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Atlanta, Georgia – Statement by Laura Colbert, Executive Director of Georgians for a Healthy Future, regarding today’s ruling by the 5th Circuit Court of Appeals in the Texas v. U.S lawsuit.

The lawsuit seeks to invalidate the Patient Protection and Affordable Care Act; Georgia is a plaintiff in the case.

“Today’s ruling by the 5th U.S. Circuit Court declaring the Affordable Care Act’s individual mandate unconstitutional and remanding the law back to District Court only serves to prolong Georgians’ uncertainty about their access to quality, affordable health care.

“More than 480,000 Georgians enrolled in health coverage through the ACA’s marketplace in 2019 and nine in 10 benefit from financial help to reduce their costs. Many, many more Georgians benefit from the standards and protections put in place by the ACA.

“As long as the court continues to entertain this legally dubious case, thousands of Georgians are at risk of losing their health coverage, protections for people with pre-existing conditions, and access to basic health services like mental health care and prescription drugs. Revoking the ACA’s protections and disentangling the law from Georgia’s health care system would only serve to sow chaos and confusion, to the detriment of Georgia families. These losses would disproportionately affect Georgians of color who already face inequitable barriers to care.

“The support of this lawsuit by Georgia Governor Kemp and Attorney General Carr is incongruent with their respective statements about increasing access to care and improving affordability for Georgia families and individuals. We urge Georgia leaders to re-consider their support of this case.

“It is important for Georgia consumers to know that this does not change the coverage they have today or their 2020 insurance plans. Georgians should maintain their health coverage and seek help at healthcare.gov if a life change results in a loss of their current coverage.”

For more information about Georgia consumers and Georgia’s ACA marketplace: Getting Georgia Covered: What we can learn from the 6th open enrollment period

About GHF:

With a mission to build and mobilize a unified voice, vision, and leadership to achieve a healthy future for all Georgians, Georgians for a Healthy Future provides a strong voice for Georgia consumers and communities on the health care issues and decisions that impact their lives. Georgians for a Healthy Future has a three-pronged approach which includes: 1) outreach, education, and engagement with consumers and communities; 2) coalition building and mobilization; and 3) public policy advocacy. For more information, visit www.healthyfuturega.org.

On November 4, 2019, Governor Brian Kemp released a draft plan that, if approved, would drastically undermine comprehensive coverage for the 417,000 consumers who now have comprehensive coverage through the marketplace. Federal law allows states to make changes to the Affordable Care Act (ACA) so long as a comparable number of Georgians have coverage that is at least as comprehensive and affordable as they would have under the ACA, and the changes do not increase the federal deficit. Even under the most forgiving interpretation of these guardrails, Governor Kemp’s proposal fails to meet the test.

Fortunately, there’s still time to fight back! The state is required to seek public comments on this plan and will be accepting comments until December 3, 2019. Comments can be submitted online at CoverGA.org, at in-person comment hearings. This is an opportunity for Georgians to tell state leaders how this plan will impact their health and finances, and the health and finances of their loved ones.

Instead of undermining the coverage that so many Georgians rely on, state leaders should focus on preserving critical consumer protections, strengthening comprehensive coverage, investing in outreach and enrollment to Georgia communities, and working to address the rising health care costs for low-and middle-income Georgians. 

Disrupts coverage for more than 400,000 Georgians with a privatized marketplace 

Governor Kemp’s proposal seeks to expand coverage to approximately 30,000 out of more than one million uninsured Georgians at the peril of those consumers currently enrolled in comprehensive coverage using a risky new program. 

At the center of his plan, Governor Kemp aims to decentralize how consumers currently enroll in individual market coverage in favor of private web brokers and insurers. This means that consumers would no longer have an unbiased place to compare plan options and instead would be forced to rely on private entities who would have the incentive to enroll consumers in plans that offered the highest commission and not necessarily the plan that best fits their health needs.

Likely result: Georgia consumers will struggle to navigate numerous websites, translate the sales lingo of insurers, and disentangle conflicting information. For many, it may be harder to find in a plan that they feel good about.

Limits financial assistance, increasing out-of-pocket costs

Along with dismantling healthcare.gov, Governor Kemp plans to restructure financial assistance in a way that would raise premium costs for comprehensive coverage and likely cause many Georgians to lose coverage altogether. Under his plan, consumers could use financial assistance to purchase skimpier coverage, like short-term plans, that don’t have to meet the ACA’s minimum standards. Additionally, his plan doesn’t address whether or not cost-sharing reductions would be required, which currently help to lower deductibles and other out-of-pocket costs for certain low-income consumers. As a result, Georgia consumers should expect to pay more out-of-pocket to get the care they need.

