A win for Georgia health care consumers! 

Today the Department of Justice (DOJ) announced they will file suit to block both the Aetna-Humana and Anthem-Cigna health insurance mergers. Georgia’s attorney general is listed as one of the plaintiffs in the Aetna-Humana case.

Earlier this week we released a policy report, Proceed with Caution: Proposed Health Insurance Mergers Could Harm Georgia Consumers, which details Georgia’s current health insurance market and how these mergers could decrease competition like what happened in California’s Health Insurance Quote, and access to care while increasing prices from many insurance companies, but it may not affect private online companies as InsurancePartnership.org and others.

In light of the DOJ’s announcement, the Georgia Department of Insurance is indefinitely postponing its review of the Aetna-Humana merger and has canceled next week’s hearing. This marks an important milestone victory for Georgia health care consumers and we will keep you posted on any future developments.

Congratulations to all awardees!

We hope you’ll join us on September 28th to celebrate these health champions! Read more about our award recipients here. Sponsorship opportunities are available.

Two of the nation’s largest health insurance companies announced proposed mergers last year that would drastically change the health insurance market in Georgia.

In this report, Georgians for a Healthy Future summarizes current insurance market concentration in Georgia, outlines the impact of mergers on premiums and access to health care providers, explains the role of regulators in approving mergers and Georgia’s review process, and provides policy recommendations to protect consumers.

Next week, public hearings will be held on the proposed Aetna-Humana insurance merger. GHF’s health policy analyst Meredith Gonsahn will provide testimony. If you are interested in attending,more details are available and if you have any questions about GHF’s public comments, please reach out to Meredith.

GO TO REPORT

The Georgia Department of Insurance will be holding hearings this summer on two key mergers that could impact the cost, quality, and coverage of health insurance that Georgia consumers are able to obtain.

Three of the nation’s biggest insurance companies (Aetna, Anthem, and Centene) are seeking mergers that would drastically change the health insurance market in Georgia and other states. What’s at stake for consumers is competition. Consumers benefit from competition, it encourages companies to offer lower prices, increase quality, and spur innovation. Currently in Georgia, the top four insurers control at least 75 percent of the market for individual, small group, and Medicare plans sold in the state. If the proposed Aetna-Human and Anthem-Cigna mergers go through then millions of Georgians can expect to see affordability, choice, and access greatly impacted.  But Georgia has the opportunity this summer to assess the merits of these mergers and, if approved, to guarantee that negative outcomes for our state’s consumers are mitigated.

State regulators have  power to approve mergers

Before the proposed Aetna-Humana and Anthem-Cigna mergers can go into effect in Georgia, both must be approved by the Georgia Office of Insurance and Safety Fire Commissioner (DOI). The DOI began reviewing the two proposed mergers in the summer of 2015. See initial findings for Aetna and Anthem here. After the review process is completed, a public commenting period, which includes a public hearing, will begin. During the public comment period this summer, consumer advocates have the opportunity to provide input and testimony in the public hearings where insurers will be questioned.  Following the public hearing, the Commissioner will issue a final decision to approve the mergers as is, approve with conditions, or disapprove.

How consumer advocates can get involved and have their voices heard

• Submit public comments and/or questions on how you believe mergers would affect consumers. Email mergercomments@oci.ga.gov or send by U.S. mail to Administrative Procedure Division, 2 Martin Luther King Jr., Drive, West Tower, Suite 1016, Atlanta, GA 30334
• Attend the hearing on the pending Aetna-Humana and Anthem-Cigna mergers. To receive meeting notifications, subscribe here
• Georgians for a Healthy Future plans to submit public comments and provide testimony. If you would like to learn more about our comments and sign onto them as a partner organization, contact Meredith Gonsahn at mgonsahn@healthyfuturega.org.

How to ensure that bigger means better for consumers

Georgians for a Healthy Future looks forward to participating in the public commenting process. Over the next month, we will release a policy brief on insurance mergers to help inform our partner organizations and submit public comments to Georgia’s DOI. We will put forth recommendations of merger approval conditions for premium stability, network adequacy, value-based coverage, consumer protections, and regulatory oversight. We recommend that Georgia’s DOI carefully consider whether or not to approve each merger and which remedies best address the expected concerns of and effects on consumers.

