Early voting began last week ahead of the upcoming November 6^th Election Day. Georgians across the state are heading to the polls to cast their votes for Governor, Insurance Commissioner, state legislators and other elected positions, and voters’ decisions about the candidates in each race will have a critical impact on consumers health issues in Georgia.

One of the most visible positions on the ballot and one that plays a meaningful role in health care policy for the state is Georgia’s Governor. The Governor heads the state’s executive branch, which is broadly responsible for implementing, supporting, and enforcing Georgia’s laws.

As head of the executive branch, the Governor has the authority to appoint and provide direction to the leaders of most of Georgia’s executive branch departments, including the Commissioners of the Departments of Community Health (the state’s Medicaid agency), Public Health, Behavioral Health and Developmental Disabilities, and Family and Children Services. Because most health-related programs in the state are run by one of these agencies, the ability to appoint department leadership provides the Governor with outsized influence on the direction, priorities, and initiatives within each.

Ahead of the state legislative session, the Governor has the added responsibility of proposing an annual state budget for the General Assembly’s consideration. Health care is regularly the state’s second largest expenditure, making up almost 20% of the annual budget. Aside from expected items like Medicaid expenditures, the Governor may propose special investments that promote his/her health-related priorities. For example, Georgia’s FY19 budget includes an additional $21.4 million to improve and expand children’s behavioral health services as recommended to Governor Deal by his Commission on Children’s Mental Health. Once the legislature has considered and passed a budget, the Governor has the power to veto or approve the spending plan.

At the end of each year’s legislative session, the Governor has 40 days to approve or veto (“veto” means “to reject”) legislation. Most laws passed by the General Assembly are approved but a few each year are rejected by the Governor because they are ill-informed, controversial, or contrary to the Governor’s priorities. In recent years, Governor Deal has vetoed some health-related laws like SB 357 in 2018, which would have established a Health Care Coordination and Innovation Council.

Once a bill is approved, the Governor may direct the executive branch agencies about how the law should be carried out. For example, if the Georgia General Assembly approves future legislation to expand Medicaid in Georgia, the Governor may provide the Commissioner of Community Health with instructions about how the expansion should be implemented, including program elements that make it easier or harder for people to enroll in or use their new coverage.

Georgia’s next Governor will have a significant role in shaping the state’s health care landscape over the next four years or more. Whether and how the state addresses issues like access to care, health care affordability, the opioid crisis, and the sustainability of the rural health care system may be decided by voters at the ballot box this November.

This blog is part of a series from Georgians for a Healthy Future to educate consumers about the impact of the 2018 election on timely consumer health issues. Please check out our previous blog, Eight questions for health care voters to ask Georgia candidates, where you can find a list of questions to help health care voters get to know the candidates on their ballots.

*Georgians for a Healthy Future is a non-partisan, 501(c)3 organization. We do not endorse or support any candidates or political party.

Georgians across the state are being asked to decide how they will cast their votes in November for positions such as Governor, Insurance Commissioner, state senator and state representative. The decisions made by voters about these elected positions will directly impact critical consumer health issues in Georgia like access to health care, affordability of health insurance, the opioid crisis, and the sustainability of the rural health care system.

As candidates crisscross the state or their districts asking for support, voters will consider their stances on a number of important issues including health care. To help voters make their decisions, we put together this list of questions for voters to ask of candidates about five timely and pressing consumer health care issues.

These questions can be used at town halls and candidate forums or posed to candidates via social media or in one-on-one conversations.

Closing the coverage gap

• Over 240,000 Georgians make too little to receive financial help to buy private health insurance but do not qualify for Medicaid, meaning they fall into the Medicaid coverage gap. Many of the families who fall in the gap are hard-working people who work in industries that make up the backbone of our state: trucking, food service, and childcare. Do you support using federal funds to close the Medicaid coverage gap and offer affordable health coverage to these 240,000 Georgians while boosting the Georgia’s economy? Please explain.
• A 2016 Department of Health and Human Services study showed that marketplace premiums were on average 7 percent lower in states that extended Medicaid to low-income residents. Do you support closing the Medicaid coverage gap as one method to reduce health care costs and lower the uninsurance rate for consumers in Georgia? Please explain.

Georgia’s health insurance marketplace

• Health insurance premiums for Georgia consumers will rise by as much as 15 percent in 2019 due to the repeal of the individual mandate by Congress and the elimination of cost-sharing reductions, among other things. If elected, what improvements would you make to our health care system to ensure your constituents have access to high quality, comprehensive and affordable health insurance?
• The federal government has expanded insurance companies’ ability to sell short-term plans that do not cover key services like mental health treatment or prescription drugs. These plans will increase health care costs and roll back consumer protections that many families in our state depend on. How do you think Georgia should regulate these plans?

