at risk of being gutted through an amendment proposed by U.S. Senator Mike Johanns (R-NE) on which the U.S. Senate will vote on September 14th.

The Johanns amendment would use the Prevention and Public Health Fund as an offset to repeal a tax compliance provision (also created under the Affordable Care Act) through the Small Business Jobs and Credit Act. The shortfall that this creates would be paid for by eliminating the $11 billion from the Prevention and Public Health Fund. If this amendment passes, there will be no funding to support these crucial public health initiatives. An alternative amendment proposed by U.S. Senator Bill Nelson (D-FL) would also address the concerns raised by small businesses on the tax compliance provision but would preserve the Prevention and Public Health Fund. More information is available here. Please contact Georgia Senators Johnny Isakson and Saxby Chambliss and ask them to support the preservation of the Prevention and Public Health Fund. To learn more and take action, click here.

Connecting Kids to Coverage Challenge:

On September 3rd, Secretary of Health and Human Services Kathleen Sebelius announced a renewed effort to cover the nearly 5 million uninsured children throughout the country, including 193,000 children here in Georgia, who are eligible for but not enrolled in existing Medicaid and CHIP programs. In Georgia, 80.6% of children eligible for these programs are enrolled, which is not statistically different from the national average. In conjunction with this announcement, two companion reports were released in the journal Health Affairs, one releasing state-by-state data on eligible but enrolled children and the other describing tools to enroll eligible children. To learn more about the challenge, including the range of organizations who are participating, see www.insurekidsnow.gov. For more information about children’s health here in Georgia, see www.georgiavoices.org.

Opportunity to Support Child Nutrition Programs:

The Child Nutrition and WIC Reauthorization Act expires on September 30, 2010. In August, the U.S. Senate passed the Healthy, Hunger-Free Kids Act (S. 3307), which in part expands access to healthy school meals, establishes higher health standards for school lunches, and regulates the food available in school vending machines. On the House side, the House Education and Labor Committee passed the Improving Nutrition for America’s Children Act (H.R. 5504), but the full U.S. House of Representatives has not yet voted on that legislation. When Congress returns from summer recess on September 13, they are expected to act on this issue. While both pieces of legislation improve the nutritional quality of food served to children in schools and improve access to meals, the House language is more comprehensive in its approach to addressing child hunger. Voices for Georgia’s Children is urging Members to support legislation to strengthen child nutrition programs as much as possible via a letter to Members of the Georgia Delegation of the U.S. House of Representatives. To read a copy of the letter and to add your organization’s signature and support to it, please contact Whitney Brown at Voices for Georgia’s Children at wbrown@georgiavoices.org.

AFFORDABLE CARE ACT AND YOU:

California Passes Legislation to Establish Health Insurance Exchange:

The Affordable Care Act requires states to establish health insurance exchanges to restructure the individual health insurance marketplace by 2014, or to allow their citizens to access a federal fallback exchange. California is on track to become the first state to establish such an exchange, having passed legislation to do so on August 25th. California’s Governor is expected to sign the legislation. More information is available here. All states have the opportunity to apply for federal grant dollars to begin planning for the establishment of a health insurance exchange. We will keep you updated as we learn about Georgia’s plans.

Healthcare.gov Web Portal Now Available in Spanish:

This week, the Department of Health and Human Services unveiled www.CuidadodeSalud.gov, a Spanish language website that will connect consumers to new information and resources that will help them access quality, affordable health care coverage.  The website is a one-stop-shop for information about the implementation of the Affordable Care Act as well as other health care resources.  The website connects consumers to quality rankings for local health care providers as well as preventive services.

Latinos suffer disproportionately from chronic health diseases such as diabetes and cardiovascular disease.  Latinos also have the highest rate of uninsured, with more than one in three going without insurance.  Cuidadodesalud will help address these disparities by including price estimates for health insurance plans as well as new information on preventing disease and illness and improving the quality of health care.  The website also includes a series of mechanisms through which users can indicate whether pages were helpful to them, so feedback can be used to grow and strengthen the site.

