Peach Pulse: October 31, 2012

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 10th 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.