Tag: coverage

A consumer health advocates guide to the 2020 elections: U.S. Congress

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:

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We are fighting for Georgians

As Georgia faces the public health emergency of COVID-19, it can be hard to be optimistic about our health and our futures. However, Georgians for a Healthy Future believes that our state can successfully overcome this tremendous challenge if Georgians adhere to the advice of public health experts and our state’s leaders swiftly adopt evidence-based policies that protect the health and safety of all Georgians. At the same time, Georgia leaders must look ahead to ways they can promote the health and well-being of all Georgians in the economically challenging months to come. Georgians for a Healthy Future has identified policy priorities that we believe are necessary for success in addressing the immediate public health emergency and the emerging economic consequences. These are the policies that we will fight for as we continue our fight for the health and wellness of all Georgians.

Our recommendations are shaped by feedback from GHF’s board of directors, partner advocacy organizations, local groups helping Georgians in their communities, and stories from Georgians just like you. You can share your COVID-19 experiences with GHF here. Thank you for your generous input.

As the status of this crisis changes and we gather more information, you can find updates to these policy recommendations and actionable information here.



Health system capacity and public safety

GHF supports:

  • Statewide and local shelter-in-place orders and other aggressive social distancing practices to slow the spread of the COVID-19 virus
  • Funding to quickly expand the capacity of Georgia’s Department of Public Health to test and monitor the spread of COVID-19
  • Funding to purchase personal protective equipment for health care workers
  • Funding to purchase equipment for patient care like ventilators and respirators
  • Maximizing the scope of practice for all qualified and licensed health care providers (e.g. physicians assistants, advanced practice registered nurses, registered nurses)
  • Expanding options and health coverage of telehealth and virtual visits in all medically appropriate circumstances

Access to quality, affordable health care for all Georgians

GHF supports:

  • Maximizing Medicaid flexibility and funding to increase access to care by:
    • Expanding Medicaid to all poor and near-poor Georgians (those making less than 138 percent of the federal poverty line)
    • Taking advantage of emergency 1135 waivers to increase the number of providers who can see Georgians with Medicaid coverage
    • Adopting administrative changes to preserve coverage for current Medicaid members and to enroll Georgians who are already eligible but unenrolled, including the expansion of presumptive and retroactive eligibility and a halt on the annual renewal process
    • Expanding coverage of home- and community-based services and long-term services and supports
  • Expanding access and protections in comprehensive private health coverage
    • Promoting enrollment for people who qualify for private insurance, especially among those who are eligible for financial assistance through the Affordable Care Act (ACA) by:
      • Establishing a new Special Enrollment Period for people who wish to purchase health insurance now
      • Easing the enrollment and paperwork requirements for people enrolling in coverage due to job loss or income changes
      • Prohibiting health insurers from canceling a consumer’s coverage, even if they fall behind on premium payments
    • Eliminating cost-sharing for COVID-19 testing (and related tests) and treatment
    • Limiting the sale of plans that do not offer comprehensive benefits or follow the standards set by the ACA
    • Establishing comprehensive surprise billing protections
  • Promoting access to mental health services and substance use recovery supports for all Georgians
  • Easing limits on prescription drugs so that consumers can more easily access 90-day supplies of medications

Equity at the center of the response

This pandemic will hit some Georgia communities harder than others. All federal and state policy remedies should endure to offer the most help to those who are disadvantaged due to income, race or ethnicity, disability or health status, age, geography, and other factors. Georgia’s response must proactively address health equity concerns. Among other strategies, this should include disseminating public health messages that include information about affected groups and communities in languages and contexts they understand and directing additional funding to community health centers and other providers that serve disproportionately impacted communities.