National News:

State Guidance Now Available for FMAP Funds

Last week the Center for Medicare and Medicaid Services (CMS) released guidance on how states can apply for money now available through the extension of the enhanced federal Medicaid funding, known as FMAP.  That extension was recently signed by the President and will provide Georgia with $230 million in Medicaid funding that the state needs to stave off deep cuts to essential health services.  According to CMS, “as a condition of receiving these additional Federal funds…the Chief Executive Officer of the State must submit a request…within 45 days of enactment, or by September 24, 2010.”  In order to receive the funding, the Chief Executive Officer of the State must submit a letter of intent to the Secretary of Health and Human Services and affirm that certain conditions are met. To view the letter and learn more about the requirements, read the CMS bulletin here.

The FMAP funding extension was already built in to the 2011 budget, but the amount Georgia will receive is less than was anticipated and will still leave the state with a budget gap.

What’s New in Georgia:

Department of Community Health Presents Options for Budget Cuts to Health Programs

On Thursday, the Georgia Department of Community Health presented its proposed options for cuts to the amended FY 2011 budget and the FY 2012 budget in response to a requirement from the Governor to reduce all programs in FY 2011 by 4, 6, and 8 percent and all programs in FY 2012 by 6, 8, and 10 percent, using the current FY 2011 budget as the baseline. Medicaid and PeachCare are not exempt from these cuts; however, because of Maintenance of Effort (MOE) requirements in the new federal health care law, states must maintain current eligibility standards for Medicaid and the Children’s Health Insurance Program (PeachCare). As a result, cuts will likely come from reimbursement rates to providers, which would negatively impact access to services for Medicaid and PeachCare beneficiaries. Significant cuts to public health programs were also proposed. To view the full presentation, click here. To learn more about the MOE requirements, click here.

Georgia Misses Opportunity to Protect Citizens Against Insurance Rate Hikes

The Affordable Care Act requires the Secretary of the Department of Health and Human Services (HHS), in conjunction with the States, to establish a process for the annual review of health insurance premiums to protect consumers from unreasonable, unjustified and/or excessive rate increases.  As part of process, the Federal government has made $46 million available to states to provide for grants to help them improve the health insurance rate review and reporting process between now and 2014.  In the first round of grant funding, Georgia passed on $1 million to help crack down on unreasonable health insurance rate hikes.  Georgia is just one of just five states who did not apply for the money. This is a missed opportunity to correct a situation that far too many Georgians face—being priced out of a plan when a disease or condition is diagnosed and costs sky-rocket.  Georgia is still able to apply for the second round of funding but it remains to be seen whether they will pursue this opportunity. For more information, click here.

Savannah Passes a Smoke-Free Ordinance

On Thursday, the Savannah City Council passed an ordinance supported by Mayor Johnson and Healthy Savannah to ban cigarette smoking in bars and other public spaces in Savannah, thereby reducing exposure to second-hand smoke and improving public health. The ordinance could serve as a model for the state. For more information, click here. To learn more about the work of Health Savannah, click here.

Local Doctors Build Advocacy Campaign in Georgia

Doctors for America (DFA) is a non-profit, grassroots, national organization of physicians and medical students who advocate for changes in the health care system to ensure affordable access to quality care for all.  Here in Georgia, confusion persists about the new health care law, and many doctors have come together to build a Georgia chapter of DFA to educate their patients and communities about the new law so that they can make appropriate, well-informed decisions regarding their care. If you are a physician and want to learn more about how you can get involved, please contact Gayathri Suresh for more information.

Special Council on Tax Reform and Fairness Continues its Work

On Wednesday, the 2010 Special Council’s four economists presented the principles of tax reform that will guide the council. These principles are:

• Growth enhancing
• Stability
• Clearness/simplicity
• Efficiency
• Equity/fairness
• Properly developed/transparency

This week the Council also held its first public hearing, or “fact finding session,” in Atlanta to gather comments from interested parties. Let the Council hear from you on the need to protect revenues for important services like public health, Medicaid, and PeachCare by submitting comments online (http://fiscalresearch.gsu.edu/taxcouncil/contribute.htm) or by attending one of the upcoming fact finding sessions in your community.

FACT FINDING SESSION SCHEDULE:  (All meetings from 4:00 PM to 7:00 PM)

To address the Council, submit a request by 5pm on the day prior to the hearing here.

