Many rural Georgians are faced with compounding health disparities, such as a lack of job-based medical insurance, long travel times to access medical services and increased rates of chronic conditions,…
This year, no Georgian has been left untouched by the health or economic impacts of COVID-19. America’s singular failure to control the pandemic has spotlighted the importance of public policy decisions that prioritize the health and wellness of populations, the consequences of underfunding essential public infrastructure (like departments of public health), and the disparate impact that public policies have had on Black Americans and other people of color. National, state, and local leaders, many elected by the public, are responsible for the policy decisions made ahead of and in response to COVID-19, its economic fallout, and the movement for racial justice.
Ahead of the 2020 election season (October to November 3, 2020), Georgians have the opportunity to learn more about these elected positions, the decision-making power each has, and how those positions impact their health and the well-being of Georgians. This year, Georgians will cast their votes for the U.S. President, members of U.S. Congress, state legislators, state supreme court judges, and other positions. Voters’ decisions about the candidates in each race will have an unprecedented impact on consumers health issues in Georgia as we continue to battle through the current health crisis.
In this blog, we cover the U.S. Congress’s impact on the health and well-being of Georgians and their families. To jump to a specific section, click these links:
- About U.S. Congress
- The U.S. budget—including what gets passed along to states like Georgia
- Congress passes laws that impact Georgia
- Senate’s power to approve public appointments has direct consequences for Georgia
- This year’s election
On July 9, 2020, Georgia’s Governor announced that the state was re-opening the public comment period on his 1332 private insurance proposal. The proposal was considerably revised since it was last considered in February of this year. The new plan still consists of two parts:
- A reinsurance program to lower premiums; and
- The Georgia Access model—which would separate Georgia from healthcare.gov but would not replace it, instead directing consumers to insurers and web brokers to shop and enroll in coverage.
Other provisions of the previously proposed Georgia Access model were dropped (cap on financial assistance, new kinds of health plans, etc.).
The Governor’s announcement began a 15-day public comment period on the new proposal, allowing Georgians, health advocates, and other interested parties to weigh in. Along with more than 600 others, GHF submitted comments to communicating our deep concerns about the plan’s continued shortcomings. You can read GHF’s full comments here.
More than 1 million Georgians have lost their health coverage due to job loss during the COVID-19 pandemic. If this is your situation, you can keep yourself and your family covered during this health crisis.
You have three main pathways to coverage:
- Affordable Care Act
- With financial assistance—half of Georgians who lose their insurance will qualify for ACA coverage with financial help to lower the premium they pay each month. In some cases, you may see lower deductibles & co-pays too.
- Without financial assistance—some Georgians, despite a job loss, will still make too much for financial help but you should still shop for coverage to see if there’s a plan that fits your new budget.
- Medicaid & PeachCare for Kids—About 25% of Georgians losing their health coverage may qualify for Medicaid. Georgians most likely to qualify for Medicaid coverage include children, low-income pregnant women, and very low-income parents. Other Georgians who qualify for Medicaid are people with disabilities, seniors, and low-income women with breast or cervical cancer.
- COBRA—in most cases, you will be able to find less expensive coverage from the ACA marketplace. COBRA may be the best option for you if it is important that you maintain a consistent provider (pregnant women, people with chronic or complex conditions).
Some Georgians who have lost their health coverage due to job loss will fall in Georgia’s coverage gap because the state has not expanded Medicaid. That means they can’t get financial help through the ACA and they also don’t qualify for Medicaid.
If you are in the coverage gap because you lost your job, please read the If you are uninsured section (click to go directly there). Then contact Georgians for a Healthy Future at 404-567-5016 x 4 to learn how you can share your story and help fix the problem!
Affordable Care Act (ACA) coverage
You may be eligible for a Special Enrollment Period up to 60 days after losing your job-based health insurance. You only qualify for coverage for 60 days after you lose your health coverage, so shop and enroll as soon as possible. Visit healthcare.gov to shop and enroll.
Financial assistance is available!
When you begin the shopping/enrollment process, healthcare.gov will ask you about your estimated income for 2020. With that information healthcare.gov will let you know if you qualify for financial help to lower your premiums and other costs. Most Georgians qualify for financial help!