To make matters worse, because financial help is based on premiums for comprehensive coverage that will likely become more expensive under this plan, providing financial help to all eligible Georgians will cost more than what is currently budgeted. This means that some consumers who currently receive (or are eligible for) financial help would lose this valuable benefit.

Likely result: Premiums for comprehensive coverage will rise. At the same time, fewer Georgians will receive financial help to purchase coverage. Georgians will pay more out-of-pocket when they need health care.

Weakens consumer protections

In order to allow private companies to run enrollment, the Governor’s plan seeks to eliminate crucial consumer protections. The protections that may be suspended include the requirement that insurance plans include enough doctors and hospitals so people can get care (called “network adequacy”); requirements about what information insurers must provide to consumers and how that information is presented; and mental health parity, which requires insurers to cover mental health services in a similar way as other health care. The Governor’s plan assumes these new skimpy plans will provide 90% of the benefits that comprehensive coverage under the ACA provides. There is no explanation or evidence to support this assumption.

Removing the requirement to cover the ten essential health benefits and mental health parity threatens access to critical services for many consumers with pre-existing conditions. For example, treatment and recovery services for people with substance use disorders would be threatened at a time when the state continues to struggle with opioid-related deaths and substance use disorders in general. These consumer protections enable people with mental illness and substance use disorders to obtain insurance that covers their conditions without bankrupting them. Without them, consumers will have to pay out-of-pocket for life-saving care, opening them up to thousands of dollars of medical debt.

Likely impact: Skimpy plans that do not offer basic health services like prescription drugs, maternity care, or mental health services will become commonplace. As a result, Georgians will have a harder time accessing needed care and will pay more out-of-pocket.

The bottom line is Governor Kemp’s plan is terrible for Georgians. Any rational analysis will find it doesn’t meet even the laxest requirements of federal law. Georgians should weigh in today to reject this plan!   

In March 2019, Georgia lawmakers approved SB 106, the Patients First Act. The new law allows Georgia to use two kinds of health care waivers to make changes to health coverage in the state. These waiver plans could affect you, your friends, family, neighbors, and Georgians all across the state and the way you access and pay for health care.

(Waivers allow a state to set aside or “waive” certain requirements imposed by the federal government and try new models of providing health coverage and care.)

The state has hired Deloitte as a consultant to work with state leaders to develop the waiver plans. Georgia’s decision-makers have proposed an aggressive timeline and aim to finalize the waiver plans by the end of 2019.

Two types of waiver plans

Two types of plans are being developed by state leaders: an 1115 waiver and a 1332 waiver. An 1115 waiver allows Georgia to make changes to the state’s Medicaid program. Medicaid is the state’s health insurance program that covers kids, some low-income parents, seniors, and people with disabilities, and pregnant women. SB 106 limits the 1115 waiver to cover people making up to the poverty line (about $12,000 a year for an individual or $26,000 for a family of four). Medicaid expansion, which GHF has advocated for, would extend public coverage to people with incomes just above the poverty line (138% of the federal poverty line.) A successful way to use an 1115 waiver would be to cover everyone under the poverty line and exclude barriers to coverage such as burdensome paperwork requirements, confusing cost-sharing, or counterproductive lock-out periods.

A 1332 waiver allows the state to make changes to private insurance and the health insurance marketplace. About 450,000 Georgians buy their health coverage through the marketplace. Most of these Georgians receive federal tax credits to cover some or all of their premium costs. (Another 827,600 of Georgians are eligible for private coverage and financial help to buy it but have not yet enrolled.) A successful way to use a 1332 waiver is to establish a “reinsurance program” to reduce premium costs. This waiver should also ensure all plans continue to cover the essential health benefits (like prescription drugs) and maintain protections for people with preexisting conditions.

You can weigh in!

Now is the time to ensure that Georgia gets a plan that will provide comprehensive coverage to as many people as possible. Thousands of Georgians across the state could gain health care coverage through the Patients First proposals. While positive intentions have been expressed by Georgia’s elected officials about the forthcoming waivers, none has yet committed to ensuring all Georgians have a pathway to comprehensive, affordable coverage.

For every 1115 and 1332 waiver that the state wants to pursue, Georgia’s policymakers must seek input from the public. Because there are required state and federal public comment periods for each waiver proposal, there will be at least four public comment periods (a state and federal period for an 1115 waiver and a state and federal period for a 1332 waiver). These are your chances to help shape and influence health care in Georgia!

GHF and our Cover Georgia partners will let you know when the public comment periods begin and end and we will provide an easy way for you to have your say. Make a plan to submit comments during every public comment period so that state leaders know how their ideas will impact you and your family! Your story can help make a difference for thousands of Georgians and can support positive changes in health care coverage.

To learn more, visit coverga.org and download our new Happening Now fact sheet! Follow #CoverGA on FaceBook and Twitter for the most current updates!