August 30 – Augusta – Doubletree Hotel, Master’s Ballroom?2651 Perimeter Parkway?Augusta, GA 30909

August 31 – Savannah – Coastal Georgia Center, Auditorium?305 Fahm Street?Savannah, GA 31401

September 1 –Valdosta – Wiregrass Georgia Technical College, Brooks Hall Conference Center?4089 Val Tech Road?Valdosta, GA 31602

September 2 – Macon – Macon State College, Professional Sciences Conference Center, Banquet Hall?100 College Station Drive?Macon, GA 31206

September 7 –Rome – Forum Civic Center, Riverwalk Ballroom?Downtown Rome ?2 Government Plaza?Rome, Georgia 30162

September 9 –Gainesville – Gainesville State College, Gainesville Campus, Continuing Education, Business Division and Performing Arts Building, Auditorium?3820 Mundy Mill Road?Oakwood, GA  30566

The Affordable Care Act and You:

Health Reform Implications for Employers

Earlier this week, the Health Policy Center at Georgia State University released an analysis of the employer responsibility provisions of the new health care law and an interactive calculator for small businesses to estimate their eligibility for tax credits available through the new law to provide health insurance for their workers. The report is available here. The calculator can be accessed here.

Several Health Reform Provisions To Take Effect on September 23rd:  Spotlight on the Dependent Care Provision

On September 23, 2010, the 6-month anniversary of the passage of the Affordable Care Act, several key reforms will go into effect. One of the most highly anticipated changes is the dependent care provision, which will allow young adults up to age 26 to remain on a parent’s health insurance plan.  Today, young adults aged 19 through 29 comprise about 13 million of the 47 million uninsured Americans.  Previously, young adults not enrolled in college full-time could not remain on their parents’ private health insurance plans as a dependent. However, because young adults just entering the workforce tend to have a more tenuous connection to the labor market (for example, as part-time, temporary, or low-wage hourly workers), they are less likely to have access to an employment-based health insurance plan. If they had been eligible for public programs like Medicaid and PeachCare as a child, they also generally lose eligibility for these programs when they reach age 19. To address this problem, the ACA requires private health plans to extend the age of coverage for dependents to 26, regardless of whether that young adult is enrolled in school.  While the provision takes effect on September 23, families who want to extend coverage to their children should consult their insurer and determine when their open enrollment period occurs.

On September 3, Young Invincibles, a group that works on health care issues for young adults, will unveil their Getting Covered campaign aimed at educating families about this new provision.  Their website, www.gettingcovered.org will go live that day and help educate the public about their rights under this provision.

Future issues of the Peach Pulse will highlight additional provisions taking effect on September 23^rd.

Implementation and the States: New Resources Available

Several elements of the new health care law will be implemented at the state level. To help states prepare, a range of resources have recently become available. The National Governors Association recently released a document identifying states that have passed legislation or issued Executive Orders to oversee and coordinate the process for health reform implementation. Highlighting eighteen states and the U.S. Virgin Islands, the document explains how many state legislatures and governors have begun setting up the infrastructure for implementing the new law. State implementation efforts, to date, include creating task forces or appointing officials responsible for moving forward with federal requirements.  Georgia has not yet set up such a structure. The table is available here.

The National Conference of State Legislatures also recently released a checklist for state legislatures that identifies state laws that may need to be amended to be in accordance with the new federal law. The checklist is available for download here.

Earlier this month, the Alliance for Health Reform held a briefing to outline key challenges and decision points for states as they embark on implementation. To read the event summary, transcript or to listen to the podcast, visit the Alliance for Health Reform website.

Additional resources to help guide state officials and advocates as they think through implementation include a recent report from the Robert Wood Johnson Foundation on harnessing federal resources for state goals, available here, and a guidebook from U.S. Pirg to help officials and advocates deliver on the promise of health reform, available here.

New Information on the Medicaid Expansion

The new health care law significantly expands the Medicaid program. Beginning in 2014, all Americans with household income up to 133 percent of the federal poverty level will be eligible for health insurance through Medicaid. Here in Georgia, this expansion is expected to considerably reduce the number of low-income uninsured Georgians. By 2019, between 645,000 and 900,000 could gain coverage through Medicaid. The Kaiser Family Foundation recently released two reports providing additional information about how this expansion will impact states. The first report provides state-by-state information on the number of people who will gain coverage through the program and the associated cost to states and is available here. The expansion will be entirely federally financed in the first two years, and will scale down to 90 percent federal/10 percent state in 2020 and thereafter. The second report describes several state Medicaid agencies’ efforts to prepare for health reform implementation while addressing challenges associated with the current economic downturn and is available here.