Meeting the basic needs of Georgians and their families

As evidenced by yesterday’s job loss statistics, it is imperative that the public health response to the COVID-19 crisis be followed by an ambitious economic response. GHF supports policies that provide equitable opportunities for stability, dignity, and well-being for all Georgia families. While not an exhaustive list, these policies include:

  • Expanded access to Georgia’s unemployment insurance system, including 26 weeks of benefits and the easing of eligibility requirements and activities.
  • A moratorium on foreclosures and evictions, the provision of rental assistance and mortgage forbearance, and other supports that keep Georgians in their homes
  • Improved access to nutritious foods through SNAP, WIC, school system food programs, and other public programs
  • Universal paid family leave that allows workers regardless of income to take time off to care for themselves and their loved ones in times of sickness and crisis
  • A moratorium on utility shut offs, including internet access so that families can keep the lights on and children can continue to learn remotely

GHF will support partner organizations in their efforts to advocate for these policies and supports for Georgia families and individuals.


Some of these policies have been adopted or partially adopted by federal officials, Governor Kemp, and state agency officials. GHF thanks Georgia leaders for the actions they have already taken. In the coming weeks, GHF will track which policies are fully implemented, partially adopted, or not taken up at all, and will provide updates accordingly.

Thank you for your support and advocacy. We wish you health and safety!


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Your health coverage, health care, and well-being during the COVID-19 pandemic

Updated: September 16, 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 October 10, 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: AmerigroupCareSourcePeachState 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:

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
    • 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


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Court ruling in health care repeal lawsuit endangers Georgia consumers

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

About GHF:

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.


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Philip’s story: Rural Georgians continue to struggle without health coverage

Philip is a 57 year old part-time roofer who resides in Fort Gaines, Georgia, a rural community in the southwest region of the state.

Philip suffered a knee injury along with a herniated disc in his back while repairing a roof. Because he is uninsured he has been repeatedly refused medical care because of his inability to pay. Despite making financial sacrifices to see several doctors and specialists, he has been unable to receive adequate help and get the treatment he needs. Philip says that if he had health coverage he would find the right specialist, get an MRI, and have his back fixed so he would no longer be in severe pain every day.

For the time being, Philip is able to see Dr. Karen Kinsell, the last practicing physician in Clay County. Dr. Kinsell is a volunteer physician who provides medical care to approximately 3,000 patients in a small office building that once served as a Tastee Freeze stand. Dr. Kinsell has advised Philip to stop roofing in order to ease the pain in his back but roofing is currently his family’s only income and Philip says there are no other viable job options for him in the area.

Philip believes access to health care is important and that significant changes need to be made so more people can access care. “Fix the issue, fix the problem, health insurance isn’t affordable for low-income people trying to work. Help us.”

Like Philip, 360,000 low-income Georgians, many of whom are uninsured, live in small towns and rural areas across the state. These areas have the most at stake in the debate over whether or not to close Georgia’s health insurance coverage gap. For rural Georgia residents like Philip, health coverage would open doors to the physicians and other health services that they need to stay employed or get back to work. For rural communities like Fort Gaines, more residents with health coverage could attract another primary care physician to the area.

Right now, Georgia’s policy makers are drafting two health care “waivers”. One of the waivers could be used to extend coverage to all low-income adults, including Philip and his southwest Georgia neighbors. Or state leaders could continue to ignore the needs of low-income, rural Georgians with a more limited plan.

The details of these waivers will be announced in the coming weeks and state leaders must offer online and in-person opportunities to hear public feedback. GHF will keep you up-to-date about what the waivers will mean for Georgians like you and Philip, and help you weigh in during the public comment periods!


Your story is powerful! Stories help to put a human face to health care issues in Georgia. When you share your story, you help others understand the issue, its impact on Georgia, and why it’s important.

Your health care story is valuable because the reader may be your neighbor, friend, someone in your congregation, or your legislator. It may inspire others to share their stories or to become advocates. It is an opportunity for individuals who receive Medicaid or fall into the coverage gap, their family members, their physicians and concerned Georgia citizens to show that there are real people with real needs who will be impacted by the health policy decisions made by Congress and Georgia’s state leaders.

Share your story here!