When you estimate your income, include the money you made from your job before you were laid off, any unemployment checks that you expect to receive, and any money that you expect to make from getting re-hired/a new job later in the year. Do not count your stimulus check as income!
For free help with the enrollment process, contact Insure Georgia at insurega.org or 866-988-8246.
Coverage through the ACA marketplace covers testing for COVID-19. It will also cover part or all of the costs related to COVID-19 treatment. Contact your insurance company for more information.
Medicaid & PeachCare for Kids
You can enroll yourself, your family, or your children in Medicaid or PeachCare for Kids at any time, if you qualify. Enroll at gateway.ga.gov.
Children are most likely to quality for Medicaid and PeachCare. Pregnant women and some parents may be eligible for Medicaid coverage depending on your monthly income. (The amount of unemployment you get from Georgia counts as income but the additional $600 per week from the federal government does not.)
Click here to see if you can qualify as a parent and to see if your kids qualify. If you are pregnant, you must make less than these amounts to qualify for Medicaid:
Medicaid is required to cover COVID-19 testing and treatment for free. In addition, you do not have to pay any Medicaid or PeachCare premiums or co-pays during the COVID-19 national emergency.
If you have or enroll in Medicaid coverage, you cannot be disenrolled (kicked off) during the COVID-19 national emergency.
If you have questions about Medicaid and whether you qualify, call the Georgia Division for Family & Children Services at 877-423-4746.
You may also contact Atlanta Legal Aid (find the phone number for your county here) or Georgia Legal Services Program at 1-800-498-9469 with questions or concerns.
If you are uninsured/unable to get health coverage
Do not skip or avoid health care just because you are uninsured! You can get free or low-cost health services at:
- Community Health Centers—find the clinics closest to you here
- Charity Care Clinics—find the clinic closest to you here
- Health care over the phone/online (telehealth)—Giving Health offers free telehealth services to people who are uninsured. Visit givinghealth.org/how-it-works or call 866-662-1923.
- Check with your local hospital to see what financial assistance programs you may qualify for
References & resources
COVID-19 Town Hall PowerPoint slides by Center on Budget & Policy Priorities
Frequently Asked Questions by Center on Budget & Policy Priorities
Updated: December 18, 2020
The Georgians for a Healthy Future team is continuing to monitor the COVID-19 (coronavirus) outbreak closely. As always, GHF strives to be a resource for Georgia consumers. While things continue to change quickly during this health care pandemic, we will share practical advice and actionable information to help you navigate a confusing time and find the answers you need. Here we present information about how to access health care services and what to expect from your health insurance coverage when you do. We will keep the corresponding blog post updated as things change and with links to helpful resources as they become available.
Georgia’s statewide shelter in place ended on April 30, 2020 for most Georgians. Vulnerable populations including those who are medically fragile and elderly should continue to shelter in place until June 12, 2020.
Governor Kemp also extended Georgia’s public health state of emergency through January 08, 2020. He also issued executive orders requiring businesses to operate by strict social distancing and sanitation rules through May 13, 2020. As of June 1, 2020 restaurants are still required to abide by 39 restrictions to open their dining rooms.
We encourage all of you to continue to help prevent the spread of the virus by taking the necessary steps to “flatten the curve” including staying home, avoiding group gatherings, washing your hands, practicing good hygiene, and following the guidance of public health experts.
If you are experiencing symptoms of COVID-19 or may need a test
If you believe that you are experiencing symptoms of COVID-19 or have been exposed to the novel coronavirus, call your primary care doctor or an urgent care clinic. Let them know you think you may have COVID-19, so they can take the proper precautions and direct you to available testing sites. You may also call the Georgia Department of Public Health on their COVID-19 hotline at 844-442-2681. Public health officials are urging people not show up unannounced at a doctor’s office, emergency room or other health care facility.
The Centers for Disease Control and Prevention have a Coronavirus Self-Checker which may be a helpful tool if you think you are experiencing symptoms of the virus.
You can find out more about COVID-19, its symptoms, what to do if you think you are sick, and other COVID-19 information at dph.georgia.gov/novelcoronavirus.