New Implementation Timeline Helps Explain the ACA

The Commonwealth Fund recently released an updated timeline for implementation of the Affordable Care Act.  Several provisions have recently taken effect, including the Pre-Existing Insurance Program (PCIP), the launch of the web portal and a requirement that no cost-sharing be applied to preventive services. However, most of the changes place between now and 2014. To view the timeline, visit the Commonwealth Fund’s website.

National News

President Signs FMAP Extension

On Tuesday, the U.S. House of Representatives passed and the President signed into law an extension of the enhanced federal Medicaid funding, known as FMAP. The additional $16 billion in Medicaid funding will bring approximately $230 billion to Georgia, staving off potential deep cuts to essential health care services. The federal legislation also contained an additional $10 billion in education funding for states. Both Georgia Senators voted against the enhanced FMAP extension. To find out how your House member voted, click here.  For those elected officials who voted in favor, please be sure to thank them for their support.

Healthy, Hunger-free Kids Act Unanimously Passes Senate

Last week, the U.S. Senate passed the Healthy, Hunger-Free Kids Act of 2010. The act requires the Secretary of Agriculture to establish national nutrition standards that would apply to all food sold on school campuses during the day, including food from vending machines. The new act will provide $4.5 billion to improve the National School Lunch Program, promote the health benefits of breastfeeding, and establish new national nutritional standards to help children eat healthier foods at school. With a childhood obesity rate of 31.7% in Georgia, this hits close to home. To learn more about the legislation, visit the Food Research and Action Center.

Senator Chambliss has helped to lead this effort through his work on the Senate Agriculture Committee and now the measure moves to the House where it is expected to pass.

What’s New in Georgia

Budget Revenue Estimates Show Case for Cautious Optimism

Last week, Gov. Perdue announced revenue collections for the state in July 2010 of $1.15 billion, which represents a 4.7% increase over last July’s numbers. According to the Georgia Budget and Policy Institute, revenues must grow by 4.3% each month to meet the Governor’s revenue estimates.  While the increase is cause for cautious optimism, a fuller picture of how actual FY 2011 revenue collections match up with FY 2011 revenue estimates won’t emerge until we have several months of data. If revenue collections fall short of revenue estimates, further budget cuts may be in store.

Kids Count Report

On July 27, the Annie E. Casey Foundation released its 21st Annual Kids Count Data Book.  This annual snapshot of America’s children, ranks states and provides county-level information on 10 measures of well-being.  Among the 50 states, Georgia remains ranked at 42 for overall child well-being, seeing no improvement over last year.  Here is a brief snapshot during one year in Georgia:

–       501,892 children live in poverty (nearly 1 in 5 children)

–       5,493 babies are born to girls ages 15-17 (15 each day)

–       14,014 babies are born low birth weight, less than 5.5 pounds (38 babies each day)

More information about Georgia and Kids Count data can be obtained from the Georgia Family Connection website.

Trauma Tag Fee Referendum

This November, Georgia voters will vote on a referendum to levy a $10 car tag fee dedicated to funding Georgia’s trauma care system. The tag fee, which would raise an estimated $80 million a year, would help the already existing 16 trauma hospitals in the state and be used to entice other hospitals to enhance their facilities to become trauma centers. Georgia’s trauma death rate is 20 percent higher than the national average and an estimated 700 Georgians die every year because they do not receive trauma care within the critical 60-minute window — the “golden hour” — immediately following injury. To read more about this issue, go to the Healthy Debate GA blog and read “Is it Worth $10 to Save a Life?”

Childhood Obesity in Georgia

A new report highlights the seriousness of the growing obesity epidemic in Georgia. In 2007, adult obesity prevalence in Georgia varied by county from 23.3% to 35.6%, with a statewide prevalence of 29%. Among children between the ages of 10 and 17, our state’s obesity and overweight rate is 31.7%.

The health consequences of rising obesity include: having risk factors associated with cardiovascular disease such as high blood pressure and high cholesterol; developing asthma, sleep apnea, and Type 2 diabetes.  There are many initiatives under way to combat this alarming trend, including efforts to get children physically active, increase the amount of quality physical education they receive in school as well as making sure they have nutritional options while there.  For example, see The First Lady’s Let’s Move campaign and legislation such as the Healthy, Hunger-Free Kids Act of 2010.

