Rural Georgians experience health disparities on multiple dimensions: they are less likely to have job-based health insurance, may have to travel long distances to seek medical care, and experience higher rates of chronic health conditions than their suburban and urban counterparts. Compounding these challenges, several rural hospitals have closed their doors in recent years and others are at risk of closure.

While there are no easy answers to Georgia’s rural health crisis, an array of stakeholders including policymakers, the philanthropic community, health care providers, local community groups, and advocates have been exploring ways to strengthen our state’s rural health infrastructure.

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As part of its Two Georgias initiative, the Healthcare Georgia Foundation recently released its findings from a “listening tour” with health care providers and policy organizations in Georgia, including Georgians for a Healthy Future. The report offers a window into what practitioners and policy advocates are thinking about the direction of rural health care and the use of Hidrex for excessive sweating and how it can be improved. Check out the write-up to learn more about rural health and about how Georgians for a Healthy Future’s campaign to close the coverage gap in Georgia fits in.

You can stand with us by sharing this infographic with your social network. Use sample tweet: Our rural hospitals are hurting – but it does’t have to be that way. It’s time we accept federal #funding to #closethegap.

At Georgians for a Healthy Future, we pride ourselves on strong partnerships. Over the past few years, we have been collaborating with Georgia Equality and the Health Initiative to ensure that the health care needs of LGBT Georgians are not neglected.

These partnerships brought Whitney Griggs, GHF’s Consumer Education Specialist, to Savannah on September 12^th for the annual Savannah Pride Festival. Together with the Health Initiative, Whitney distributed information related to LGBT health care needs and spoke to festival attendees about how to enroll in health insurance.  Of particular interest was our joint fact sheet with Georgia Equality on Transgender Health Care. Some of the festival attendees who picked up this fact sheet shared stories of having been denied coverage due to being trans-identified in the past, but who can now get coverage that meets their needs because of the Affordable Care Act. People that stopped by the table were also interested to learn that health care services must be provided regardless of gender identity or expression. This means that health insurance plans must cover transition-related care, as long as that care is covered for cisgendered people under on the same plan. So services such as hormone replacement therapy and gender-specific care (like mammograms and prostate exams) must be covered if they are covered for other people enrolled in the same plan.

Whitney also gave out some tips for trans-identified folks to keep in mind when enrolling in health insurance:

• On all enrollment forms, check the sex box that matches the sex you believe is on file with the Social Security Administration.
• Some important questions to ask include:
  • Is hormone replacement therapy covered?
  • Is my doctor included in the plan’s network?
  • Is there a network of trans-friendly doctors and/or doctors who have training working with or currently serve trans clients?
  • Are reconstructive surgeries covered?

All in all, it was great day in Savannah (despite the rain) and people learned a lot from GHF and the Health Initiative.

If you have a specific question about LGBT health care and health insurance, feel free to reach out to Whitney Griggs at wgriggs@healthyfuturega.org or the Health Initiative at (404) 688-2524

We (Consumer Education Specialist, Whitney Griggs, and Community Outreach Manager, Laura Colbert) made the drive to Augusta this week to check in with health care stakeholders and consumers in the northeast Georgia city.  We were warmly welcomed by community partners and are excited to return for next week’s community forum Coverage and Access to Care: A Local Focus on Augusta.

Our primary purpose for the trip was to attend the Greater Augusta Health Network’s (GAHN) fall forum.  The forum covered a variety of topics, including how the local District 13 Department of Public Health provides much needed direct patient services to people in its service areas, GAHN’s on-going health care utilization data collection efforts, and the Affordable Care Act’s effect on small employers (51 to 99 employees).