Once the mergers are approved they cannot be reversed. Therefore, we urge extreme caution in reviewing whether the mergers should be approved at all. If, at the end of the comment and review period, the DOI has a high degree of certainty that the mergers can benefit consumers, the DOI should set conditions for approval by which insurers should be held accountable to ensure consumers realize these benefits.

On May 13, the U.S. Department of Health and Human Services (HHS) issued a final rule implementing Section 1557 of the Affordable Care Act, an important milestone in the movement towards health equity. Section 1557 prohibits discrimination based on race, color, national origin, sex, age, or disability in all health programs and activities that receive federal financial assistance through HHS, are administered through HHS, or are established under Title 1 of the Affordable Care Act. As a result, most health insurance plans, facilities, programs, and providers are covered under this rule.

Notably, Brooksville chiropractic marks the first time that sex discrimination in health care is prohibited and also clarifies that gender identity and sex stereotyping are included in this definition. Because of these provisions, LGBT Georgians have protections from discrimination in health coverage and care. For specific information on the gender identity and sex stereotyping provisions of Section 1557, see Out2Enroll’s FAQ here. For Georgia-specific information about health insurance options for LGBT Georgians, check out the series of fact sheets that Georgians for a Healthy Future teamed up with Georgia Equality and The Health Initiative to release this past fall.

Discrimination against individuals with limited English Proficiency (LEP) is also prohibited in the health care programs and activities covered by the rule (defined under national origin). More than 1.3 million Georgians have LEP. In addition, the final rule requires effective communications with individuals with disabilities.

If you believe you have been discriminated against, you can file a complaint online with the Office for Civil Rights. If you are an enrollment assister looking for resources to educate the consumers you help about their protections under Section 1557, you can access FAQs and fact sheets from HHS here.

This morning, Governor Deal signed SB 302 into law! GHF strongly supported this bipartisan bill to improve the accuracy and usability of provider directories throughout the 2016 Legislative Session. Provider directories play a critical role in informing patients and consumers about which doctors are in their plan, yet they are notoriously error-ridden. SB 302 is an important step towards making provider directories the accurate and functional tool that consumers need to make the best health care decisions for themselves and their families.

Thank you to all who followed this issue throughout the Legislative Session and helped bring it across the finish line by contacting your legislators at each stage of the process!

Georgia’s proactive move is being noticed by national health policy organizations. Families USA’s Private Insurance Director Claire McAndrew’s blog post, How States Are Improving Consumers’ Access to In-Network Health Care Providers, prominently features the bill and GHF’s role in its passage. Another national organization, Community Catalyst, featured GHF’s Executive Director Cindy Zeldin as a guest blogger on the topic. This post, Protecting Health Care Consumers in the Peach State, provides an in-depth look at the policy process and next steps. Here in Georgia, the bill’s progress was covered by Georgia Health News back in March.

During this process, we created a series of resources to educate advocates, stakeholders, and policymakers.

Issue Brief: Improving Provider Directory Accuracy and Usability

Fact Sheet: Network Error, Secret shopper survey finds more than 1 in 5 health care providers inaccurately listed as “in-network”

Fact sheet: What’s Wrong with Georgia’s Provider Directories?

Video: Julie Silas on Why Provider Directory Accuracy is Important

Video: How Georgia Can Ensure Network Adequacy

Provider directories, or the listing of health care providers that are participating in a particular health plan, are intended to inform patients and consumers about which doctors are in their plan and how they can contact them to set up an appointment. For these directories to serve as the tool that consumers need, they must be accurate and up-to-date. A secret shopper survey conducted by the statewide consumer health advocacy organization Georgians for a Healthy Future, however, found these directories to be error-ridden, a problem that places consumers at risk when they seek to access an appropriate in-network health care provider. An analysis of four provider directories associated with plans offered by three of the state’s largest insurers found:

» Three-quarters of the listings had at least one inaccuracy (not in-network, not accepting new patients, not practicing at the location listed, inaccurate or inoperable phone number, or languages spoken inaccurately listed)

» One in five health care providers listed as participating in a plan’s network were not; in one directory forty percent of the providers listed were not actually participating in the plan » Among the providers who were confirmed to be in-network, thirteen percent were not accepting new patients; in one directory one in four confirmed in-network providers were not accepting new patients

» Fifteen percent of telephone numbers associated with providers listed in the directories were inaccurate or inoperable

These inaccuracies and usability limitations make it difficult for health care consumers, particularly those who haven’t had insurance before, to find and access an appropriate medical care provider. Setting basic standards for provider directories and protections for the consumers who rely upon them would go a long way towards making provider directories the tool that patients and consumers need when they shop for and use their health insurance.

Download the full set of findings here.

WEEK 7

Crossover day is behind us and we are quickly approaching Sine Die, the final day of the legislative session. We are proud to say that one of GHF’s biggest legislative priorities – ensuring accurate provider directories for health care consumers – passed the full Senate unanimously last week! Thank you to those of you who contacted your legislators to voice your support! This week’s legislative update includes an a run down of which health care bills made it through Crossover Day and which did not. You can see a list of all the bills were’re tracking here along with supplemental information on most bills like relevant news, articles ad committee testimony delivered by GHF.

WHAT HAPPENED THIS WEEK

The Provider Directory Improvement Act
Last week SB 302 went for a vote in the Senate chamber and passed unanimously, 50 – 0! The bill is now in the House Insurance Committee where we expect it to receive a hearing soon. Join the Georgia Health Action Network(GHAN) to get important alerts about committee hearings, votes, and steps you can take to make sure your voice is heard at the Gold Dome!

Surprise Out-of-Network Billing
SB 382, the Surprise Billing and Consumer Protection Act had two hearings last week. While there is strong support for the legislation among consumer advocates and many health care stakeholders, hit did not pass through the Senate Health and Human Services Committee prior to Crossover Day. SR 974 is still a possible path to bring Senate-side policymakers together with stakeholders and advocates in the off-session to further study this complex issue.

Medicaid Payment Parity
The governor’s budget, introduced earlier this legislative session, maintained last year’s partial Medicaid payment parity. Full Medicaid parity would allow doctors to be reimbursed at the same rates for seeing Medicaid patients as Medicare patients. The FY 2017 budget, as passed by the House, adds $26.5 million for for Medicaid payment parity. The bill is now in the Senate for consideration.

Closing Georgia’s Coverage Gap
If you’ve been following our updates, you know that this session has seen growing interest in addressing the issue of Georgia’s uninsured rate and our struggling rural health infrastructure. Neither Sen. Rhett’s SB 368 nor Rep. Abram’s HB 823 crossed over. However, Sen. Rhett’s SR 1056, which proposes a study committee to look at approaches to covering the uninsured, is still viable as a Senate-side study committee (but would still need to pass through the Senate HHS Committee and the full Senate) and stakeholders continue to express interest in continuing the conversation passed the legislative session.