Here in Georgia, there are several groups and organizations committed to fighting the alarming obesity trends.  The Center Helping Obesity In Children End Successfully (CHOICES) helps prevent obesity and eliminate the overweight epidemic in children by enabling them to make better choices as it relates to food and lifestyle.  To learn more about ways they are making a difference, visit their website.  Youth Becoming Healthy (YBH), based in Albany, GA, was created in order to reduce the burden of childhood obesity in the community. This program was created in memory of CEO Pamela Green-Jackson’s brother Bernard Green, who died in February 2004 from the effects of obesity-related illnesses. YBH has facilities in six middle schools and one elementary school in Albany and provides free fitness and nutrition education to about 350 students a year.  To learn more, visit their website.  Also, check out the Policy Leadership for Active Youth (PLAY) and their Childhood Obesity section. PLAY is a collaborative effort between universities, state agencies, professional associations, and not-for-profit organizations in Georgia.  The initiative is led by the Institute of Public Health at Georgia State University, with support from Healthcare Georgia Foundation. You can visit their website here.

County-by-County Data on Health Insurance Now Available

The Census Bureau recently released county-by-county data on health insurance. This information is useful in determining gaps in access and affordability across the state and will help guide decision makers’ efforts to address these disparities in the future.

Last month, Small Area Health Insurance Estimates (SAHIE) released 2007 estimates of health insurance coverage by age, sex, race, Hispanic origin, and income categories at the state-level and by age, sex, and income categories at the county-level.  The data indicates that Echols County, Georgia has the highest percent of uninsured at 37.6 percent, while Telfair County has the lowest at 12.4.  Additionally, looking at all demographics, in sheer numbers, Gwinnett County has the highest number of uninsured with 163,870, representing 22.2 percent of the population there.  To learn more about the breakdown in each county as well as how Georgia compares to the rest of the country, visit the SAHIE website.

The Affordable Care Act and You

New Resources Available for States to Build Health Insurance Exchanges

On July 29, the Department of Health and Human Services (HHS) announced the availability of up to $1 million in grants per state to help states begin work to establish health insurance exchanges. Under the Affordable Care Act (ACA), the Exchanges are to be operational by 2014 and will provide eligible consumers and businesses with a “one-stop shop” where they can compare and purchase health insurance.  This round of funding will give states resources to conduct initial research and planning for the exchange. Each state has the option to establish and operate its own Exchange or partner with another state or states to operate a regional Exchange. If a state decides not to create an Exchange for its residents, HHS will establish one on their behalf.

HHS also issued a request for comment asking states, consumer advocates, employers, insurers, and other interested stakeholders to provide input as HHS develops the rules and standards Exchanges should be required to meet. Comments are due by October 4, 2010.  To read the complete request for comment, visit http://www.healthcare.gov/center/regulations.

The Impact of Community Health Centers

This week, the Department of Health and Human Services (HHS) announced the availability of up to $250 million in grants for New Access Points for the delivery of primary health care services for underserved and vulnerable populations under the Health Center Program. Organizations eligible to compete include public or nonprofit private entities, including tribal, faith-based and community-based organizations who meet health center funding requirements.

Once fully implemented, the ACA will result in an additional 32 million Americans with health insurance coverage, with about half of these individuals likely to be covered through an expansion of the Medicaid program. Policymakers identified community health centers as ideal locations to provide this additional care and included an additional $9.5 billion in operating expenses for these centers.  The $250 million in grants are just the start of the investment in community health centers across the country.

According to state-by-state data recently released by The Center for American Progress, the total projected economic activity of community health centers by 2015 in Georgia will be $663 million–$412 million of which will be as a result of health care reform.  In terms of job growth, community health centers expect to see 5,696 employees there with 3,541 of those jobs attributable to efforts undertaken by the ACA.  These community health centers serve vulnerable populations, regardless of their ability to pay and will continue to provide a much needed service to communities across Georgia.  In 2008, 275,743 patients were seen because of these institutions and with the availability of new funding, more patients will have greater access and more communities will be served.  To view the interactive map, visit http://www.americanprogress.org/issues/2010/08/chc_econ_impact_map.html.