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Legislative Update: Patients First Act, healthy housing, HIV treatment and prevention bills move forward

Legislative Update: Week 10
Risky health care waiver bill passed by House committee

Last Wednesday, the House Special Committee on Access to Quality Health Care held a hearing on SB 106, the Patients First Act. GHF’s Executive Director, Laura Colbert and several Cover Georgia coalition members testified and emphasized the need for changes in the bill. Read Laura’s full testimony here.

As we have previously reported, the legislation allows for an 1115 waiver to extend Medicaid coverage to some adults making up to 100% of the federal poverty level ($12,100 annually for an individual). GHF and its partners requested that the income cap be lifted to 138% FPL so that it would cover more Georgians at a lower cost to the state. As currently written, the bill would leave out thousands of Georgians who earn just above the poverty line and who would be covered under a traditional Medicaid expansion or a broader 1115 waiver. SB 106 also allows the state to make potentially dramatic changes to private health insurance in Georgia through 1332 waivers with little accountability. The bill now sits in the House Rules committee and is expected to receive a vote on the House floor sometime next week.

There is still time for the House to make changes to SB 106 so that it covers more people and costs less. Read more about SB 106 CoverGA.org and then contact your state representative to let them know that we need to amend this bill to cover every eligible Georgian!


 

Behavioral health commission passes in both chambers
Georgia Mental Health Reform and Innovation Commission passed by Senate

The Senate passed an amended version of HB 514 on Thursday. This bill, sponsored by Rep. Kevin Tanner, would create the Georgia Mental Health Reform and Innovation Commission which would work to analyze and offer improvements to the state’s mental health system. Changes to the bill in the Senate included additions to the make-up of the Commission so that it includes a professional who specializes in substance abuse and addiction, and a representative of a community service board to serve as a nonvoting member of the 23-member panel. The bill will now return to the House to receive an “Agree” on the changes made in the Senate and will then go to the Governor’s desk to be signed.


HIV prevention & treatment bills move forward in the Senate
Two HIV-related bills move forward in Senate committee

Two significant pieces of HIV-related legislation passed the Senate Health and Human Services committee last week. HB 217, which would decriminalize the act of working or volunteering for a syringe services program and HB 290, which would would establish a pilot program to provide preexposure prophylaxis (PrEP) drug assistance or services to persons at risk of being infected with HIV will now go to the Senate Rules Committee to await a vote by the full Senate. A third bill, HB 158 would improve Medicaid coverage but has not yet been taken up by the Senate HHS committee. Georgia currently leads the U.S. in the rate of new HIV cases diagnosed each year and all three bills would contribute to the slowing of the epidemic by preventing new infections and improving care for people currently living with the condition. (For more details on all three pieces of legislation, see our February 26th legislative update).


What happened last week
Recess legislation passes in Senate committee

The Senate Education and Youth committee voted to pass HB 83 last Thursday. This bill would require a daily 30-minute recess for all students in grades K-5 unless they have already had a physical education class or structured activity time in the day. This bill now sits in the Senate Rules committee and awaits a vote on the Senate floor. To learn more about the impact of recess on children’s physical and mental health, read this fact sheet from Voices for Georgia’s Children.


Healthy housing legislation makes progress in Senate

Georgians for a Healthy Future is a member of the Healthy Housing Georgia coalition because evidence shows the strong and direct influence housing has on a person’s health. The coalition supports HB 346 which passed with amendments by the Senate Judiciary committee last week. This bill would prohibit retaliation by a landlord against a tenant for complaining to Code Enforcement about unsafe or unhealthy housing conditions like the presence of mold, radon, rodents, insect infestations, or lead. Georgia is the only state in the country that does not protect tenants against unsafe and uninhabitable housing conditions with a “warranty of habitability.” The Senate Rules committee will now decide when the legislation may receive a vote on the Senate floor. (For more details on the legislation, see our March 5th legislative update.)


GHF has you covered
Stay up-to-date with the legislative session

GHF will be monitoring legislative activity on a number of critical consumer health care topics. Along with our weekly legislative updates and timely analysis of bills, we have the tools you need to stay in touch with health policy under the Gold Dome.


