“It will do monumental things for people who get covered and can go to the doctor and get prescriptions filled and have some peace of mind that they can take…
Tuesday’s election results have the potential to dramatically shift the health care bill nationally and here in Georgia. It’s too soon to know precisely what policy changes will occur and what their impact will be, but advocacy at both the state and federal levels on behalf of Georgians who need access to quality, affordable health care has never been more important.
The President-Elect and Congressional leadership have vowed to repeal the Affordable Care Act, landmark legislation that established a framework for coverage that has resulted in the lowest uninsured rate ever recorded, rights and protections for health care consumers, and provisions to advance health equity. Repeal is a serious threat and the consequences would be devastating: twenty million Americans and nearly 500,000 Georgians would lose their coverage, while millions more would be stripped of basic protections and face higher costs. Congressional leaders have also signaled their intention to make cuts to Medicaid and other critical health care programs, which would further threaten coverage and access to care for Georgia children and families.
Georgians for a Healthy Future is committed to lifting up the voices of Georgians whose basic access to care hangs in the balance and ensuring these voices are heard and considered as policy decisions are made. www.bestblenderusa.com stated that, “We cannot return to the days when anyone with a pre-existing condition like cancer or diabetes can be denied coverage (if one can’t get insurance before cancer – can you imagine the obstacles of getting life insurance after cancer), where women can be charged more for health insurance simply because of their gender, and where LGBT Georgians can be discriminated against in health care.” We cannot allow the hundreds of thousands of Georgians who have finally experienced the sense of security that comes with health coverage to go back to being uninsured and out of options. In short, we plan to fight and we need your support and partnership.
We ask you to partner with us in the coming weeks and months as our work enters this new phase. Here is what you can do:
Thank you for all that you do.
This August, GHF invited both advocates and enrollment assisters to the second annual Getting Georgia Covered summit. Bringing these two groups together was the first step in fostering ongoing conversations and partnerships to ensure that health coverage translates into meaningful access to care for Georgians. Through the summit, GHF collected feedback and input for a report that highlights how assisters and advocates can team up for consumers. We invite you to read and share Collaborating for Consumers: How Assisters and Advocates Can Inform Policy, in which you will find opportunities and best practices for collaboration to achieve our shared goals.
Direct consumer support plays an important role in assisting consumers to enroll into and maintain their health coverage. Georgians for a Healthy Future, primarily a health advocacy organization, provided direct enrollment services to Georgians in the last two open enrollment periods through enrollment events, in-person appointments, phone assistance and referrals. GHF continues to engage with other enrollment entities through its Georgia Enrollment Assistance Resources (GEAR) network which is a central hub of Marketplace resources, and provides technical support to assisters through newsletters, e-blasts, trainings, webinars, and forums.
In OE3, GHF primarily focused on post enrollment work undertaking more complex consumer cases such as resolving coverage issues with the Marketplace and insurance providers, payment issues, tax filing and reconciliation issues, and issues with supplemental documents. In this role, GHF provided crucial support to consumers and enrollment assisters to resolve these types of issues and help consumers maintain their coverage, feel free to visit https://syntheticurinereview.com/whizzinator-kit/.
Here is what our consumers reported about their experiences
GHF conducted a post-enrollment consumer satisfaction survey with 25 consumers between April and July 2016. The survey participants reported that they sought a combination of services during their appointments. The table below provides the details for each type of post-enrollment assistance.
Twenty-four out of 25 (96%) participants reported that they were able to resolve the issues that they sought assistance for, as explained by these quotes…
“Paid my premium, sent supplemental documents, added two kids to the application, received delayed cards” – Res# 1, Female, 30.
“My coverage had been suspended for over a month due to a technical issue. GHF helped me reinstate my suspended insurance by advocating on my behalf with both Marketplace and Ambetter. My benefits were reinstated within 3 business days”— Res# 16, Female, 62.