Partner Up! For Public Health Campaign Now Underway

On July 14th, a public awareness and advocacy campaign was launched to educate policymakers and the public about the vital role that our state’s public health system plays in prevention, food safety, halting the spread of infectious disease, and other key aspects of population health. After nearly a decade of funding cuts, Georgia’s per capita spending on public health is about four cents a day, among the lowest in the nation. Georgians for a Healthy Future is one of thirty organizations represented on the campaign’s advisory board. To learn more and to get involved, visit www.togetherwecandobetter.com.

Public Health Commission Begins its Work

The first meeting of the Public Health Commission was held on Monday, July 12th. As part of the legislation that reorganized the Department of Human Resources, a Public Health Commission was created to examine whether the interests of the state are best served with the Division of Public Health being a part of the Department of Community Health, an attached agency, a completely separate agency or a part of some other organization. The Georgia Public Health Association is monitoring the meetings and providing ongoing information about the Commission’s progress on its website. More information about the Commission and its members is also available on the Department of Community Health’s website. The Commission will meet once a month and meetings are open to the public. The next meeting is scheduled for August 9th at 8:30am. The Commission’s report is due December 1, 2010.

What’s New in Georgia:

Budget Crisis Continues: Senators Still Need to Hear from Advocates

Governor Perdue has ordered Georgia agencies, with the exception of K-12 schools, to cut their budgets by another 4 percent starting in August. Georgia had been relying on Congress to pass an extension of the enhanced matching funds for Medicaid that the state was receiving as part of the American Recovery and Reinvestment Act, known as FMAP, when the Legislature and the Governor approved the FY 2011 budget. Those enhanced funds would have brought in about $375 million to the state. Without the enhanced FMAP, Georgia may have to make cuts to essential health care services for our most vulnerable families or cut reimbursement rates to providers, potentially limiting access to care and further harming our state’s fragile economy.

Please call Senator Isakson at (202) 224-3643 and Senator Chambliss at (202) 224-3521 and urge them to support an extension of the enhanced FMAP.

Special Tax Council Takes Aim at Changing Tax System

The first meeting of the Special Council on Tax Reform and Fairness was held on Wednesday, July 28th. The Council was created by the Georgia Legislature to study the tax system and provide recommendations to the General Assembly in January 2011.  The council will consider information from economists and from the public, according to remarks made at the initial meeting yesterday.  The work of the council provides an opportunity for consumers and advocates to weigh in. As an alliance member of 2020 Georgia, Georgians for a Healthy Future supports a balanced approach to state budget and revenue solutions that can meet the short and long-term needs of our state and its people, including vital health services for Georgians. Information about the council can be found here.

The Battle for a Smokefree Savannah Heats Up!

The Savannah City Council has begun public discussion on the Healthy Savannah proposal to make all workplaces and places open to the public smoke-free. Council members plan two public meetings before the introduction and first reading on August 12. The proposed ordinance seeks to eliminate problematic exceptions in state law, and includes:
•    All workplaces
•    Outdoor eating areas in restaurants
•    All Bars and Restaurants
•    Long-term care facilities
•    Private and semi-private rooms in health care facilities
•    International airports
•    Convention facilities
•    Private clubs
•    Retail tobacco stores
•    Distances 15 to 20 feet from the entrance to any public building

The measure is supported by many health organizations under the umbrella of Healthy Savannah. Healthy Savannah is a great example of a community based health program. They address a myriad of issues that are barriers to a healthy lifestyle.  The Mayor of Savannah, Otis Johnson, has endorsed the ordinance, saying it is an important step in protecting those who, like him, have heart conditions or other health risks aggravated by exposure to secondhand smoke.

If you know advocates in Savannah who would lend their support, please encourage them to contact the American Lung Association at jdeen@lungga.org.

The Affordable Care Act and You:

84% of Small Businesses in Georgia Eligible for New Health Care Tax Credits

Beginning this year, as part of the new health care law, small businesses that employ 25 or fewer workers, have average wages of less than $50,000, and contribute at least 50 percent of each employee’s health insurance premium are eligible for a tax credit to help with the cost of employee health insurance premiums. The tax credits are worth up to 35 percent of the employer’s cost for employee coverage, and the amount of the tax credit depends on firm size and average wage, with the smallest, lowest-wage firms receive the largest tax credits.

In Georgia, more than 120,000 small businesses–or 84 percent of all small businesses operating in our state–are eligible for the tax credit in 2010, according to a study released last week by Families USA and the Small Business Majority. Further, about 37,500 small businesses in Georgia qualify for the full 35 percent tax credit. A tax credit calculator is available here, and detailed FAQs about how the tax credit works are available here. Read the full report here.