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GHF testifies on Patients First Act (SB 106)

GHF’s Executive Director Laura Colbert provided testimony to the House Special Committee on Access to Quality Health Care on SB 106 and the risks this legislation poses for consumers as it is currently written.

Testimony of Laura Colbert, GHF’s Executive Director
March 20, 2019

“Thank you Chairman Smith and members of the committee.  My name is Laura Colbert and I am the ED of GHF. We represent health care consumers across Georgia and work to build a future in which all Georgians have the quality, affordable health coverage and care they need to live healthy lives and contribute to the health of their communities.

First, we want to thank Governor Kemp, Senator Tillery and Representative Lott for your work on this bill. We are excited that this very important conversation is moving forward. We appreciate your open door and on-going dialogue with us on this issue.

Like my colleagues before me, GHF agrees with the goals of this bill and we are pleased by the prospect of meaningful coverage for 240,000 Georgians who live below the poverty line. We are to balance that with our consternation that 200,000 uninsured Georgians who make just more than the poverty line may remain uncovered by this bill as it’s written.

Georgians with insurance coverage are healthier, better able to work and go to school, have less medical debt and better credit scores, and have healthier families, among other benefits. While Georgians below the poverty line are sure to reap these benefits after gaining coverage, those just above it likely will not if SB 106 is not amended to specifically include them.

Based on other states’ coverage expansions and the affordability information provided to you by Ms. Haynes at Georgia Watch, it is clear that many near-poor constituents are likely to face significant cost-related barriers to health care, even with the ACA’s financial assistance. While Georgians in this income range can afford more than those below the poverty line, it is unrealistic to expect them to pay as much as 20% of a person’s $14,000 yearly wage or a family of four’s $30,000 salary for health care. An investment that large for families barely making ends meet effectively keeps them locked out of the health care system, only experiencing the benefits of coverage in emergency situations. The financial protection and access to care provided by Medicaid can better serve as the stepping stones for these families to climb into Georgia’s middle class.

Georgia is at the table now, and we have the opportunity to get this right for all Georgians on the first try.

That is why we recommend that this committee amend the bill to expand eligibility to 133% FPL and cover more Georgians for fewer state dollars. Georgia is at the table now, and we have the opportunity to get this right for all Georgians on the first try. Or consider removing the percentage provision altogether so that the bill is silent on the exact income limit, providing flexibility to the state to negotiate the waiver specifics that work best for Georgians and Georgia’s budget, particularly in the likely event that CMS is unable to provide an enhanced match rate for a partial expansion.

I also want to briefly turn to the second part of the bill concerning Section 1332 State Innovation waivers. A 1332 waiver to establish a reinsurance program would help thousands of Georgians by reducing insurance premiums and attracting more insurers to the marketplace. GHF stands in support of such efforts. However, the legislation as currently written is so broad that it leaves the door open to many more changes, some of which could destabilize Georgia’s marketplace and jeopardize access to care for Georgians covered by individual or small-group health insurance.

We recommend that this committee consider narrowing the scope of an allowable 1332 waiver by specifying that the state is authorized to establish a reinsurance program or, if other proposals may be considered, lay out criteria that any innovation waiver must meet. Georgians for a Healthy Future has laid out four criteria that we believe are critical to ensuring that any 1332 waiver benefits consumers without putting vulnerable groups at risk.

We appreciate your consideration of our suggestions and hope that we can act as a resource for the state as it drafts these waivers. Thank you very much for your time and your efforts on behalf of all of the health care consumers in your districts.”


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Legislative Update: Crossover edition

Legislative Update: Week 8
Crossover Day brings legislative action late into the night

Last Thursday was the 28th day of the Georgia legislative session, which is also referred to as Crossover Day. Crossover Day is the final day for a bill to cross from its chamber of origin to the opposite chamber to remain viable for this legislative session. This week’s legislative update provides a rundown of consumer health legislation: which bills made it through and which did not. You can see a list of all the bills we’re tracking here. (Note: After a flurry of activity last week, we are still working to update our legislative tracker with the current status of each bill. So while many of the bills are updated, it is best to find the bill you are interested in and click through to find the full information on the bill’s statis on legis.ga.gov.