CROSSOVER DAY UPDATE

• HB 919: Tax credits  for contributions to rural health care organizations – CROSSED OVER
  HB 919 passed out of the House on February 25 and is now in the Senate Health and Human Services Committee. The total cap for the tax credits was reduced from $250 million to $100 million. GHF encourages policymakers to look at this legislation in conjunction with other bills around closing the coverage gap and addressing rural health so that we can tackle our rural health challenges comprehensively, including developing a pathway for rural, uninsured Georgians to gain coverage so they can better access health care services and finding a solution that can drawn down federal dollars available to the state through the Medicaid program.
• HB 838: Health insurers to pay brokers a minimum of 4% of premiums collected – CROSSED OVER
  This bill passed out of the House on February 24th and is now in the Senate Insurance and Labor Committee.
• HB 1055: Repeal Certificate of Need program – DID NOT CROSS OVER
  CON regulates the construction of health care facilities and the services they provide. This bill would have eliminate that structure and set up a different one based on permits. Read more on this bill from Georgia Health News.
• HB 684: To allow dental hygienists to provide certain services without direct supervision –  DID NOT CROSS OVER
  According to recent reports made on https://www.life-smiles.net/, this bill would have allowed dental hygienists to clean teeth in safety-net health centers with the permission of a dentist. Read more about the bill here.
• HB 965: “The Honorable Jimmy Carter Cancer Treatment Access Act” – CROSSED OVER
  HB 965 would require that insurance companies cover stage four cancer treatment recommended by a physician regardless of cancer’s response to other treatments. The bill passed the House on February 22nd and is now in the Senate Insurance and Labor Committee.
• SB 158: “Insurer Transparency Act” – CROSSED OVER
  This bill defines and regulates rental networks through the Department of Insurance. SB 158 passed the Senate on February 16th and is now in the House Insurance Committee. Read: great guide to tenant screening
• HB 768: The ABLE Act – CROSSED OVER
  The ABLE Act would establish a tax exempt account to pay for qualified expenses for people with significant disabilities that started before the age of 26. HB 768 passed the House on February 23rd and is now in the Senate Finance Committee.
• SB 299: “Georgia Health Care Transparency Initiative” – DID NOT CROSS OVER 
  SB 299 proposed to create the Georgia Health Care Transparency Initiative and an all-payer claims database.
• SB 291: “Georgia Affordable Free Market Health Care Act” – DID NOT CROSS OVER
  SB 291 proposed to allow direct contracts between physicians and patients for primary care services.
• HB 834: Establish charity care organizations for healthcare for the uninsured – DID NOT CROSS OVER
  This bill proposed tax credits for donations to charity care organizations.
• HB 694: Disclosure of Health Care Fees Act – DID NOT CROSS OVER
  HB 694 would proposed to require providers to disclose all fees prior to non-emergency services.
• SB 265: Physician Direct Pay Act – DID NOT CROSS OVER
  SB 265 proposed to allow direct contracts between physicians and patients for primary care services.

LETS CHAT

As SB 302 moves over to the House for consideration, we talked to Sen. Elena Parent about why she supports the Provider Directory Improvement Act.

WEEK 6

We seem to be approaching cross-over day at the speed of light! Last week saw progress towards increasing provider directory transparency, Medicaid payment parity, ending surprise out-of-network billing, and even closing the coverage gap! Check out our updates below. If you’re looking for a complete list of all the bills we’re following, click here.

WHAT HAPPENED THIS WEEK

The Provider Directory Improvement Act (SB 302)

Last Thursday, the Provider Directory Improvement Act was passed unanimously out of the Senate Insurance and Labor committee. The bill now goes to the Rules Committee. We’re excited about the progress made and will keep you posted as the bill continues to move through the process. You can review our fact sheet on SB 302 and read our longer policy brief on the importance of accurate provider directories here.

Closing Georgia’s Coverage Gap

Last week, the Georgia Legislature held its first-ever hearing on closing the coverage gap. Closing the gap is the most important step our state policymakers can take to lower the number of uninsured, improve access to care, and stabilize the rural health infrastructure in our state. The hearing focused on discussion of SB 368, legislation introduced by Sen. Rhett to extend coverage to low-income, uninsured Georgians. While some pieces of the bill are problematic and the committee took no action, they started an important conversation. If you are interested in getting involved in the movement to close the gap, join our Georgia Health Action Network (GHAN) to receive updates on how you can help! If your organization supports closing the gap, please consider joining the Cover Georgia coalition to help amplify your voice.

Surprise Out-of-Network Billing

On February 16th, Sen. Unterman introduced SB 382, the Surprise Billing and Consumer Protection Act. This bill has been scheduled for a hearing today at 3:00 PM in the Senate Health and Human Services Committee. Addressing surprise out-of-network billing is an important issue for Georgia consumers, and the legislation is complex. Sen. Unterman has simultaneously also introduced SR 974, the Senate Surprise Billing Study Committee. Should SB 382 not move during this session, SR 974 provides legislators with the opportunity to study this important consumer issue during the off-session period.