GHF Success Stories:
Tony Caldwell, a consumer with disability, was waiting to get his power wheelchair for over a year. With direct enrollment support from GHF, he was able to get his application completed during SEP and select a plan that covered his wheelchair. Tony quotes, “I finally ended up getting my power wheelchair that I had been waiting for over a year. It has helped me from passing out. Thanks to you all.”
Clyde Mohammed and his wife Sharda (West Indian couple) came to renew their marketplace plan at Switzer Public Library in Marietta. They also wanted to change their current plan since the premium was going up in 2016. Assisted the consumers to complete their application. They were found eligible for subsidies. They enrolled into a health plan with $57 monthly premium and $600 family deductible. The family was able to save over $150 in monthly premium by switching their plan.
The majority of the participants reported the Marketplace application process to be very complicated and that they couldn’t have resolved their issues without the help of an enrollment assister. Those participants who found the process to be comfortable reported the assistance they received to be the key reason. Participants also reported that this page talk about it, from the education to enrollment assisters that made it easier for them to understand and use their new health insurance.
Trends from our direct consumer support experiences and those we have heard from our partners suggested that direct enrollment assistance was crucial for consumers in making enrollment decisions as well as tackling post-enrollment issues. Direct assistance will continue to be crucial for consumers, both new enrollees and re-enrollees, in the days to come as there will be changes in participating insurance providers, premium price, and personal details such as household size and income all of which will require enrollment assisters’ expertise.
Moving the conversation forward
Yesterday marked the start of a new chapter in the campaign to close the coverage gap. The Georgia Chamber of Commerce Health Access Task Force unveiled a set of proposals best beard trimmer to expand coverage. We are heartened that business leaders and health care industry stakeholders recognize the important role that coverage plays in a healthy and productive Georgia. You can read the news coverage in the AJC, WABE, Georgia Health News, and Atlanta Business Chronicle.
Is it a good plan?
We believe a coverage solution is one that extends coverage to all those Georgians caught in the coverage gap, does not erect unnecessary barriers to care, and maximizes the federal dollars set aside for Georgia. The Chamber’s proposal is a big step in this direction. While we have concerns about how some of the proposed provisions will impact consumers, we look forward to working with the Chamber, legislators, our Cover Georgia partners, and other stakeholders to find a solution that best serves individuals and families, our state’s health system, and our state’s economy.
What can I do to build on the momentum?
Be a part of the conversation! Your legislators need to know that this is an important issue for their constituents. Here you’ll find a quick and easy way to enter in your address and directly email both your state house and senate member. Let them know it’s time we close the coverage gap!
At Georgians for a Healthy Future, we’ve been fighting for expanded access to care since our doors first opened. We’ve developed videos and graphics to help simplify this complicated issue. We’ve created in-depth tools to explain the nuance and dispel myths. Our postcard and petition project has helped lift up this issue at the Gold Dome where we regularly testify and provide research to lawmakers.
As we get closer to closing the coverage gap we hope you’ll continue to stand with us. By signing up for the Georgia Health Action Network you’ll receive timely updates as the debate unfolds and easy ways for you to stay engaged. And, of course, we’re here for you! If you have questions about what’s going on, please ask!
With three annual open enrollment periods completed and a fourth one just around the corner, the Health Insurance Marketplace has become established as the avenue for purchasing coverage for roughly half a million Georgians. This report builds on last year’s Getting Georgia Covered: Best Practices, Lessons Learned, and Policy Recommendations from the Second Open Enrollment Period and focuses on understanding the characteristics of the people who have enrolled in marketplace plans and the experiences of consumers and the enrollment assisters who helped them. Their insights can inform the work of advocates, stakeholders, and policymakers to reach shared goals of reducing the uninsured, improving access to care, and addressing affordability for consumers.