Opioid/substance use crisis

• In 2016, about three Georgians died each day from drug overdoses and thousands of Georgians live with substance use disorders regularly. To slow this crisis, a broad spectrum of strategies will be needed from prevention and early intervention to expanded access to treatment. If elected, what would you do to address the state’s substance use crisis?

 Communities left behind

• Seven rural hospitals in Georgia have closed since 2010. Rural hospitals are often the largest employer in the area and are the economic engines that help to support local small businesses (like the flower shop or pharmacy). If elected, what will you do ensure that rural communities have adequate access to quality, affordable health care?
• People of color in Georgia have shorter life expectancies, higher rates of chronic disease, and are more likely to be uninsured and live in medically underserved areas. The causes of these outcomes are complex and linked to reduced access to quality education, fewer economic opportunities, discrimination, and other social and economic factors. As (Governor/Insurance Commissioner/other position title), how would you address the health disparities experienced by people of color in Georgia?

Defending health care gains

• Over the past two years Congress has repeatedly attempted to repeal the AffordableCare Act (ACA) and slash federal Medicaid funding that our state relies on, despite the fact that 74 percent of the public view the Medicaid program favorably. If elected, will you support/continue to support the program in the face of threats? Please explain.

Did you ask one of these questions to a candidate? Let us know! We want to know which questions were most helpful and how candidates are responding. Email Michelle Conde at mconde@healthyfuturega.org with your feedback.

*Georgians for a Healthy Future is a non-partisan, 501(c)3 organization. We do not endorse or support any candidates or political party.

Georgians for a Healthy Future hosted another Georgia Voices for Medicaid training on Friday, August 10^th in partnership with the Athens Clarke County Library. The Georgia Voices for Medicaid trainings are designed to give participants the knowledge and skills they need to advocate for timely, important health care issues impacting Georgians.

At last week’s training, participants learned that Georgia’s Medicaid program provides health insurance for half of Georgia’s children, and that it also covers low-income people with disabilities, seniors, and pregnant women. In Clarke and Barrow counties, 15,830 and 10,845 residents respectively are covered through Medicaid. Alyssa Green, GHF’s Outreach & Education Manager, shared testimonials from several Georgians who are covered by Medicaid to demonstrate the real benefits of coverage to training participants. Alyssa also introduced ways that participants can advocate for the health care issues that matter most to them, like protecting and improving the Medicaid program or bringing down health care costs.

The training concluded with an invitation for attendees to continue their health care advocacy work with GHF’s new Georgia Health Action Network (GHAN) program. GHAN is a volunteer-led program that fosters and supports grassroots health advocates who work alongside GHF to reach a day when all Georgians have access to the quality, affordable health care they need to live healthy lives and contribute to the health of their communities.

If you were unable to attend this Georgia Voices for Medicaid event, check out our upcoming trainings or contact Alyssa at agreen@healthyfuturega.org or 404-567-5016, ext. 2 to schedule a training in your community. You can also contact Alyssa learn more about GHF’s new Georgia Health Action Network.

Georgians for a Healthy Future hosted its Georgia Voices for Medicaid training on Thursday, July 19^th in partnership with the Central Outreach & Advocacy Center.  The Georgia Voices for Medicaid trainings are designed to give participants the knowledge and skills they need to advocate for timely, important health care issues impacting Georgians.

At this week’s training, participants learned that Georgia’s Medicaid program provides health insurance for half of Georgia’s children, and that it also covers low-income people with disabilities, seniors, and pregnant women. In Fulton and DeKalb counties—Georgia’s two most populous counties–118,755 and 107,340 residents respectively are covered through Medicaid. Alyssa Green, GHF’s Outreach & Education Manager, shared testimonials from several Georgians who have Medicaid, including the story of a Georgia man who credits Medicaid as the reason he is able to financially support himself and work in his community.

GHF’s Executive Director Laura Colbert introduced ways that participants can advocate for the health care issues that matter most to them, like protecting and improving the Medicaid program or bringing down health care costs. Participants were given the opportunity to practice their advocacy skills by sending an introductory email to their state legislators that communicated what they learned at the training.

The training concluded with an invitation for attendees to continue their health care advocacy work with GHF’s new Georgia Health Action Network (GHAN) program. GHAN is a volunteer-led program that fosters and supports grassroots health advocates who work alongside GHF to reach a day when all Georgians have access to the quality, affordable health care they need to live healthy lives and contribute to the health of their communities.