Our priorities

Surprise billing legislation moves forward

SB 56, sponsored by Senator Chuck Hufstetler, received approval by the full Senate on Wednesday and may be considered by the House Insurance Committee in the coming weeks. The legislation aims to improve transparency for consumers who may be subject to a surprise out-of-network bill. This bill would disallow surprise billing in emergency situations but does not prohibit surprise billing in non-emergency situations like when a physician uses an out-of-network laboratory for diagnostic tests. This bill now sits in the House Insurance committee. (For more details on the legislation, see our February 11th legislative update.)


Legislation to fully expand coverage stalls; Patients First Act advances

HB 37, the Expand Medicaid Now Act, and SB 36 sponsored by Representative Bob Trammell and Senator Steve Henson respectively, did not receive hearings and did not cross over last week. Each bill was written to expand Medicaid in Georgia as envisioned by the Affordable Care Act.

Meanwhile SB 106, the Patients First Act, has moved quickly through the Senate in the weeks before Crossover Day. The legislation, as written, would allow the Department of Community Health to request an 1115 waiver to extend Medicaid coverage to adults making up to 100% of the federal poverty level (FPL) ($12,490 annually for an individual). This “partial expansion” would leave out thousands of new-poor Georgians who are meant to be similarly covered according to federal health law and will likely cost the state more to cover fewer people. Additionally, the bill allows the Governor to make potentially tremendous changes to private health insurance in Georgia through 1332 waivers with little accountability. The bill will now awaits a hearing from the House’s Special Committee on Access to Quality Healthcare.


Healthy housing legislation moves to Senate committee

Georgians for a Healthy Future is a member of the Healthy Housing Georgia coalition because evidence shows the strong and firect influence housing has on a person’s health. The coalition supports HB 346, which would prohibit retaliation by a landlord against a tenant for complaining to Code Enforcement about unsafe or unhealthy housing conditions like the presence of mold, radon, rodents, insect infestations, or lead. Georgia is the only state in the country that does not protect tenants against unsafe and uninhabitable housing conditions with a “warranty of habitability.” This bill now sits in the Senate Judiciary committee. (For more details on the legislation, see our March 5th legislative update.)

 


Crossover day recap

HB 30: Amended FY 2019 Budget | CROSSED OVER

HB 30 makes adjustments to the state budget for the current fiscal year which runs through June 30, 2019. The “little budget” has passed both chambers of the General Assembly and been signed by the Governor. The amended budget went into effect on Saturday, March 9th.


HB 31: FY 2020 Budget | CROSSED OVER

HB 31 is the budget document for the coming state fiscal year which will run from July 1, 2019 to June 30, 2020. The budget includes several new investments in behavioral health and mostly maintains funding for other health care programs and priorities. The Senate will continue to hold hearings on the “big budget” this week. For more information on the health care highlights in the proposed FY 2020 budget, read the Community Health and Behavioral Health budget overviews from the Georgia Budget & Policy Institute.


HB 37: Expand Medicaid Now Act | DID NOT CROSS OVER

HB 37, sponsored by Rep. Bob Trammell, expands Medicaid in Georgia as envisioned by the Affordable Care Act by increasing Medicaid eligibility for adults up to 138% of the federal poverty guidelines (FPL). This is equivalent to $17,236 annually for an individual and $29,435 for a family of three.


HB 63: Step therapy legislation: CROSSED OVER

HB 63, sponsored by Rep. Sharon Cooper, would require health insurance plans to establish step therapy protocols and outline a process for health care providers to request exceptions. Step therapy is a requirement by some insurers that patients try a series of lower-cost treatments before the insurer will cover the higher-cost treatment prescribed by a patient’s physician.


HB 84: Provider network transparency | DID NOT CROSS OVER

HB 84, sponsored by Rep. Richard Smith, increases transparency related to possible surprise medical bills. The legislation requires that information on billing and the providers that a consumer may encounter during a course of care must be provided to the consumer at their request. In circumstances where a consumer receives a surprise bill, HB 84 also allows for arbitration between the consumer and the health care provider, the specifics of which would be determined by Georgia’s Department of Insurance.