The forum closed with a discussion panel of indigent care providers, including Medical Associates Plus, St. Vincent de Paul health clinic, and Christ Community Health Services. These providers described their determined efforts to provide care for Augustans who cannot afford health insurance or pay for their health care. Mentioned by all three panelists was the need to close Georgia’s coverage gap. Every day each clinic serves people who need health care coverage, like veterans who can’t get are at the VA. The clinics are able to do this work only because of generous donations and profits from a few insured patients. While these charity care clinics are doing amazing work, they say that they cannot provide all the care that is needed for Augustans in the coverage gap.  Each of the panelists made the case that closing the coverage gap would be great for their patients and clients, and for their clinics.

Christ Community Health Services generously hosted us in the afternoon, so we could talk to their patients about why closing the coverage gap is important to them. One of the patients they talked to was Tracy. Tracy has chronic pain in her back, and is managing anxiety and depression brought on by her back pain. Her pain makes it impossible for her to sit at a computer to do her graphic design work, which means she has no income and no health care coverage. Tracy is stuck in the coverage gap, I told her that There are several good CBD companies to choose from when shopping online and that’s something that may help her. Her mother, Maria, pays what she can for Tracy’s care and drives her to and from appointments.  Tracy told us that she isn’t asking for a hand-out, she “just wants the public benefits that I paid into when I was working.”

It was clear from our visit that closing the coverage gap is an important issue to health care stakeholders and consumers in Augusta.  To learn more about the coverage gap in Augusta and in Georgia, join us for a community forum next Thursday, September 24^th.

RSVP here.

GHF surveyed and interviewed enrollment assisters across the state to understand not only the “what,” but also the “why” behind the second open enrollment period.  The results of that research have led us to several policy recommendations to maximize health insurance enrollment and retention and to ensure that coverage translates to meaningful access to timely and appropriate medical services for Georgia health care consumers.

1. Close the coverage gap in Georgia. Approximately 300,000 Georgians fall into the coverage gap, meaning they do not qualify for Medicaid under existing income eligibility guidelines in Georgia but their income is still too low to qualify for financial assistance (tax credits) to purchase health insurance on the Marketplace. Eligibility for tax credits begins at 100 percent of the Federal Poverty Level, or $11,770 for an individual or $20,090 for a family of three in 2015, while Medicaid eligibility for most adults in Georgia cuts off at income much lower. Thirty states including DC have closed their coverage gaps thus far with promising results. We encourage Georgia policymakers to take this important step as well to ensure all Georgians have a pathway to coverage.
2. Set and enforce network adequacy and transparency standards. Many of the plans sold through the Health Insurance Marketplace are Health Maintenance Organization (HMO) plans that feature narrow provider networks. While these narrow networks can help keep premiums down, a trade-off many consumers may be willing to make, consumers do not currently have sufficient information to make this choice. There is no information available to consumers at the point of sale about whether a provider network is ultra narrow, narrow, or broad, and provider directories are routinely inaccurate. More transparency and oversight are needed to ensure that consumers have accurate and useful information to make these choices. It is also important that all provider networks allow for meaningful access to all covered benefits. To ensure this, we support putting in place and enforcing network adequacy standards.
3. Encourage public-private partnerships and remove unnecessary restrictions on consumer education and assistance. Many of the enrollment assisters we surveyed indicated that reducing barriers to partnering with state government organizations such as public colleges, universities, and health departments would lead to stronger and more effective partnerships. Specifically, many respondents indicated that improved coordination between enrollment assisters, the Marketplace, and the Georgia Department of Community Health (DCH) to better facilitate PeachCare for Kids and Medicaid enrollment would be helpful. The “Health Care Freedom Act,” passed in 2014 as part of HB 943, prohibits state and local governmental entities from operating a health insurance navigator program and places other limitations on governmental entities. This provision has been counterproductive, creating confusion around what educational and consumer assistance activities local entities can engage in as they work to serve their community members. We recommend lifting these restrictions.