If you were unable to attend this Georgia Voices for Medicaid training, join us for our next training event in Athens or contact Alyssa at agreen@healthyfuturega.org or 404-567-5016, ext. 2 to schedule a training in your community. You can also contact Alyssa learn more about GHF’s new Georgia Health Action Network.

Teresa began working as a teacher for the Headstart preschool program in 1994 but retired in 2010 because multiple health conditions made it difficult for her to work. Now her family’s only source of income is her husband’s monthly disability check, which is too high to allow him to qualify for Medicaid and too low to allow them to qualify for financial help to purchase private insurance through the Affordable Care Act. (Teresa cannot qualify for Medicaid no matter how low her income is because she does not have a disability or a child under the age of 18.) Both of them fall in Georgia’s coverage gap.

Teresa and her husband are just two of 197 of the Georgians in Clay County that are uninsured because Georgia’s decision makers have not extended health insurance coverage to low-income adults in Georgia (those making less than $16,000 annually for an individual or $20,780 for a family of three.)

Teresa struggles to manage multiple health conditions, the worst of which is a jaw condition that has caused her teeth to rot. Because Teresa has not had health coverage since 2009, she has had to find alternative, insufficient treatments for her jaw condition. She would have to pay $5000—almost four months of income—to receive the necessary medical remedies to alleviate her pain and stop the dental deterioration. If Georgia were to close the coverage gap, Teresa would be able to see her doctor on a regular basis without having to forgo appointments and services that would otherwise be too costly.

Georgia’s Governor and legislature have so far rejected the option to close the state’s coverage gap, leaving people like Teresa and her husband uninsured. Until Georgia’s policymakers extend health insurance to all low-income Georgians, Teresa, her husband, and 240,000 other Georgians will likely continue to skip health care appointments and forgo needed care because they have no pathway to coverage.

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 its importance.

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!

Despite several missed opportunities to address consumer health concerns during this year’s state legislative session, the FY2019 budget includes several impactful investments. Last week, Governor Nathan Deal traveled through Georgia and held budget signing ceremonies in Atlanta, Acworth, Blue Ridge, Statesboro, and Tifton for the $26 billion spending plan which will begin on July 1 of this year through June 30, 2019. The infusion of dollars into children’s mental health is especially noteworthy and exciting because of the impact it is expected to have across the state.

Governor Deal has recently made children’s behavioral health one of his top health care priorities and this year included in his proposed budget $20.6 million to fund recommendations from the Governor’s Commission on Children’s Mental Health. During its consideration of the state budget, he legislature ultimately increased the funding dedicated to these recommendations to $21.4 million.

These funded recommendations include behavioral health crisis services, supported employment and education for young adults with behavioral health needs, provider training and telehealth, and opioid abuse prevention for youth. Funding for suicide prevention will in part go towards expanding the capacity of GCAL, the Georgia Crisis and Access Line, which provides 24/7 online and telephone support for people who are seeking services for developmental disabilities, mental health, or substance use issues. Some of the additional funding is also dedicated to the Georgia Apex Program, a school-based mental health program that improves early identification, access to and coordination of needed behavioral health (BH) services for children with BH needs..

In the coming months, we will break down the Commission’s funded priorities and their impact on young Georgians. Look for our Healthy Minds, Healthy Bodies blog mini-series.

Looking for more information on this topic? Georgians for a Healthy Future will be hosting an educational forum later this month during which we will explore the behavioral health needs of Georgia children and youth, Georgia’s publicly-supported behavioral health landscape, and successes and opportunities in the current system of care. Join us in person or via webcast for this exciting and important event!

Travis suffered from a series of strokes when he was 11 years old that left him with several physical disabilities. He is one of the approximately 250,000 Georgians with disabilities to be covered by Medicaid.

Several years ago, Travis started volunteering with DisabilityLINK because he believes in the power of community and he likes being able to help others. Since then, he was hired as a Independent Living Specialist at the organization, where he connects people with disabilities to community-based resources and assists in coordinating various events at the DisabilityLINK office. He also works alongside other activists on issues such as housing, accessibility and self advocacy.

Travis recognizes that Medicaid is the reason he is able to financially support himself and work for an advocacy organization. Without the support Medicaid provides, Travis explains, he would not be able to help others the way he has been able to through his work at DisabilityLINK. When asked what he wanted others to know about him being able to receive affordable health insurance he replied, “With me working I am able to be a tax paying citizen.”

Medicaid is essential to ensuring that people with disabilities, like Travis, are able to lead fulfilling, independent lives as active participants in their communities. Georgia’s Medicaid program provides almost 2 million low-income children, people with disabilities, seniors, pregnant women, and very low-income parents with access to the health care services that they wouldn’t have otherwise.

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 its importance.

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!