Sean “Saifa” Wall is an Atlanta-based intersex justice activist. He is currently enrolled in a health plan with Ambetter through the Affordable Care Act’s health insurance marketplace (also called healthcare.gov).

As an activist, Saifa’s income is generated exclusively through contractual work, which means that his employers do not provide health benefits. He talks to people about issues that affect the intersex community. He also serves as a public health researcher that consults with racial justice and domestic violence organizations.

Saifa enrolled in coverage in 2016 with the help of a GHF health insurance navigator after being uninsured for over two years. (He was also able to purchase dental coverage.) Saifa pays a premium of $63 per month after a $500 tax credit helped to lower his costs. His coverage allows him access to hormone therapy and behavioral health services, among other essential health benefits. He loves his medical provider and receives high quality treatment as an intersex person who is hormone dependent.

Saifa was recently diagnosed with osteopenia, which means his bones aren’t as dense as they need to be to prevent breaks and other injuries. Saifa will need comprehensive medical care as he works to build bone mass; much or all of that care will be covered by the comprehensive insurance plan he purchased through the ACA.

Like Saifa, 450,000 Georgians rely on the ACA marketplace to access comprehensive, affordable health coverage. Many more Georgians are eligible for marketplace coverage but remain uninsured for a variety of reasons.

Georgia’s new law, called the Patients First Act or SB 106, may bring changes to private health insurance in the state but Georgia leaders have not yet spelled out what changes they plan to seek. An effective way to use their new flexibility would be to maintain the protections and financial help that Georgia consumers enjoy while building a “reinsurance program” to bring down premiums for everyone. (This approach has been successfully tried in seven other states.) If premiums fall or remain steady, this could attract more Georgians to the marketplace and get more people covered.

When Saifa was asked what he would tell legislators about having health coverage, he replied: “As an intersex activist, I believe health care is a human right.” While this belief isn’t yet reflected in Georgia’s state health laws, the ACA allows consumers like Saifa to take advantage of comprehensive, affordable coverage options and protections from discrimination in the health system, among many other advances.

Legislative Update: Week 8

Crossover Day brings legislative action late into the night

Last Thursday was the 28th day of the Georgia legislative session, which is also referred to as Crossover Day. Crossover Day is the final day for a bill to cross from its chamber of origin to the opposite chamber to remain viable for this legislative session. This week’s legislative update provides a rundown of consumer health legislation: which bills made it through and which did not. You can see a list of all the bills we’re tracking here. (Note: After a flurry of activity last week, we are still working to update our legislative tracker with the current status of each bill. So while many of the bills are updated, it is best to find the bill you are interested in and click through to find the full information on the bill’s statis on legis.ga.gov.

Our priorities

Surprise billing legislation moves forward

SB 56, sponsored by Senator Chuck Hufstetler, received approval by the full Senate on Wednesday and may be considered by the House Insurance Committee in the coming weeks. The legislation aims to improve transparency for consumers who may be subject to a surprise out-of-network bill. This bill would disallow surprise billing in emergency situations but does not prohibit surprise billing in non-emergency situations like when a physician uses an out-of-network laboratory for diagnostic tests. This bill now sits in the House Insurance committee. (For more details on the legislation, see our February 11th legislative update.)

Legislation to fully expand coverage stalls; Patients First Act advances

HB 37, the Expand Medicaid Now Act, and SB 36 sponsored by Representative Bob Trammell and Senator Steve Henson respectively, did not receive hearings and did not cross over last week. Each bill was written to expand Medicaid in Georgia as envisioned by the Affordable Care Act.

Meanwhile SB 106, the Patients First Act, has moved quickly through the Senate in the weeks before Crossover Day. The legislation, as written, would allow the Department of Community Health to request an 1115 waiver to extend Medicaid coverage to adults making up to 100% of the federal poverty level (FPL) ($12,490 annually for an individual). This “partial expansion” would leave out thousands of new-poor Georgians who are meant to be similarly covered according to federal health law and will likely cost the state more to cover fewer people. Additionally, the bill allows the Governor to make potentially tremendous changes to private health insurance in Georgia through 1332 waivers with little accountability. The bill will now awaits a hearing from the House’s Special Committee on Access to Quality Healthcare.

Healthy housing legislation moves to Senate committee

Georgians for a Healthy Future is a member of the Healthy Housing Georgia coalition because evidence shows the strong and firect influence housing has on a person’s health. The coalition supports HB 346, which would prohibit retaliation by a landlord against a tenant for complaining to Code Enforcement about unsafe or unhealthy housing conditions like the presence of mold, radon, rodents, insect infestations, or lead. Georgia is the only state in the country that does not protect tenants against unsafe and uninhabitable housing conditions with a “warranty of habitability.” This bill now sits in the Senate Judiciary committee. (For more details on the legislation, see our March 5th legislative update.)