Non-Profit Hospitals and Their Roles in Communities

Until recently, neither federal nor state governments clearly laid out expectations for hospitals around charity care and the requirements for maintaining their non-profit status. As a consequence, it has been hard for patients to understand what services are available to them when they need care they cannot afford. The Affordable Care Act (ACA) clarifies the role of non-profit hospitals and their committment to the communities they serve. For more information on the specific provisions of the ACA, see the fact sheet created by national nonprofit organization Community Catalyst:  Non-Profit Hospitals: Providing Essential Benefits to Local Communities.

The IRS issued a call for comments on these provisions, asking for input on the need for additional guidance to non-profit hospitals on how to fulfill the new requirements. Consumer advocates weighed in with many recommendations that included: 1) Setting standards for financial assistance policies that guarantee effective notification practices, fair and transparent application procedures, and eligibility criteria that reflect the needs of the hospital’s community; 2) Protecting consumers from harmful debt collection practices; 3) Clarifying what hospitals can charge their patients for care; and 4) Clarifying that hospitals must consult with consumer advocates and members of the communities they serve when conducting community needs assessments.

During the month of August, Georgia’s Congressional Delegation will be home for back in the state for their August Recess.  So that the final rule ensures that you can depend on nonprofit hospitals to deliver the care you need on fair
terms, at an affordable price that is accessible to all, please contact your Congressman to make sure they are playing a leadership role to make health care more affordable for all Georgians.  To stay updated on this issue, visit the Georgia Watch website.

New Rules Regarding Preventive Services Unveiled Last Week

Last week, the Department of Health and Human Services issued new rules relating to preventive care services. Under the new regulations, new health plans beginning on or after September 23, 2010, must cover preventive services that have proven evidence-based health benefits, and these plans may no longer charge a patient a co-payment, coinsurance or deductible for these services when they are delivered by a network provider. Services that will now be covered include: blood pressure, diabetes, and cholesterol tests; many cancer screenings; routine vaccinations; pre-natal care; and regular wellness visits for infants and children. For more detailed information about these new provisions, visit the HHS web portal to learn more.

FMAP and the Looming Budget Crisis in Georgia

The economy is still in a fragile state and all across the country states are struggling to balance budgets and still provide for their citizens.  Here in Georgia, it is no different.  Governor Purdue’s FY 2011 budget was balanced in large part based on the assumption of a continuation of enhanced FMAP for an additional six months.  Provisions were enacted through last year’s Recovery Act to enhance the Federal match dollars to protect state Medicaid programs at a time of crisis.  The crisis was two-fold, for individual families and as fiscal relief to states.  The enhanced FMAP was used to help keep state budgets afloat and to maintain vital health services to children and families at a point where much assistance was needed.  To date, no FMAP extension has been approved by Congress which places our state in a dangerous position.  Without an extension of the enhanced FMAP through the end of our 2011 State Fiscal Year, Georgia is short at least $375 million dollars.

Advocates must make their voices heard to get the FMAP extension passed very soon.  Take Action Today!  Call Senator Isakson and Senator Chambliss and urge them to support their constituents in Georgia and to extend the enhanced FMAP.  Their support will maintain our state’s commitment to providing coverage and health service access to vulnerable Georgians through Medicaid.

Update on the Babies Born Healthy Program

Effective June 7th, the Department of Community Health ceased operations of the Babies Born Healthy Program, which provides prenatal care to women who are at or below 250 percent of the federal poverty level, ineligible for Medicaid, and otherwise uninsured or underinsured. The Department of Community Health recently released a letter explaining this decision, which is available for download here, and an FAQ on the decision, available for download here. Since the program has closed, Healthy Mothers, Healthy Babies Coalition of Georgia, which operates a Powerline program to connect women in need of services with those health care services, is working to locate low-cost prenatal resources across the state of Georgia. If you are aware of low-cost prenatal services in your community, Healthy Mothers, Healthy Babies would like to be able to share that information with the women who call the Powerline. Please contact Pam Gaston, Executive Director of Healthy Mothers, Healthy Babies, with this information.