COVID-19 testing is available for all Georgians, regardless of whether you have coronavirus symptoms. Anyone can call their local health department to get scheduled for testing. They can also download the Augusta University ExpressCare app, visit augustahealth.org, or call (706) 721-1852.
Effective May 7, 2020, COVID-19 testing is available to all Georgians who request it, whether they have symptoms or not. Call your local health department to schedule an appointment at a location near you and to inquire if testing is free.
What to expect from your health insurance
If you have insurance, make sure to use it for any testing and medical exams related to COVID-19 and any other medical services you may need during this time.
The COVID-19 crisis has caused many Georgians to lose their jobs and also lose their employer-sponsored health care coverage. If you have lost your coverage or have had a drop in your income, you may be eligible for Medicaid or financial assistance to buy health insurance through the Affordable Care Act. Please read the If You Lose Your Job section below.
If you have Medicaid or PeachCare for Kids
If you and your family have lost your source of income in this crisis, or are in lower-income work with no health coverage, enrolling in Medicaid may be an option for you.
Medicaid provides all “medically-necessary” services to its members. During the national public health emergency period, your Medicaid coverage will cover the cost of a COVID-19 test. If you are diagnosed with COVID-19 and need medical treatment, Medicaid should also cover those costs.
Check with your Medicaid insurance company for more information and guidance. Click the name of your Medicaid company to find out more: Amerigroup, CareSource, PeachState Health Plan, and WellCare.
If you need other health care services during this time, check with your Medicaid insurance company and doctor to see if you can have a “virtual appointment” using the internet, video call, or telephone call, instead of going in-person.
Georgia’s Department of Community Health (DCH) has announced that Medicaid & PeachCare members will not owe any co-payments for any health service from May 1, 2020 until the end of the national public health emergency.
No one can willingly lose their Medicaid coverage during the public health emergency. If you lose your Medicaid coverage during this time, contact your Medicaid insurance company.
If you have private insurance
If you have insurance through your job, the State Health Benefit Plan, or the Affordable Care Act marketplace (also called healthcare.gov), use it for any testing or medical exams related to COVID-19. The Families First Act requires that health plans and insurers cover testing for COVID-19 so your test should be free. If someone wants to charge you for a test, call the DPH’s COVID-19 hotline.
If you are diagnosed with COVID-19 and require medical treatment, you should expect to pay some out-of-pocket costs like your deductible.
As of March 21, 2020 Cigna, Humana, Aetna, and UnitedHealthcare have waived cost-sharing for COVID-19 treatment. Aetna and Cigna have pledged to waive COVID-19 treatment costs for qualified medical bills until June 1, 2020. Humana has not announced an end date to their COVID-19 cost-sharing policy.
If you purchased coverage outside of the ACA marketplace or you have a short-term plan or health-sharing ministry, call your insurance company to find out how they are covering COVID-19 testing and treatment. The cost-sharing requirement under the Families First Act does not apply to people who are enrolled in non-ACA compliant plans (ex: short-term plans).
If you need other health care services during this time, check with your insurance company and doctor to see if you can have a “virtual appointment” using the internet, a video call, or a telephone call instead of going in-person.
In order to ensure people affected by COVID-19 have access to health care Georgia’s Insurance Commissioner issued a directive on March 20, 2020, that instructed health insurers to refrain from canceling health policies due to non-payment. That directive expires on May 31st. If you are behind on your premium payments or expect to be, call your insurance company right away to see if they can offer a payment plan, financial assistance, or other help to keep you enrolled.
If you have Medicare
Medicare covers the lab tests for COVID-19. You pay no out-of-pocket costs. All necessary hospitalizations are also covered by Medicare, including hospitalizations for quarantine. More information about Medicare’s coverage and services is available here.
If you are uninsured
If you need a COVID-19 test, contact your local public health department to find a testing site and to ask whether the test will be free. Request that they waive any testing costs.
If you need other health care services during this time, find a local community clinic, or apply for financial assistance through a hospital charity care program. Georgians should not let their insurance status get in the way of getting needed testing or treatment.