Crossover day recap

HB 30: Amended FY 2019 Budget | CROSSED OVER

HB 30 makes adjustments to the state budget for the current fiscal year which runs through June 30, 2019. The “little budget” has passed both chambers of the General Assembly and been signed by the Governor. The amended budget went into effect on Saturday, March 9th.

HB 31: FY 2020 Budget | CROSSED OVER

HB 31 is the budget document for the coming state fiscal year which will run from July 1, 2019 to June 30, 2020. The budget includes several new investments in behavioral health and mostly maintains funding for other health care programs and priorities. The Senate will continue to hold hearings on the “big budget” this week. For more information on the health care highlights in the proposed FY 2020 budget, read the Community Health and Behavioral Health budget overviews from the Georgia Budget & Policy Institute.

HB 37: Expand Medicaid Now Act | DID NOT CROSS OVER

HB 37, sponsored by Rep. Bob Trammell, expands Medicaid in Georgia as envisioned by the Affordable Care Act by increasing Medicaid eligibility for adults up to 138% of the federal poverty guidelines (FPL). This is equivalent to $17,236 annually for an individual and $29,435 for a family of three.

HB 63: Step therapy legislation: CROSSED OVER

HB 63, sponsored by Rep. Sharon Cooper, would require health insurance plans to establish step therapy protocols and outline a process for health care providers to request exceptions. Step therapy is a requirement by some insurers that patients try a series of lower-cost treatments before the insurer will cover the higher-cost treatment prescribed by a patient’s physician.

HB 84: Provider network transparency | DID NOT CROSS OVER

HB 84, sponsored by Rep. Richard Smith, increases transparency related to possible surprise medical bills. The legislation requires that information on billing and the providers that a consumer may encounter during a course of care must be provided to the consumer at their request. In circumstances where a consumer receives a surprise bill, HB 84 also allows for arbitration between the consumer and the health care provider, the specifics of which would be determined by Georgia’s Department of Insurance.

HB 158: Improve Medicaid patient access to effective HIV treatment | CROSSED OVER

HB 158, sponsored by Rep. Deborah Silcox, requires that Medicaid recipients have the same access to antiretroviral drugs used to treat HIV and AIDS as to those included in the formulary established for the Georgia AIDS Drug Assistance Program. This change would allow for increased continuity of care for people living with HIV/AIDS in Georgia.

HB 198: Eliminate certificate of need requirements | DID NOT CROSS OVER

HB 198, sponsored by Rep. Matt Hatchett, would change the certificate of need process that is used to regulate health care facilities. The bill also included requirements for increasing transparency of hospital financial information and an increase in the rural hospital tax credit from $60 million to $100 million.

HB 217: Needle exchange program | CROSSED OVER

HB 217, sponsored by Rep. Houston Gaines, decriminalizes the act of working or volunteering for a syringe services program, a step towards legalizing the programs. Distributing clean hypodermic syringes and needles to people who use injection drugs (e.g. heroin) helps to prevent the spread of HIV and Hepatitis C, and does not increase the likelihood that people will newly take up injections drug use.

HB 290: PrEP pilot program | CROSSED OVER

HB 290, sponsored by Rep. Sharon Cooper, would establish a pilot program to provide preexposure prophylaxis (PrEP) drug assistance or services to persons at risk of being infected with HIV. PrEP is a medication taken by people who are HIV-negative to reduce their risk for infection. The pilot program would provide PrEP to people in counties identified by the Centers for Disease Control & Prevention as at risk of HIV outbreaks due to a high rate of opioid use and participants would receive regular HIV testing and related support services.

HB 321: Medicaid financing program | CROSSED OVER

HB 321, sponsored by Rep. Jodi Lott, would extend the sunset provision of the hospital provider fee for five years. The hospital payment program, which draws down additional federal funding, provides almost $1 billion annually to the state’s Medicaid budget. More information about HB 321 is available here.

HB 514: Georgia Mental Health Reform and Innovation Commission | CROSSED OVER

HB 514, sponsored by Rep. Kevin Tanner, would create the Georgia Mental Health Reform and Innovation Commission through at least June 30, 2020. Within the Commission, several subcommittees would be established to include Children and Adolescent Mental Health; Involuntary Commitment; Hospital and Short-Term Care Facilities; Mental Health Courts and Corrections; and Workforce and System Development.

SB 16: Interstate Medical Licensure Compact Act | CROSSED OVER

SB 16, sponsored by Sen. Kay Kirkpatrick, would allow Georgia to enter the “Interstate Medical Licensure Compact Act” which allows health care providers to more easily obtain licenses to practice in multiple states. It also provides Georgia’s Medical Board with easier access to investigative and disciplinary information about providers from other states, an important protective measure for Georgia patients.