Medicaid Payment Parity

The governor’s budget, introduced earlier this legislative session, maintained last year’s partial Medicaid payment parity. Full Medicaid parity would allow doctors to be reimbursed at the same rates for seeing Medicaid patients as Medicare patients. Last week, $26.5 million was added to the FY 2017 budget for this purpose. While this does not restore full parity, it is a significant step towards that goal. The FY 2017 budget has passed in the House and goes to the Senate for consideration.

HB 919

Rep. Duncan’s HB 919 would provide up to $250 million in tax credits to individuals or corporations for contributions to rural health care organizations. This legislation has sparked a conversation about the ever worsening plight of our rural hospitals. However, state funding could be better utilized by helping those in rural communities get health insurance coverage, an approach which would also draw down considerable federal dollars (at least $9 in federal funding for every $1 of state funding). This would be much more effective in reducing the uncompensated care burden of rural hospitals, while also providing patients with the benefits of health coverage, something that HB 919 does not accomplish in its current form. Because of this session’s multiple bills that attempt to address Georgia’s uninsured population and health care infrastructure, we hope that lawmakers will take this opportunity to consider these issues in tandem through a study committee. This will allow all stakeholders to take part in an open conversation about how to best utilize state and federal dollars to save our rural hospital and provide quality health care to all Georgians.

LET’S CHAT

In this week’s Consumer Health Advocacy Today, we sit down with Sen. Rhett to talk about his proposal to close the coverage gap. Here’s what he had to say.

WEEK 5

As the session has progressed, additional pieces of legislation that could impact health care consumers have been introduced. For a list of all the bills we’re watching, click here. SB 302, the Provider Directory Improvement Act was heard in committee and goes to a vote this week.

WHAT HAPPENED THIS WEEK

Improving Provider Directories

SB 302 was heard in committee last Thursday. We are happy to report that the conversation was widely favorable. There were a few points of contention around the usability provisions in the bill but the committee chair and bill sponsor were optimistic that consensus could be reached ahead of this coming Thursday’s committee meeting, where a vote is expected.

Please call or email the committee members and ask that they vote for SB 302, the Improving Provider Directories Act!

Sen. Charlie Bethel (Chairman)  404-651-7738

Sen. David Shafer (Vice Chairman) 404-656-0048

Sen. P.K. Martin (bill sponsor) 404-656-0048

Sen. Gail Davenport 404-463-5260

Sen. Marty Harbin 404-656-0078

Sen. Ed Harbinson 404-656-0074

Sen. Burt Jones 404-656-0074

Sen. Josh McKoon 404-463-33931

Sen. Renee Unterman (bill co-sponsor) 404-463-1368

Sen. Larry Walker 404-656-0081

Surprise Out-of-Network Billing

In both the House and Senate we are still hearing strong interest in addressing surprise out-of-network billing. We expect legislation to be introduced this week from Sen. Renee Unterman that would address this issue. Join the Georgia Health Action Network (GHAN) to receive updates on health-related legislation the General Assembly is considering and information about steps you can take to show your support (or raise your concerns)!

Network Adequacy 

GHF supports updating Georgia’s network adequacy standards. We don’t expect to see legislation this year, but there are conversations happening in both chambers and in both parties. GHF will be advocating for a study committee to meet during the 2016 off-session so that the legislature will have enough information during the 2017 Legislative Session to debate the best standards for Georgia. To read more about network adequacy and why is matters to Georgia check out our new policy brief. You can also watch this interview with Julie Silas of Consumers Union on the topic.

Closing Georgia’s Coverage Gap

Rep. Stacey Abrams has sponsored HB 823, the Expand Medicaid Now Act. While we don’t expect this legislation to receive a hearing this year, it is sparking important conversations about the coverage gap in Georgia. Read more here.

If you want to get involved in the movement to close Georgia’s coverage gap you can share this video with your social network or sign this petition. You can also follow the conversation on Twitter using #CoverGA

LET’S CHAT

This week we’re highlighting a conversation with Consumer’s Union policy expert, Lynn Quincy. Lynn talks about why Georgia should be talking about health value, and the cost to taxpayers when we don’t.