WHAT’S NEW IN GEORGIA

New Report on Metro Atlanta Hospitals

Only about half of metropolitan Atlanta’s hospitals comply with state regulations to advertise the availability of financial assistance, according to a report released in June by Georgia Watch. These findings are the result of an 18-month study through the organization’s Metropolitan Atlanta Hospital Accountability Project, or HAP, which focuses on financial aid programs for low-income, uninsured and underinsured patients at general hospitals in the 21-county metro area. For this project, Georgia Watch representatives visited all hospitals studied to see if signage was posted advertising the availability of free or reduced cost care, and if financial assistance policies were made available to the public. In addition, the HAP team surveyed 900 low-income, uninsured, or underinsured individuals about their financial experiences at area hospitals. Using publicly-available information, HAP compared and contrasted hospitals throughout the metro area in regards to their offerings for these vulnerable populations, and analyzed the specific barriers and challenges these populations face. You can read the report at GeorgiaWatch.org.

New Poll Reveals Cancer Patients Struggle to Afford Health Care and Pay Bills in Tough Economic Times

A new American Cancer Society Cancer Action Network(ACS CAN) poll of families affected by cancer shows that cancer patients, survivors and their families continue to struggle to afford health care and pay for other basic needs such as food and heat in the troubled economy. The findings suggest the need to implement the Affordable Care Act so that it benefits people with cancer.

The poll finds that nearly half of cancer patients and survivors under age 65 have had difficulty paying for health care costs such as health insurance premiums, co-pays and prescription drugs in the past two years. One-third of those currently in active treatment have had to delay some type of health care in the past year.  To learn more about the poll, take a look at the ACS Press Release and the Lake-Bellweather Poll Report.

The Commish: The Race for Insurance Commission is On

Georgia’s Insurance Commissioner is responsible for regulating insurers and enforcing consumer protections in health insurance. As many features of the new health care law begin to take effect, the Insurance Commissioner will have new watchdog and enforcement responsibilities over health insurance.  On June 25, the Atlanta Press Club hosted several candidate debates in advance of the July 20th primary elections, one of which was between candidates for the office of Insurance Commissioner. Georgia Public Broadcasting has the video on its website now of the Republican primary debate. There was no debate in the Democratic primary because that race is uncontested. There were several questions about health insurance regulation and the new health care law. The video is available here.

THE AFFORDABLE CARE ACT AND YOU

The Pre-Existing Conditions Insurance Plan and Web Portal are Live!

An important reform of the 2010 Patient Protection and Affordable Care Act takes effect July 1 when Georgians who have been without health coverage for at least six months and who have been denied coverage because of pre-existing health conditions will be given access to affordable, quality coverage. They will receive it through a new Pre-existing Condition Insurance Plan (PCIP) created by the U.S. Department of Health and Human Services (HHS).To find the new coverage available in Georgia and information about the complete range of health coverage options available for consumers by ZIP code through a website set up by HHS, see http://www.healthcare.gov

The HHS Web site and other information about the new program will be available on July 1.  The new website is the first to provide consumers and small businesses with information about private insurance, Medicaid, the Children’s Health Insurance Program, Medicare, and other coverage options in one place. Federal officials are emphasizing that the PCIP is not the long-term solution to the insurance industry’s practice of denying coverage based on pre-existing conditions; instead, it will serve as a bridge to 2014, when the reform law bans denials of coverage based on pre-existing conditions.

State-Level Implementation and Insurance Regulation:  New Resources from the NAIC

Over the next several years, state Insurance Commissioners will play an important role in implementing the new federal health care law. The National Association of Insurance Commissioners, comprised of health insurance regulators across the 50 states, is charged with several standard-setting and consultative responsibilities and now has a special section on its website dedicated to state insurance regulation and the Patient Protection and Affordable Care Act (PPACA). Among other things, the site includes information about potential funding opportunities for states through PPACA, a glossary of health care terms, and information about the new high-risk pools, now known as the Pre-Existing Condition Insurance Plan (PCIP).

New Reports and Resources

A  new series of issue briefs released by the Robert Wood Johnson Foundation walks through the effect on state governments, children, young adults, seniors, health outcomes, and premiums. The series is available for download here. The Georgetown Center for Children and Families also released a new report outlining key decisions for states in the implementation of the new law. That report is available for download here. For Georgia-specific information, the Health Policy Center at Georgia State University has a fact sheet on the implications of health reform in Georgia, which is available for download here.