SB 74: Eliminate certificate of need requirements | DID NOT CROSS OVER

SB 74, sponsored by Senator Matt Brass, would eliminate certificate of need requirements for all health care facilities except certain long-term care facilities and services. This bill is the Senate companion piece to HB 198. Both bills aim to change the current certificate of need structure which regulates hospitals in Georgia.

GHF has you covered

Stay up-to-date with the legislative session

GHF will be monitoring legislative activity on a number of critical consumer health care topics. Along with our weekly legislative updates and timely analysis of bills, we have the tools you need to stay in touch with health policy under the Gold Dome.

• Sign up for the Georgia Health Action Network (GHAN) to receive action alerts that let you know when there are opportunities for advocacy and action
• Track health-related legislation
• Updated for 2019: GHF’s annual Consumer Health Advocate’s Guide. (Contact Michelle Conde at mconde@healthyfuturega.org for a printed copy.)

Legislative Update: Week 6

Patients First Act moves quickly through Senate committee

Last week, the Senate Health and Human Services (HHS) committee met to discuss and hear testimony on SB 106. Titled the Patients First Act, the legislation permits Georgia’s Governor to pursue two health care waivers that could make significant changes to health coverage for Georgia consumers. The bill passed out of committee with no changes and now sits in the Senate Rules Committee awaiting a vote to move to the Senate floor.

The legislation, as written, would allow the Department of Community Health to request an 1115 waiver to extend Medicaid coverage up to 100% of the federal poverty level (FPL). This would leave out thousands who would be covered under a full Medicaid expansion and will likely cost the state more to cover fewer people. Additionally, the bill allows the Governor to make potentially tremendous changes to private health insurance in Georgia through 1332 waivers with little accountability. This proposed legislation falls short of the promise to put a health insurance card in the pockets of all Georgians.

There is still time to ensure that this bill covers all Georgians in need of an insurance card in a fiscally responsible way. Join us this Thursday, February 28th, for Cover Georgia Day at the Capitol to talk with your elected officials about this important piece of legislation. 

(Can’t make it? Call or send an email to your state legislators today!)

General Assembly moves forward on budget bills

Budget progresses through General Assembly

The House and Senate are inches away from completing work on HB 30, the FY2019 supplementary budget which only needs a House “agree” to move to the Governor’s desk. The supplemental budget (also called the “little budget”) makes necessary, mid-year adjustments to the current state budget. The Governor’s proposed amended FY2019 budget provides $1 million for the Department of Community Health to hire an external consultant to draft the waiver options authorized in SB 106, if passed. The House Appropriations Committee has begun working on the FY 2020 budget, (also called the “big budget”). The FY2020 budget contains significant additions for health, including $8.4 million to fund a school-based mental health initiative called Project Apex, which aims to increase access to mental health services for children and youth.

Legislature prioritizes HIV prevention & treatment

Bills to increase prevention & treatment of HIV move forward in the House

Georgia now leads the U.S. in the number of new HIV cases diagnosed each year. State legislators have turned their attention to this problem with the introduction and passage of several bills aimed at preventing the further spread of HIV/AIDS and increased access to treatment for those living with the disease:

• HB 158, sponsored by Rep. Deborah Silcox, requires that Medicaid recipients have the same access to antiretroviral regimens used to treat HIV and AIDS as to those included in the formulary established for the Georgia AIDS Drug Assistance Program. This change would allow for increased continuity of care for people living with HIV/AIDS in Georgia. The bill has passed the House and has been referred to the Senate HHS committee.
• HB 217, sponsored by Rep. Houston Gaines, decriminalizes the act of working or volunteering for a syringe services program, a step towards legalizing the programs. Distributing clean hypodermic syringes and needles to people who use injection drugs (e.g. heroin) helps to prevent the spread of HIV and Hepatitis C, and does not increase the likelihood that people will newly take up injections drug use. This bill was passed by the House yesterday and now moves to the Senate.
• HB 290, sponsored by Rep. Sharon Cooper, would establish a pilot program to provide preexposure prophylaxis (PrEP) drug assistance or services to persons at risk of being infected with HIV. PrEP is a medication taken by people who are HIV-negative to reduce their risk for infection. The pilot program would provide PrEP to people in counties identified by the Centers for Disease Control & Prevention as at risk of HIV outbreaks due to a high rate of opioid use and participants would receive regular HIV testing and related support services. The House HHS committee passed HB 290 last week and now awaits a full vote by the House.

