Peach Pulse Archives
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 6th, 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 10th!
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. MORE >
Special Health Reform Edition
This week’s election results removed any uncertainty about the Affordable Care Act’s future: the health reform law is here to stay. Now it is time to do the hard work of ensuring that health reform meets its promise in Georgia and that health care consumers have access to meaningful and affordable coverage.
Over the past three days, several news stories have outlined the key next steps and decision points for Georgia policymakers on Medicaid and the private health insurance marketplace, and many of them turned to Georgians for a Healthy Future to explain the implications for Georgia health care consumers.
Georgians for a Healthy Future’s Executive Director Cindy Zeldin discussed the need to move forward with the Medicaid expansion in an interview with the Augusta Chronicle: “We have one of the highest uninsured rates in the nation…We have one of the highest number of uninsured in the nation. And many of them are low to moderate income. The Medicaid piece is really what is going to make a dent in the uninsured in a big way.” She also talked about the important role expanding Medicaid (which is optional for states but largely federally financed) can play in improving access to care and bolstering Georgia’s economy and what it means for consumers if Georgia opts for a federal health insurance exchange rather than a state-based exchange. All articles are linked below.
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.
MORE >
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.
MORE >Medicaid Expansion and Cover Georgia
Georgia policymakers are currently weighing the opportunity to cover an estimated 650,000 uninsured Georgians through an expansion of the Medicaid program. Under the Affordable Care Act, states can create a new category of eligibility for Medicaid to cover low-income individuals and families, financed almost entirely with federal dollars. Implementing this expansion is the only viable way to cover Georgia’s low-income uninsured, and it will pump resources into our state’s health care delivery system. We can’t miss this opportunity to improve access to health care and to strengthen Georgia’s health care economy, but we need your voice to make it happen.
Health care consumer and patient advocacy groups, providers, stakeholders, and community groups are coming together under the Cover Georgia umbrella to show support for expanding Medicaid, and we invite you to join us. If you are interested in getting involved in this discussion, please contact Amanda Ptashkin.
In November, the Cover Georgia campaign will unveil a website full of resources to help you better understand and advocate for the Medicaid expansion with policymakers and in your community. In the meantime, please visit Families USA’s Medicaid Expansion Center, with links to studies and reports about the value of Medicaid, and the Center on Budget and Policy Priorities’ Tool Kit for State Advocates on the Medicaid expansion.
Update on Essential Health Benefits (EHB)
The 2013 Budget
Recent Events
Meeting with the Greater Augusta Healthcare Network
Upcoming Events
October is shaping up to be a busy month for health advocates and there are some opportunities we wanted to be sure to share with you:October 10th 12:30pm-2:30pm: Join the Center for Black Women’s Wellness for their community forum, “Getting to the Root: Breast Cancer Disparities,” for health care professionals, breast cancer survivors, caregivers and community advocates. GHF Outreach and Advocacy Director, Amanda Ptashkin, will present on health care reform and what it means to breast cancer survivors, caregivers and advocates. Registration is closed for lunch but those interested can still attend at 12:30. Click herefor more information.
October 19th 8am-11am: Join the Georgia Budget & Policy Institute for their Fall Forum, “Expanding Health Coverage in Georgia” at the Carter Center. Join them for this highly anticipated discussion on the benefits of the Medicaid expansion under the Affordable Care Act. Click here to register.
October 23rd 12pm-1pm: 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, email Amanda Ptashkin.
An opportunity to cover Georgians and improve access to care
Today’s Atlanta Journal-Constitution features an op-ed from Georgians for a Healthy Future’s Executive Director in support of expanding Medicaid to cover the uninsured and improve access to care in Georgia. Zeldin writes, “Covering the lowest-income uninsured through Medicaid will provide access to basic prevention and treatment services that uninsured Georgians lack today.” The benefits also go far beyond covering an estimated 650,000 uninsured Georgians. Expanding Medicaid will strengthen our state’s health care delivery system and bolster Georgia’s economy by bringing new resources into Georgia. “We have an unprecedented opportunity to improve the health of Georgia patients and consumers, strengthen our state’s health care delivery system, and bolster the state’s economy by moving forward with the Medicaid expansion.” To read the full op-ed, click here.
Cover Georgia
The next big opportunity to improve access to care for hundreds of thousands of Georgians will be deciding whether Georgia should move forward with the Medicaid expansion. Georgians for a Healthy Future has begun work on building a large-scale, statewide coalition that will help make the case that this is good for consumers, good for the health care infrastructure and good for the economy. We are in the process of reaching out to partner organizations, civic groups, community leaders, etc. to join our efforts. If you are interested in getting involved in this discussion, please email us.
Capturing the Moment: An Evening with Georgians for a Healthy Future
Last month Georgians for a Healthy Future held a cocktail reception and fundraiser at Nelson Mullins to bring together our partners, our champions and our allies to celebrate our health care victories over the past three years and to plan for the future. We are grateful to those who attended and contributed to the future of our organization. To see pictures from the event, click here. To support our efforts, click here.
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:
“Today, the Georgia Department of Community Health (DCH) announced that it will move forward with implementing key recommendations from its Medicaid and CHIP (Children’s Health Insurance Program) Redesign task forces and workgroups. It will not, however, pursue wholesale restructuring of Georgia’s Medicaid program at this time because of increasing uncertainty at the federal level.”
The changes that the state will move forward with include:
- Proceeding with at-risk managed care to serve Georgia Families members
- Transitioning children in foster care to one designated vendor statewide within the new Georgia Families program
- Maintaining Georgia’s current Fee-For-Service structure for ABD populations and services
- Moving forward with Home and Community-based Services Rebalancing. This rebalancing will help move patients from skilled nursing facilities to home and community based services.
- Begin utilizing a value-based purchasing model. Value-based purchasing will allow DCH to continuously improve the quality of care for our members while better engaging our providers and ultimately containing costs.
- Creating a one-stop portal will improve accountability and efficiency. Specifically the portal will give health care providers better information about their members and their medical history, streamline their credentialing process, and present providers with a measurement of key performance metrics and allow them to monitor quality and outcomes compared to their peers.
- Creating a Common Pharmacy Preferred Drug List that will simplify the program and reduce administrative burden on providers
The Department has committed to continuing its work with the task forces and work group through the RFP process and past the go-live date. As members of the Children and Families Task Force and Substance Use and Mental Health Working Group, Georgians for a Healthy Future will continue to provide a consumer voice in these discussions and will continue to advocate for greater access to care for Georgia’s most vulnerable citizens. For more information about the redesign process, visit http://healthyfuturega.
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.
MORE >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.
MORE >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.
MORE >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/
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.