If you lose your job
Many Georgians across the economy have lost their jobs and may be at risk of losing their coverage. If this is your situation, you can keep yourself and your family covered during this health crisis. You may be eligible for a Special Enrollment Period up to 60 days after losing your job-based health insurance. When you begin the enrollment process, healthcare.gov will ask you about your estimated income for 2020 and will let you know if you qualify for financial help to lower your premiums and other cost-sharing.
For free help with the enrollment process, contact these organizations:
- Insure Georgia, insurega.org, 866-988-8246
- The Health Initiative, thehealthinitiative.org, 404-688-2524 (leave a voicemail in the general mailbox)
Coverage through the ACA marketplace (healthcare.gov) covers testing for COVID-19. It will also cover part or all of the costs related to COVID-19 treatment. Call your insurance company for more information.
If you are unable to enroll in a health insurance plan, you may have other options through services such as a community clinic, which can connect you with the care you need.
Resources for you and your loved ones
During this uncertain time, many of our partner organizations are doing the hard work of finding and centralizing the information that you and your loved ones may need. Here are a few that we think are most helpful. We will continue to update this list with actionable resources and information so you can stay healthy, safe, and well.
- COVID-19 guidance and information
- Information from public health experts: Visit the Georgia Department of Public Health’s website for the latest guidance and updates about COVID-19 in Georgia.
- Coronavirus resources for people who are not strong readers: Georgia State University has published a library coronavirus materials for people who may not have strong reading or literacy skills. They have included materials up to a 9th-grade reading level.
- COVID-19 guidance and information for people who do not speak English as a first language:
- Google Drive folder with resources in 20 languages, collected and maintained by the Center for Pan Asian Community Services
- The GSU School of Public Health’s Prevention Research Center has compiled COVID-19 information sheets (from CDC & the International Rescue Committee) in 25 languages
- Make sure your basic needs and finances are taken care of:
- If you need help finding food:
- Food Bank of Northeast Georgia: Visit www.foodbanknega.org, click “Need Help”. Call the office at (706) 354 8191
- Atlanta Community Food Bank: Text the word FINDFOOD to 888-976-2232 with your ZIP code and street address and you will be sent a list of the three closest distribution centers.
Text service also available in Spanish, using the word COMIDA
- Georgia Mountain Food Bank: uses the same system as Atlanta Community Food Bank
- Golden Harvest Food Bank Visit www.goldenharvest.org, click on ‘Find Help’ at the top of the page, you will be taken to a map where you can enter your zip code to find the nearest food distributor
- Middle Georgia Community Food Bank–Call 211 and you will be connected with an associate who will be able to tell you where you can find food
- Feeding the Valley Food Bank: Visit feedingthevalley.org, on the front page, enter your zip code into the ‘Need Food’ box and you will be shown the closest food pantries to your location
- America’s Second Harvest of Coastal Georgia: Visit helpendhunger.org, select ‘Find Food’ on the homepage, you will be taken to a map where you can enter your zip code or county to be shown the nearest food distribution centers
- Second Harvest of South Georgia: Visit feedingsga.org, select ‘Find Help’ in the ‘Learn’ section at the top of the page, you will be taken to a map where you can find the closest distributors to you
- Georgia Covid-19 Resource List, Atlanta Legal Aid Society, Inc.
- GLSP’S Eviction Prevent Project, Georgia Legal Services Program
- COVID-19 stimulus payments: The IRS has published a way for people to receive their recovery refund (also called COVID-19 stimulus payments) even if you were not required to file taxes in 2019. Details are available here.
- Avoid scams: What Consumers Need to Know About COVID-19 Scams, Georgia Watch
- Direct financial assistance: Patient Advocates Fund’s COVID Care Recovery Fund delivers $500 in direct financial aid to eligible patients who need non-medical, cost-of-living help as a result of their diagnosis of COVID-19.