Surprise billing legislation advances

Surprise billing legislation approved by Senate committee

SB 56, sponsored by Senator Chuck Hufstetler, was approved by the Senate Insurance and Labor Committee last week. The legislation addresses surprise out-of-network billing and aims to improve transparency. A surprise medical bill can occur when a consumer unknowingly encounters an out-of-network (OON) provider at an in-network facility and can have serious financial impacts on individuals and families. This bill would disallow surprise billing in emergency situations but does not prohibit surprise billing in non-emergency situations like when a physician uses an out-of-network laboratory for diagnostic tests. (For more details on the legislation, see our February 11th legislative update.) The bill was approved and now sits the Senate Rules Committee awaiting a vote.

GHF has you covered

Stay up-to-date with the legislative session

GHF will be monitoring legislative activity on a number of critical consumer health care topics. Along with our weekly legislative updates and timely analysis of bills, we have the tools you need to stay in touch with health policy under the Gold Dome.

• Sign up for the Georgia Health Action Network (GHAN) to receive action alerts that let you know when there are opportunities for advocacy and action
• Track health-related legislation
• Updated for 2019: GHF’s annual Consumer Health Advocate’s Guide. Contact Michelle Conde at mconde@healthyfuturega.org for a printed copy.

Action Alert: Patients First Act falls short

Last week, state leaders introduced SB 106. Titled the Patients First Act, the legislation permits Georgia’s Governor to pursue two health care waivers that could make significant changes to health coverage for Georgia consumers. The legislation allows for an 1115 waiver to extend Medicaid coverage to some poor adults in Georgia but leaves out thousands who would be covered under a full Medicaid expansion. Additionally, the bill allows the Governor to make potentially seismic changes to private health insurance in Georgia through 1332 waivers with little accountability. While it is heartening that Georgia’s leaders see the need to create a pathway to coverage for more Georgians, this proposed legislation falls short for two reasons, both of which we’re asking you to take action on:

1. The proposed 1115 Medicaid waiver would cover fewer people at a higher cost than Medicaid expansion. It would leave out thousands of Georgians in need of coverage and leave the state accountable for a larger share of the medical costs for those who would be newly covered. Ask Governor Kemp and your state legislators to get the best deal for Georgia by covering all eligible Georgians. (Then plan to join us for Cover Georgia Day at the Capitol on February 28th!)

2. More than 480,000 Georgians rely on Georgia’s health insurance marketplace for health coverage, and many more are eligible. Changes made to private coverage through a 1332 waiver could benefit or harm these consumers, but the legislation, as written is too broad to determine its impact. Ask Governor Kemp and your state leaders to specify in the bill that any waiver will preserve critical consumer protections (like those that protect consumers with pre-existing conditions), maintain comprehensive, quality health coverage, support a stable marketplace through increased enrollment, and will not leave consumers on the hook for higher costs.

House passes step therapy bill

Step therapy legislation moves quickly through House

HB 63, a bill sponsored by Chairman of the House HHS Committee Representative Sharon Cooper, was passed by the House this week. HB 63 addresses step therapy, which is a requirement by some insurers that patients try a series of lower-cost treatments before the insurer will cover the higher-cost treatment prescribed by a patient’s physician. This bill would require health insurance plans to establish step therapy protocols and outline a process for health care providers to request exceptions. HB 63 will now go to the Senate for consideration.

GHF releases annual consumer health advocate’s guide

A Consumer Health Advocate’s Guide to the 2019 Legislative Session

GHF’s annual Consumer Health Advocate’s Guide is your map for navigating the Georgia legislative session. This annual booklet provides information on the legislative process, legislators, and committees, key agency officials, advocate contacts, and more. Experienced advocates and new volunteers will find their way around Georgia’s Capitol more easily with the information provided in this year’s guide. Download or pick up your copy today.

(Interested in a hard copy? Contact Michelle Conde.)

RSVP for Cover Georgia Day

Join Cover Georgia at the state capitol on February 28th!

Join us on Thursday, February 28th for Cover Georgia Day at the Capitol when we will ask our state legislators to close Georgia’s coverage gap by putting insurance cards in the pockets of all Georgians. For the first time in Georgia, there is wide-spread agreement among Georgia’s legislators that something must be done to extend coverage to low-income Georgians across the state. Take advantage of this opportunity to ask your elected officials to close Georgia’s coverage gap now! RSVP today!

Can’t make it? Call or send an email to your state legislators asking them to put an insurance card in the pockets of all Georgians.

GHF has you covered

Stay up-to-date with the legislative session

GHF will be monitoring legislative activity on a number of critical consumer health care topics. Along with our weekly legislative updates and timely analysis of bills, we have the tools you need to stay in touch with health policy under the Gold Dome.