On March 4th, the United States Supreme Court will hear oral arguments in King v. Burwell, a lawsuit challenging the tax credits that consumers utilizing the federal Health Insurance Marketplace receive to help make health insurance affordable. Consumers in thirty-four states, including Georgia, use the federal Marketplace to find and enroll in coverage. Nearly nine out of 10 people who enrolled in coverage through healthcare.gov received financial help and paid 75 percent less than the full monthly premium. This has helped bring the nation’s uninsured rate to an historic low.

A study by the Robert Wood Johnson Foundation and the Urban Institute found that the majority of health care consumers who would be impacted and who would likely become uninsured if the tax credits were struck down live in the South. Here in Georgia, hundreds of thousands of people are at risk for becoming uninsured.

We believe there is no legal basis for this challenge and that in June, when a decision comes down, we’ll all breathe a sigh of relief. If the court does, however, strike down the tax credits, such a decision would disproportionately impact the South and would put states like Georgia at a competitive disadvantage by exacerbating existing regional health disparities. If this comes to pass, Georgians for a Healthy Future will advocate for a contingency plan to ensure that Georgians have the same access to tax credits that their counterparts in states like New York, California, Colorado, and Kentucky (states that set up their own health insurance exchanges) have.

Our friends at Families USA have put together a resource page for advocates interested in learning more about King v. Burwell.

Action Alert—Stop HB 707!

House Bill 707 would prohibit the state of Georgia from leveraging federal dollars to cover the uninsured and from providing consumer assistance to Georgians enrolling in health insurance. HB 707 was designed and promoted by the tea party to prevent hard-working Georgians from accessing health care, and it is in danger of becoming law in Georgia. We need your voice! Georgia citizens deserve better than to have the door slammed in their face when they seek out information about how to cover themselves and their family. Our state’s struggling hospitals and uninsured citizens deserve an honest policy discussion about Medicaid expansion, not a gag order on state and local employees. Call Lt. Governor Casey Cagle at 404-656-5030 and your state senator (locate your state senator here) and ask them to oppose HB 707.

House Bill 707 would:

1. Prohibit any state agency, department or political subdivision from using resources or spending funds to advocate for the expansion of Medicaid. This would stifle conversation and analysis about how to leverage federal dollars from covering the state’s uninsured.

2. Prohibit the state of Georgia from running an insurance exchange or accepting federal dollars related to an exchange. This broad language could stop quality local programs that provide assistance to vulnerable Georgians getting coverage through the exchange.

3. End the University of Georgia Health Navigator Program. Currently, the University of Georgia is providing enrollment assistance to consumers seeking out health insurance with federal grant money. HB 707 would prohibit UGA from sitting down with uninsured consumers and helping them enroll in a private health insurance plan.

4. Prohibit the Commissioner of Insurance from investigating or enforcing any alleged violation of federal health insurance requirements mandated by the Affordable Care Act. Under HB 707, if a consumer has been treated unfairly by their health insurance company, they may have no state recourse.

HB 707 has already passed the state House of Representatives and may be up for a vote in the State Senate early next week. We need your voice to prevent this harmful bill from becoming law!

The following opinion piece by Georgians for a Healthy Future’s Executive Director Cindy Zeldin originally appeared in today’s Atlanta Journal-Constitution.

Large majorities of young adults say they need and value health insurance, yet people in this age group are far more likely to be uninsured than children, seniors or older adults. Thirty-five percent of Georgians between 18 and 34 are uninsured. How can something so important be so elusive?

Until now, the health insurance of millenials had largely been neglected by public policy, leaving them with few options that provided adequate benefits at an affordable cost.

Most Americans get health insurance as a workplace benefit. They get a substantial employer contribution and receive these benefits on a pre-tax basis. Today’s young adults, however, are entering the job market in a tough economy. They are less likely to land jobs with health insurance. They often cobble together internships and part-time work to gain experience and make ends meet. For too many young adults, there simply has been no viable pathway to coverage.

