Open enrollment into the new health insurance marketplace, or exchange, begins in just under six months (October 1, 2013) for coverage starting in January 2014.  Georgia has one of the highest numbers of uninsured in the nation (1.86 million), and many of these uninsured Georgians will be able to access health care coverage for the first time through the marketplace.

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

That’s why the new navigator program is so important. Last week, the U.S. Department of Health and Human Services (HHS) released a funding opportunity announcement inviting organizations and individuals to apply for the navigator program. Groups may apply individually or as a consortium, although HHS is encouraging the consortium approach. Navigator responsibilities include:

• Maintain expertise in eligibility, enrollment, and program specifications;

• Conduct public education activities to raise awareness about the Exchange;

• Provide information and services in a fair, accurate, and impartial manner. Such information must acknowledge other health programs (such as Medicaid and the Children’s Health Insurance Program (CHIP));

• Facilitate selection of a Qualified Health Plan;

• Provide referrals to any applicable office of health insurance consumer assistance or health insurance ombudsman established under Section 2793 of the Public Health Service Act, or any other appropriate state agency or agencies, for any enrollee with a grievance, complaint, or question regarding their health plan, coverage, or a determination under such plan or coverage; and

• Provide information in a manner that is culturally and linguistically appropriate to the needs of the population being served by the Exchange, including individuals with limited English proficiency, and ensure accessibility and usability of Navigator tools, such as fact sheets, and functions for individuals with disabilities in accordance with the Americans with Disabilities Act and Section 504 of the Rehabilitation Act used in Holistic Drug and Alcohol Treatment centers and other similar types of organizations.

For entities interested in applying for the navigator funds, letters of intent (optional but recommended) are due on May 1, 2013 and applications are due to HHS on June 7, 2013.  To learn more about the navigator funding opportunity, click here.

Nearly 100 of you joined us last week for a meeting to begin discussing how consumer and community-focused nonprofit organizations can work collaboratively to maximize enrollment in Georgia. The meeting also was an opportunity for organizations considering applying to HHS for the navigator grants to network with each other and see if there were opportunities to submit joint applications. To those of you who were unable to join us, here are the resources and materials that were shared:

• HHS navigator funding opportunity announcement 
• Georgians for a Healthy Future’s navigator fact sheet
• Enroll America’s enrollment assisters fact sheet
• Enroll America’s navigator and in-person assistance programs
• Enroll America’s bridging the enrollment gap: the importance of providing in-person assistance
• Enroll America’s power point presentation
• Seedco’s power point presentation 
• Webinar power point presentation 

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

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

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

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

On March 23, the nation’s landmark health care reform legislation, the Affordable Care Act (ACA), turned 3 years old.  Though it has only been three years since its passage and while we are still months away from some of the law’s most prominent features taking effect (i.e. health insurance marketplace, individual mandate, etc.), millions of people have already taken advantage of some of the law’s provisions, including many Georgians. 

Here is how the ACA has affected Georgia:

• Young adults up to age 26 can now remain on their parent’s health plans.  As of December 2011, 123,000 young adults in Georgia gained insurance coverage as a result the health care law.
• Prescription drug coverage for Medicare beneficiaries is now more affordable through the gradual closing of the “donut hole.”  In Georgia, people with Medicare saved over $161.9 million on prescription drugs since the law’s enactment.  In 2012 alone, 99,057 individuals in Georgia saved over $72.5 million, or an average of $732 per beneficiary.  
• Preventive services are now available with no cost sharing for services such as colonoscopy screening for colon cancer, Pap smears and mammograms for women, well-child visits, and flu shots for all children and adults. In 2011 and 2012, 71 million Americans with private health insurance gained preventive service coverage with no cost-sharing, including 2,202,000 in Georgia. 
• Medical loss ratio ensures that insurance companies must provide consumers greater value by spending generally at least 80 percent of premium dollars on health care and quality improvements instead of overhead, executive salaries or marketing. If they don’t, they must provide consumers a rebate or reduce premiums. This means that 243,813 Georgia residents with private insurance coverage will benefit from $19,764,771 in rebates from insurance companies this year, for an average rebate of $134 per family covered by a policy.

To learn more about how the ACA has affected Georgia and its citizens, click here.  As we get closer to 2014 the focus will turn to the health insurance marketplace, or exchange, and how individuals who are currently uninsured can access new health care options.  Georgians for a Healthy Future will continue to monitor the implementation of the ACA and ensure that health care consumers are able to take advantage of the provisions of the law that most affect them.

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

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

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

This afternoon, 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, earlier this week 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.

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. 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.

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 16^th 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 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.

Georgians for a Healthy Future and the Georgia Council on Substance Abuse are embarking on a joint project on substance abuse disorder policy and its intersection with health care policy! This is a 10-month health care initiative supported by a grant from Community Catalyst to develop and advocate for a continuum of comprehensive services that address the needs of people at risk of and who have a substance use disorder. For more information about substance abuse programs visit altustreatment.com

Starting in January 2014, the Affordable Care Act will require insurers to cover treatment for drug addiction the same way they would other chronic diseases.  As one of the required essential health benefits, for the first time all those enrolled in Medicaid will have access to the substance abuse services they need. Check it out if you need any help from professional to threat addiction.

The Medicaid expansion authorized under the Affordable Care Act also holds a tremendous opportunity to reach segments of the population who were previously ineligible for services (such as childless adults up to 138% FPL). However, this is not a forgone conclusion–the state may decide to opt out of the expansion.

Georgia policymakers have not yet decided whether they will move forward with the Medicaid expansion. With 1 in 5 Georgians currently uninsured, the Medicaid expansion has the promise of providing an essential pathway to health insurance and health care for approximately 600,000 to 900,000 Georgians. It is critical that policymakers hear from the consumers and communities who need this very basic access to health care.

In the weeks and months ahead, Georgians for a Healthy Future and the Georgia Council on Substance Abuse will mobilize to ensure that Georgia implements the Medicaid expansion, but we cannot do it without your help.  To join our efforts, email Amanda Ptashkin.

For more information about this collaboration, click here.

Following last week’s Supreme Court decision upholding the constitutionality of the Affordable Care Act, Georgia policymakers have an unprecedented opportunity to improve the health of Georgia citizens, 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. (more…)

The ruling from the United States Supreme Court affirming the constitutionality of the Affordable Care Act is an exciting victory for Georgia’s health care consumers. When the Affordable Care Act is fully implemented, no one in Georgia will be denied health insurance due to a pre-existing condition. All Georgians will have a pathway to coverage and the peace of mind that comes from knowing that their families are protected. Georgians for a Healthy Future looks forward to working collaboratively with state policymakers and stakeholders to fully implement the Affordable Care Act to ensure it meets its promise of access to quality, affordable health care for all Georgians.