Georgians for a Healthy future partnered with Step Up Savannah to host a health advocacy training on Tuesday, April 3rd.  Advocates learned how they could participate and lead health advocacy efforts in their own community and received information about pressing health advocacy issues in Georgia. Representatives from Healthy Savannah and the Chatham County Safety Net Planning Council were also in attendance to share local resources.

The significance of Medicaid was highlighted throughout the event. Participants learned that Medicaid primarily covers low-income children, people with disabilities, seniors, and pregnant women, including 40,000 of Chatham County residents. Alyssa Green, GHF’s Outreach & Education Manager, discussed Georgia’s opportunity close the coverage gap so that 240,000 more Georgians would have access to health insurance coverage. Alyssa shared the story of a Georgia woman who works part-time at DisabilityLINK but is stuck in the coverage gap and, as a result, has trouble managing her high blood pressure.

GHF’s Executive Director Laura Colbert introduced ways that people can advocate for the health care issues that matter most to them, like increased access to healthcare, bringing down health care costs, and protecting the Medicaid program. She explained how to build a relationship with legislator, communicate support or opposition for significant bills, and other forms of advocacy.

The training concluded with presentations from the Chatham County Safety Net Planning Council and Healthy Savannah. The two Savannah-based organizations provided participants with information and resources to promote and build a healthy local community.

If you are interested in hosting a training like this in your community, please contact Alyssa Green at agreen@healthyfuturega.org or 404-567-5016 x 2 for more information.

Every day four Georgians die from opioid overdose and recent data from the Centers for Disease Control and Prevention confirm that the epidemic shows no signs of slowing. Health care providers, public health professionals, community leaders, and families are all searching for effective strategies to slow and stop this growing public health crisis. Some initial steps have been taken by Georgia policy makers and others to increase access to life-saving drugs like naloxone, improve and expand the prescription drug monitoring program (PDMP) to prevent over-prescribing, and raise public awareness about the risks of opioids and other substances, but more is needed. Solutions must include evidence-based strategies that emphasize prevention and early intervention, as well as timely treatment and support for recovery.

An exciting development within Georgia’s Medicaid program gives health care providers an additional tool to aid in the fight against substance use disorders, especially among adolescents and young adults. Georgia’s Medicaid agency has activated the reimbursement codes for a tool called SBIRT, which stands for Screening, Brief Intervention and Referral to Treatment. SBIRT is a set of tools that identifies people who use alcohol or other drugs at harmful levels and guides follow-up counseling and referral to treatment before serious long-term consequences occur.

Ninety percent of adults who meet the medical criteria for addiction started smoking, drinking, or using other drugs before they were 18 years old. Because Medicaid and PeachCare for Kids cover half of all Georgia children, the activation of the Medicaid reimbursement codes for SBIRT is a powerful opportunity to identify youth substance use and intervene early. Studies show that simply asking young people about drugs and alcohol use can lead to positive behavior changes and that brief interventions reduce the frequency and amount of alcohol or other drug use by adolescents.

This policy change was the product of a sustained advocacy effort by Georgians for a Healthy Future (GHF) and the Georgia Council on Substance Abuse (GCSA). We anticipate it will lead to the screening of an estimated 145,000 Georgia youth annually and that 36,000 of those youth will present substance use behaviors that prompt a brief intervention with a health care provider. Initial data from Georgia’s Medicaid agency demonstrates that some providers are already making use of the SBIRT codes in their practices.

Notwithstanding these exciting results, we have committed to continue our efforts to improve access to screening, early intervention, and recovery services and supports for young people across Georgia. While the Medicaid reimbursement codes allow physicians, physician extenders, and advanced practice registered nurses to provide SBIRT services, we recognize that RNs, LPNs, licensed clinical social workers, and certified peer counselors can and should be able to provide SBIRT to youth and adults. Further, the codes allow SBIRT to be provided primarily in health care settings, but that excludes schools and other community-based settings where most young people spend their time.

We invite you to join our efforts to prevent substance use among young Georgians. Spread the word by giving our new fact sheet to the providers in your clinic, public health department, or hospital. If you are a health care provider, attend a training to develop the skills to implement SBIRT with the people that you care for. Join our on-going advocacy efforts to activate the reimbursement codes for more practitioner levels (including RNs and LPNs) and more settings by contacting us to let us know you are interested.

The opioid and substance use crisis that is sweeping Georgia and impacting communities nationwide will require a full spectrum of solutions that leverage the expertise of health care providers, public and private resources, and community and family supports. SBIRT is an evidence-based tool that can play a significant role in our collective efforts to reduce substance use and create a healthier Georgia for all of us.

To learn more, visit our Keeping Youth on a Healthy Path page.

For health care providers: download our new fact sheet here.