HB 158: Improve Medicaid patient access to effective HIV treatment | CROSSED OVER

HB 158, sponsored by Rep. Deborah Silcox, requires that Medicaid recipients have the same access to antiretroviral drugs used to treat HIV and AIDS as to those included in the formulary established for the Georgia AIDS Drug Assistance Program. This change would allow for increased continuity of care for people living with HIV/AIDS in Georgia.


HB 198: Eliminate certificate of need requirements | DID NOT CROSS OVER

HB 198, sponsored by Rep. Matt Hatchett, would change the certificate of need process that is used to regulate health care facilities. The bill also included requirements for increasing transparency of hospital financial information and an increase in the rural hospital tax credit from $60 million to $100 million.


HB 217: Needle exchange program | CROSSED OVER

HB 217, sponsored by Rep. Houston Gaines, decriminalizes the act of working or volunteering for a syringe services program, a step towards legalizing the programs. Distributing clean hypodermic syringes and needles to people who use injection drugs (e.g. heroin) helps to prevent the spread of HIV and Hepatitis C, and does not increase the likelihood that people will newly take up injections drug use.


HB 290: PrEP pilot program | CROSSED OVER

HB 290, sponsored by Rep. Sharon Cooper, would establish a pilot program to provide preexposure prophylaxis (PrEP) drug assistance or services to persons at risk of being infected with HIV. PrEP is a medication taken by people who are HIV-negative to reduce their risk for infection. The pilot program would provide PrEP to people in counties identified by the Centers for Disease Control & Prevention as at risk of HIV outbreaks due to a high rate of opioid use and participants would receive regular HIV testing and related support services.


HB 321: Medicaid financing program | CROSSED OVER

HB 321, sponsored by Rep. Jodi Lott, would extend the sunset provision of the hospital provider fee for five years. The hospital payment program, which draws down additional federal funding, provides almost $1 billion annually to the state’s Medicaid budget. More information about HB 321 is available here.


HB 514: Georgia Mental Health Reform and Innovation Commission | CROSSED OVER

HB 514, sponsored by Rep. Kevin Tanner, would create the Georgia Mental Health Reform and Innovation Commission through at least June 30, 2020. Within the Commission, several subcommittees would be established to include Children and Adolescent Mental Health; Involuntary Commitment; Hospital and Short-Term Care Facilities; Mental Health Courts and Corrections; and Workforce and System Development.


SB 16: Interstate Medical Licensure Compact Act | CROSSED OVER

SB 16, sponsored by Sen. Kay Kirkpatrick, would allow Georgia to enter the “Interstate Medical Licensure Compact Act” which allows health care providers to more easily obtain licenses to practice in multiple states. It also provides Georgia’s Medical Board with easier access to investigative and disciplinary information about providers from other states, an important protective measure for Georgia patients.


SB 74: Eliminate certificate of need requirements | DID NOT CROSS OVER

SB 74, sponsored by Senator Matt Brass, would eliminate certificate of need requirements for all health care facilities except certain long-term care facilities and services. This bill is the Senate companion piece to HB 198. Both bills aim to change the current certificate of need structure which regulates hospitals in Georgia.


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Stay up-to-date with the legislative session

GHF will be monitoring legislative activity on a number of critical consumer health care topics. Along with our weekly legislative updates and timely analysis of bills, we have the tools you need to stay in touch with health policy under the Gold Dome.


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Legislative Update: Patients First Act, the little budget, and HIV legislation

Legislative Update: Week 6
Patients First Act moves quickly through Senate committee

Last week, the Senate Health and Human Services (HHS) committee met to discuss and hear testimony on SB 106. Titled the Patients First Act, the legislation permits Georgia’s Governor to pursue two health care waivers that could make significant changes to health coverage for Georgia consumers. The bill passed out of committee with no changes and now sits in the Senate Rules Committee awaiting a vote to move to the Senate floor.