• Sign up for the Georgia Health Action Network (GHAN) to receive action alerts that let you know when there are opportunities for advocacy and action
• Track health-related legislation
• Updated for 2019: GHF’s annual Consumer Health Advocate’s Guide

Momentum builds to close Georgia’s coverage gap

The 2019 legislative session is now in full swing and the past few weeks have brought the introduction of two bills that would close Georgia’s coverage gap by expanding Medicaid.

HB 37: Expand Medicaid Now Act; enact and SB 36 are sponsored by Representative Bob Trammell and Senator Steve Henson respectively. Each bill expands Medicaid in Georgia as envisioned by the Affordable Care Act by increasing Medicaid eligibility for adults up to 138% of the federal poverty guidelines (FPL). This is equivalent to $17,236 annually for an individual and $29,435 for a family of three.

In addition, Governor Kemp has announced that his office will seek an 1115 Medicaid waiver. An 1115 waiver provides states with the ability to experiment with or tailor their Medicaid programs. Governor Kemp has not released details of the waiver, so its impact on consumers is uncertain. The waiver could close Georgia’s coverage gap, among other changes to Medicaid coverage. Legislation to allow Georgia’s Medicaid agency to seek an 1115 waiver is expected to be introduced soon by Senate Republicans.

Tell Governor Kemp and your legislators that you support putting a health insurance cards in the pockets of Georgians regardless of their income.

Consumer protection bills introduced

Surprise medical billing emerges as a prominent issue

Surprise out‑of‑network medical billing is once again emerging as a prominent issue within the Georgia General Assembly. A surprise medical bill can occur when a consumer encounters an out-of-network (OON) provider at an in-network facility or in other circumstances. Two pieces of legislation have been introduced to address surprise billing and each attempts to resolve the issue in its own way.

HB 84: Insurance; provide for consumer protections regarding health insurance
Rep. Richard Smith, Chair of the House Insurance Committee, introduced HB 84 to increase transparency related to possible surprise medical bills. This bill sets disclosure requirements for health care providers, insurers, and hospitals. The legislation requires that information on billing, reimbursement, and arbitration of services must be provided to the consumer at their request. The bill also allows for an arbitration process between the consumer and the health care provider, the specifics of which would be determined by Georgia’s Department of Insurance. This bill currently sits in the House Insurance Committee and is in House second readers.

SB 56: Consumer Coverage and Protection for Out-of-Network Medical Care Act
Senator Chuck Hufstetler, Chair of the Senate Finance Committee, introduced SB 56 to address surprise out-of-network billing. This legislation disallows surprise billing in emergency situations under insurance plans issued after July 1, 2019. The bill contains similar transparency provisions to HB 84. For consumers who receive elective medical care after which they receive a surprise bill greater than $1000, the legislation makes available a mediation process through the Department of Insurance. This bill was referred to the Senate Insurance and Labor Committee.

Legislative calendar set

Legislature plans to finish work by April 2nd

The schedule for the remainder of the legislative session has been set in HR 152. Crossover Day, the day that legislation must move from one chamber to the other in order to be considered in 2019, will fall on March 7th. The remaining sixteen legislative days will be broken up throughout March, culminating on Sine Die, the last day of the session, on April 2nd. The full calendar can be viewed here.

RSVP for Cover Georgia Day

Join us at the state Capitol on February 28th!

Join us on Thursday, February 28th for Cover Georgia Day at the Capitol when we will ask our state legislators to close Georgia’s coverage gap by putting insurance cards in the pockets of low-income Georgians. This is the most important step that our elected officials can take to slow the growing opioid crisis, strengthen our state’s struggling rural health care system, and improve the health & finances of hardworking Georgia families. Take advantage of this opportunity to talk with your elected officials about closing Georgia’s coverage gap! RSVP today!

Can’t make it? Call or send an email to your state legislators asking them to put an insurance card in the pockets of all Georgians.

GHF has you covered

Stay up-to-date with the legislative session

GHF will be monitoring legislative activity on a number of critical consumer health care topics. Along with our weekly legislative updates and timely analysis of bills, we have the tools you need to stay in touch with health policy under the Gold Dome.

• Sign up for the Georgia Health Action Network (GHAN) to receive action alerts that let you know when there are opportunities for advocacy and action
• Track health-related legislation

The race to be Georgia’s Insurance Commissioner is one of the most overlooked statewide races on the ballot this November, despite the position’s impact on the health and finances of almost all Georgians.

Georgia’s Office of Insurance and Safety Fire Commissioner (commonly referred to as the Department of Insurance or DOI) is headed by Georgia’s Insurance Commissioner. The Department oversees health, auto, long-term care, and other insurance products that can be regulated by the state. For Georgians who have individual or small-group insurance (about 2.6 million Georgians), the Insurance Commissioner has a direct impact on their insurance rates, their ability to access needed health services, and the extent to which their coverage is transparent and fair.