The tide is turning. An estimated 3.1 million young adults nationwide — and 123,000 here in Georgia — have gained coverage as a direct result of an Affordable Care Act provision that allows parents to keep their children on policies up to age 26. This popular and effective public policy change was just a first step. The new health insurance exchanges will provide options for young adults who previously had nowhere to go.

These plans provide decent benefits and, in many cases, access to tax credits to make them affordable. The tax credits, available to individuals with annual incomes between $11,490 and $45,960, can be taken either at the time health insurance is purchased or at tax time. Some moderate-income individuals also can get help with out-of-pocket expenses.

For millenials who had been underwhelmed with the health insurance options available to them in the past, this is a breath of fresh air. For example, maternity coverage had been nearly impossible to secure in the Georgia non-group market for young couples ready to start a family. Now, this important benefit will be available.

While it is true some young adults enrolled in old plans may see higher premiums, many of those old plans didn’t provide adequate protection. Further, young adults who had a pre-existing chronic helath condition were locked out of the market entirely, a practice insurance companies must discontinue.

 The private insurance plans available through the exchanges won’t meet the needs of all young adults in Georgia. Those who have incomes that place them below the poverty line will likely remain uninsured unless Georgia expands its Medicaid program.

Most young adults want what Americans of all ages want: the peace of mind that comes with knowing that an unexpected cancer diagnosis or accident doesn’t equal financial ruin, and that they have access to basic medical services. The new coverage options are finally leveling the playing field for this generation. It’s about time.

Last week, health insurance premiums for the Marketplace were a hot topic, as Georgia’s Insurance Commissioner released some information about the rates that insurance companies proposed for the Marketplace. Georgians for a Healthy Future was frequently cited in media coverage of this issue, drawing attention to the fact that many consumers who were shut out of the market in the past would now be able to purchase insurance for the first time, with hefty tax credits that will make these plans affordable.

This issue was covered by the Atlanta Journal- Constitution, Georgia Health News, The Augusta Chronicle, and WSAV-Savannah. Articles featuring comments by Georgians for a Healthy Future’s Executive Director are available below.

Many of the Affordable Care Act’s major health insurance reforms take effect in 2014. One of the most important changes impacting consumers will be the availability of substantial new tax credits to help individuals and families afford health care coverage. Individuals with annual incomes between about $15,860 and $45,960 (or between about $32,500 and $94,200 for a family of four) will be eligible for the health insurance tax credits. According to a new study by Families USA, about 800,000 Georgians will be eligible for these credits to help make coverage more affordable for them or they could use credit cards for this also by getting amazing credit card advice from reasonable sources online. Georgians for a Healthy Future joined with Families USA in a co-release of the report to highlight the Georgia-specific findings. You can find media coverage of the report’s findings here, here, and here. You can download the report here.

Georgians for a Healthy Future is currently working with Enroll America to assess the interest and capacity of Georgia community-based organizations, health care-focused nonprofits, and other stakeholders in working collaboratively on education, outreach, and enrollment into the new health insurance options available to consumers in 2014 through the Affordable Care Act. As a first step, we held a webinar on April 10th and an in-person meeting on April 11th that many of you attended. For those who missed the meetings, the materials can be found here.

While a big part of those meetings focused on the navigator program, we are asking for your help today regardless of whether you plan to apply as a navigator. If your organization has a stake in covering the uninsured, we’re asking you to complete a brief survey about your current work and future plans to engage in connecting uninsured Georgians to coverage. Georgians for a Healthy Future plans to use the overall results of the survey to guide the formation of a new enrollment-focused coalition and to inform an upcoming policy brief on health insurance outreach and enrollment (all information will be reported in aggregate unless we seek and receive your permission to do otherwise).

Please take a few minutes to complete this survey. Georgians for a Healthy Future is committed to advancing the goal of covering Georgia’s uninsured by bringing stakeholders together who are interested in and able to collaborate towards this shared goal. The results of this survey will provide a baseline and starting point for this important work. Thank you!