The legislation, as written, would allow the Department of Community Health to request an 1115 waiver to extend Medicaid coverage up to 100% of the federal poverty level (FPL). This would leave out thousands who would be covered under a full Medicaid expansion and will likely cost the state more to cover fewer people. Additionally, the bill allows the Governor to make potentially tremendous changes to private health insurance in Georgia through 1332 waivers with little accountability. This proposed legislation falls short of the promise to put a health insurance card in the pockets of all Georgians.

There is still time to ensure that this bill covers all Georgians in need of an insurance card in a fiscally responsible way. Join us this Thursday, February 28th, for Cover Georgia Day at the Capitol to talk with your elected officials about this important piece of legislation

(Can’t make it? Call or send an email to your state legislators today!)


General Assembly moves forward on budget bills
Budget progresses through General Assembly
The House and Senate are inches away from completing work on HB 30, the FY2019 supplementary budget which only needs a House “agree” to move to the Governor’s desk. The supplemental budget (also called the “little budget”) makes necessary, mid-year adjustments to the current state budget. The Governor’s proposed amended FY2019 budget provides $1 million for the Department of Community Health to hire an external consultant to draft the waiver options authorized in SB 106, if passed. The House Appropriations Committee has begun working on the FY 2020 budget, (also called the “big budget”). The FY2020 budget contains significant additions for health, including $8.4 million to fund a school-based mental health initiative called Project Apex, which aims to increase access to mental health services for children and youth.

Legislature prioritizes HIV prevention & treatment
Bills to increase prevention & treatment of HIV move forward in the House

Georgia now leads the U.S. in the number of new HIV cases diagnosed each year. State legislators have turned their attention to this problem with the introduction and passage of several bills aimed at preventing the further spread of HIV/AIDS and increased access to treatment for those living with the disease:

  • HB 158, sponsored by Rep. Deborah Silcox, requires that Medicaid recipients have the same access to antiretroviral regimens used to treat HIV and AIDS as to those included in the formulary established for the Georgia AIDS Drug Assistance Program. This change would allow for increased continuity of care for people living with HIV/AIDS in Georgia. The bill has passed the House and has been referred to the Senate HHS committee.
  • HB 217, sponsored by Rep. Houston Gaines, decriminalizes the act of working or volunteering for a syringe services program, a step towards legalizing the programs. Distributing clean hypodermic syringes and needles to people who use injection drugs (e.g. heroin) helps to prevent the spread of HIV and Hepatitis C, and does not increase the likelihood that people will newly take up injections drug use. This bill was passed by the House yesterday and now moves to the Senate.
  • HB 290, sponsored by Rep. Sharon Cooper, would establish a pilot program to provide preexposure prophylaxis (PrEP) drug assistance or services to persons at risk of being infected with HIV. PrEP is a medication taken by people who are HIV-negative to reduce their risk for infection. The pilot program would provide PrEP to people in counties identified by the Centers for Disease Control & Prevention as at risk of HIV outbreaks due to a high rate of opioid use and participants would receive regular HIV testing and related support services. The House HHS committee passed HB 290 last week and now awaits a full vote by the House.

Surprise billing legislation advances
Surprise billing legislation approved by Senate committee

SB 56, sponsored by Senator Chuck Hufstetler, was approved by the Senate Insurance and Labor Committee last week. The legislation addresses surprise out-of-network billing and aims to improve transparency. A surprise medical bill can occur when a consumer unknowingly encounters an out-of-network (OON) provider at an in-network facility and can have serious financial impacts on individuals and families. This bill would disallow surprise billing in emergency situations but does not prohibit surprise billing in non-emergency situations like when a physician uses an out-of-network laboratory for diagnostic tests. (For more details on the legislation, see our February 11th legislative update.) The bill was approved and now sits the Senate Rules Committee awaiting a vote.


GHF has you covered
Stay up-to-date with the legislative session

GHF will be monitoring legislative activity on a number of critical consumer health care topics. Along with our weekly legislative updates and timely analysis of bills, we have the tools you need to stay in touch with health policy under the Gold Dome.