Georgia’s Insurance Commissioner is a constitutional officer in Georgia and is elected by Georgia voters for a four-year term. The Commissioner and the Department are tasked with regulating insurance companies and licensing insurance agents operating in Georgia and overseeing state fire safety initiatives, in addition to other non-health-related duties.

Because the Insurance Commissioner is primarily responsible for overseeing private health insurance in Georgia, they are key to how the Affordable Care Act and its consumer protections are implemented in the state. For example, the ACA requires that insurance companies justify any premium rate increases of more than 10% through a process called “rate review”. The Commissioner and Department staff determine how strong and transparent to make Georgia’s rate review process, and in doing so, determine how accountable insurers must be as they ask consumers for more dollars out of their household budgets.

The Commissioner and DOI are also responsible for ensuring that health plans do not design their benefits so that they discriminate against certain types of consumers. For example, if a health plan only covers one type of HIV medication and only at the highest cost-sharing level of the plan, the Commissioner could instruct his department to examine whether the plan’s design constitutes discrimination against people living with HIV. Similarly, health plans are required to cover mental health and substance use treatment services at the same level as they cover physical health services. If the Commissioner is lax in overseeing the enforcement of these laws, consumers could be financially blocked from receiving the health services that they need.

The Commissioner and his office also license insurance agents selling health insurance plans and other consumer products, as well as Georgia’s health insurance navigators. The position of “navigator” was created and funded through the Affordable Care Act in order to provide free, local, unbiased assistance for consumer enrolling into health coverage through the Marketplace. Currently, Georgia’s navigators have to meet unnecessarily burdensome licensing requirements and pay a large fee in order to be licensed by the state, something that Georgia’s next Insurance Commissioner has the power to address.

The Department of Insurance is further charged with protecting Georgia citizens from insurance fraud, mediating disputes between consumers and insurance companies, and assisting consumers with questions. The Georgia Department of Insurance has historically been under-resourced and, as a result, has struggled to carry out these tasks in a robust way. Georgia’s next Commissioner will be integral in advocating for the budget and resources needed to assist and support Georgia consumers across all insurance products.

Georgia’s next Insurance Commissioner will have a significant role in shaping the state’s health care landscape over the next four years or more. Whether and how the state addresses issues like access to care, health care affordability, the opioid crisis, and the sustainability of the rural health care system may be decided by voters at the ballot box this November.

This blog is part of a series from Georgians for a Healthy Future to educate consumers about the impact of the 2018 election on timely consumer health issues. Please check out our previous blogs in the series:

• Eight questions for health care voters to ask Georgia candidates
• Governor blog
• General Assembly Blog

*Georgians for a Healthy Future is a non-partisan, 501(c)3 organization. We do not endorse or support any candidates or political party.

Teresa began working as a teacher for the Headstart preschool program in 1994 but retired in 2010 because multiple health conditions made it difficult for her to work. Now her family’s only source of income is her husband’s monthly disability check, which is too high to allow him to qualify for Medicaid and too low to allow them to qualify for financial help to purchase private insurance through the Affordable Care Act. (Teresa cannot qualify for Medicaid no matter how low her income is because she does not have a disability or a child under the age of 18.) Both of them fall in Georgia’s coverage gap.

Teresa and her husband are just two of 197 of the Georgians in Clay County that are uninsured because Georgia’s decision makers have not extended health insurance coverage to low-income adults in Georgia (those making less than $16,000 annually for an individual or $20,780 for a family of three.)

Teresa struggles to manage multiple health conditions, the worst of which is a jaw condition that has caused her teeth to rot. Because Teresa has not had health coverage since 2009, she has had to find alternative, insufficient treatments for her jaw condition. She would have to pay $5000—almost four months of income—to receive the necessary medical remedies to alleviate her pain and stop the dental deterioration. If Georgia were to close the coverage gap, Teresa would be able to see her doctor on a regular basis without having to forgo appointments and services that would otherwise be too costly.

Georgia’s Governor and legislature have so far rejected the option to close the state’s coverage gap, leaving people like Teresa and her husband uninsured. Until Georgia’s policymakers extend health insurance to all low-income Georgians, Teresa, her husband, and 240,000 other Georgians will likely continue to skip health care appointments and forgo needed care because they have no pathway to coverage.

Your story is powerful! Stories help to put a human face to health care issues in Georgia. When you share your story, you help others understand the issue, its impact on Georgia, and its importance.

Your health care story is valuable because the reader may be your neighbor, friend, someone in your congregation, or your legislator. It may inspire others to share their stories or to become advocates. It is an opportunity for individuals who receive Medicaid or fall into the coverage gap, their family members, their physicians and concerned Georgia citizens to show that there are real people with real needs who will be impacted by the health policy decisions made by Congress and Georgia’s state leaders.

Share your story here!