- Financial health during COVID-19: Financial Resilience Center, National Disability Institute
- Health Care:
- Find a clinic – Georgia Primary Care Association
- Find a clinic – Georgia Charitable Care Network
- Resources for people with developmental disabilities:
- COVID-19 Resources for Georgians with Developmental Disabilities, Georgia Council on Developmental Disabilities
- Staying mentally healthy and keeping your recovery: Behavioral Health in the time of COVID-19 by Georgians for a Healthy Future
- Keeping children healthy and well:
- COVID-19 latest information and resources, Voices for Georgia’s Children and Georgia Statewide Afterschool Network
- Teach Kids Coping Skills, Children’s Healthcare of Atlanta Strong4Life
- Transitioning Into Your Family’s New “Normal”, Children’s Healthcare of Atlanta
- Five-Minute Coronavirus Stress Resets, The New York Times
- Resources for pregnant families during COVID-19: Healthy Mothers, Healthy Babies Coalition of Georgia has put together a toolkit for families navigating pregnancy, labor, and the postpartum period in Georgia during COVID-19
- Community Health Workers
- Information and Resources for Community Health Workers: This information kit was created for CHWs serving in Georgia to supplement the robust list of information provided by the National Association of Community Health Workers.
On December 23, 2019, the Georgia Department of Community Health (DCH) submitted Governor Kemp’s 1332 private insurance proposal to federal health officials.
The plan consists of two parts:
- A reinsurance program to lower premiums; and
- A dramatic erosion of the ACA’s rules and structures, including provisions that privatize insurance enrollment; cap the financial assistance available to low- and middle-income consumers; and erode consumer protections in private insurance
DCH’s submission of the proposal to the Centers for Medicare & Medicaid Services (CMS) comes after a 30-day public comment period, during nearly 1000 Georgians weighed in with their opinions on the plan. Despite the overwhelming opposition to the second part of his plan, Governor Kemp and DCH sent the proposal to federal officials with no meaningful changes.
On February 5, 2020, Governor Kemp wrote a letter to requesting that the reinsurance program be considered separately from the second part of his proposal, and that CMS’s consideration of the second part of the plan be paused. CMS responded to Governor Kemp on February 6 in a letter that deemed the reinsurance program application complete and requested more information about the remaining parts of the Governor’s proposal.
CMS’s response began a 30-day public comment period on the proposed reinsurance program, allowing Georgians, health advocates, and any other interested party to weigh in.
GHF, along with several partner organizations, submitted a comment communicating our support of the reinsurance program, while noting our deep concerns about the remainder of the Governor’s proposal. You can read the full comment letter here.
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
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.
In March, Georgia’s Governor and state legislature approved SB 106, legislation that allows the state to pursue an 1115 “waiver” to make changes to Georgia’s Medicaid program and a 1332 state innovation waiver to make changes to private insurance in the state. (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.)
In June, the Governor hired Deloitte Consulting to develop the proposals for Georgia’s Medicaid program and the private insurance market. Five months later, on October 31st and Nov. 4th respectively, Governor Kemp announced the details of his proposed plans.
The Governor’s proposed 1115 Medicaid waiver, called Georgia Pathways plan, would allow Georgians with incomes below the poverty line to enroll in Medicaid coverage but only if they can meet monthly work requirements (at least 80 hours per month of work, school, training, or volunteering per month). The plan would cover only a fraction of those who could be covered by a full Medicaid expansion.
The Governor’s proposal to re-shape the state’s private health insurance market consists of two parts:
- A reinsurance program to lower premiums; and
- A dramatic erosion of the Affordable Care Act’s rules and structures, including provisions that privatize insurance enrollment; cap the financial assistance available to low- and middle-income consumers; and erode consumer protections (like the requirement that health plans cover essential health services).
This plan would result in many Georgians who currently have health insurance becoming uninsured or underinsured.
The announcement of the Governor’s plans kicked off a 30-day public comment period during which Georgians impacted by these proposals, health advocates, health care industry stakeholders, and others could weigh in on the plans.
The Governor’s Medicaid proposal does not go far enough towards closing Georgia’s coverage gap and his plan to dramatically scale back the ACA in Georgia would turn back the clock on Georgians with pre-existing conditions and consumers who need financial help to afford private coverage, among many others. GHF submitted comments to state officials communicating our deep concerns about both plans. You can read GHF’s full comments here:
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.
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