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Legislative Update: Week 4

Momentum builds to close Georgia’s coverage gap

The 2019 legislative session is now in full swing and the past few weeks have brought the introduction of two bills that would close Georgia’s coverage gap by expanding Medicaid.

HB 37: Expand Medicaid Now Act; enact and SB 36 are sponsored by Representative Bob Trammell and Senator Steve Henson respectively. Each bill expands Medicaid in Georgia as envisioned by the Affordable Care Act by increasing Medicaid eligibility for adults up to 138% of the federal poverty guidelines (FPL). This is equivalent to $17,236 annually for an individual and $29,435 for a family of three.

In addition, Governor Kemp has announced that his office will seek an 1115 Medicaid waiver. An 1115 waiver provides states with the ability to experiment with or tailor their Medicaid programs. Governor Kemp has not released details of the waiver, so its impact on consumers is uncertain. The waiver could close Georgia’s coverage gap, among other changes to Medicaid coverage. Legislation to allow Georgia’s Medicaid agency to seek an 1115 waiver is expected to be introduced soon by Senate Republicans.

Tell Governor Kemp and your legislators that you support putting a health insurance cards in the pockets of Georgians regardless of their income.


Consumer protection bills introduced

Surprise medical billing emerges as a prominent issue

Surprise out‑of‑network medical billing is once again emerging as a prominent issue within the Georgia General Assembly. A surprise medical bill can occur when a consumer encounters an out-of-network (OON) provider at an in-network facility or in other circumstances. Two pieces of legislation have been introduced to address surprise billing and each attempts to resolve the issue in its own way.

HB 84: Insurance; provide for consumer protections regarding health insurance
Rep. Richard Smith, Chair of the House Insurance Committee, introduced HB 84 to increase transparency related to possible surprise medical bills. This bill sets disclosure requirements for health care providers, insurers, and hospitals. The legislation requires that information on billing, reimbursement, and arbitration of services must be provided to the consumer at their request. The bill also allows for an arbitration process between the consumer and the health care provider, the specifics of which would be determined by Georgia’s Department of Insurance. This bill currently sits in the House Insurance Committee and is in House second readers.

SB 56: Consumer Coverage and Protection for Out-of-Network Medical Care Act
Senator Chuck Hufstetler, Chair of the Senate Finance Committee, introduced SB 56 to address surprise out-of-network billing. This legislation disallows surprise billing in emergency situations under insurance plans issued after July 1, 2019. The bill contains similar transparency provisions to HB 84. For consumers who receive elective medical care after which they receive a surprise bill greater than $1000, the legislation makes available a mediation process through the Department of Insurance. This bill was referred to the Senate Insurance and Labor Committee.


Legislative calendar set
Legislature plans to finish work by April 2nd

The schedule for the remainder of the legislative session has been set in HR 152. Crossover Day, the day that legislation must move from one chamber to the other in order to be considered in 2019, will fall on March 7th. The remaining sixteen legislative days will be broken up throughout March, culminating on Sine Die, the last day of the session, on April 2nd. The full calendar can be viewed here.


RSVP for Cover Georgia Day
Join us at the state Capitol on February 28th!

Join us on Thursday, February 28th for Cover Georgia Day at the Capitol when we will ask our state legislators to close Georgia’s coverage gap by putting insurance cards in the pockets of low-income Georgians. This is the most important step that our elected officials can take to slow the growing opioid crisis, strengthen our state’s struggling rural health care system, and improve the health & finances of hardworking Georgia families. Take advantage of this opportunity to talk with your elected officials about closing Georgia’s coverage gap! RSVP today!

 

Can’t make it? Call or send an email to your state legislators asking them to put an insurance card in the pockets of all Georgians.


GHF has you covered
Stay up-to-date with the legislative session

GHF will be monitoring legislative activity on a number of critical consumer health care topics. Along with our weekly legislative updates and timely analysis of bills, we have the tools you need to stay in touch with health policy under the Gold Dome.


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