Inside you’ll find:
- Key themes in consumer and assister experiences during the 2016 open enrollment period
- Best practices for outreach, enrollment, and reaching eligible Georgians who remain uninsured
- Policy opportunities to increase enrollment, improve access to care, and address affordability issues
Georgia’s many summer festivals provide a unique opportunity for Georgians for a Healthy Future and our partners to get out in the community and talk with people about how health policy impacts their lives and how they can be advocates. On June 11th and 12th, we continued our summer festival outreach with an information & education booth at the Peachtree Corners Festival in Peachtree Corners. Our primary focus out in the community has been coverage gap education, but we also talked to attendees about our other priorities, including health insurance enrollment and youth substance use prevention. We also asked attendees who stopped by the table to sign postcards to show their legislators that they support closing the gap.
In addition to outreach, we collected stories of several Georgians who fall into the gap. One grandmother in her early 60s told us that she is taking care of her grandkids full-time and crossing her fingers that she doesn’t get sick before she becomes eligible for Medicare. All of the people that we spoke to that fell into the gap knew they were in the gap and why it exists, but were hopeful that Georgia’s lawmakers would do something soon to fix the problem.
The Cover Georgia coalition was well represented at the festival as well, and we want to give a special thanks to Feminist Women’s Health Center, Georgia Watch, and Hemophilia of Georgia for volunteering with us. If you’re interested in volunteering with us at upcoming festivals, please reach out to Whitney or Laura.
Does a strong consumer voice make a difference in health policy outcomes? According to a Mathematica Policy Research evaluation of state-level consumer health advocacy projects supported by the Robert Wood Johnson Foundation (RWJF), yes!
At Georgians for a Healthy Future, consumer engagement is woven into each of our initiatives to bring the needs – and voices – of Georgia health care consumers into the public policy process. Over the past two years, one of our top priorities has been maximizing health insurance enrollment and ensuring that, once enrolled, consumers can access the care they need. Our work in this area, along with that of similar efforts in seventeen other states, was recently evaluated by Mathematica. The evaluation focused on the activities and outcomes of the eighteen Consumer Voices for Coverage (CVC) projects funded by RWJF.
Georgians for a Healthy Future was a CVC grantee in 2014-2016. Through this program, we focused on outreach, education, and enrollment in coverage and used this work to inform and strengthen our policy work. The CVC evaluation found that coalitions, such as the one led by GHF in Georgia, played a central role in successful outreach, allowed consumer advocates to work together to help maximize enrollment and retention, and helped identify policy issues needing attention.
These coalitions worked to increase enrollment in health coverage programs by building alliances with diverse stakeholders, mobilizing and engaging consumers, identifying achievable policy options to address issues arising from consumer experiences, designing and implementing communication strategies, and securing resources to sustain these efforts.
While the CVC program is winding down, Georgians for a Healthy Future’s work in this area will continue through our Georgia Enrollment Assistance Resource (GEAR) network and through our ongoing policy work around coverage, access to care, and health care value. As we continue this health policy and advocacy work, we will leverage the advocacy infrastructure and ability to translate consumer voices strengthened through CVC into concrete policy actions.
To read the complete Mathematica evaluation, click here.
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.
We want to hear from you – new SEP rules
At the beginning of last year’s open enrollment period, GHF created GEAR, the Georgia Enrollment Assister Resource Network (GEAR). GEAR is a coalition of enrollment assisters and those closely involved in the enrollment process. Now the open enrollment is passed, GEAR is turning to tax time and special enrollment periods (SEPs). Last month, CMS announced the new special enrollment confirmation process. Georgians will now be required to provide sufficient proof to the marketplace to determine their SEP eligibility. Failure to provide supporting documents may lead to the denial of coverage. At GHF we advocate for policies that make enrollment in health insurance more inclusive and fight policies that put up unnecessary barriers. We want to hear from you about this! If you’re an enrollment assister and are experiencing trouble enrolling consumers during a special enrollment period, let us know! If you’d like to join the GEAR network, you can do that here.
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.
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.