As consumers navigate the new landscape of increasingly narrow networks and high deductibles, they need the right tools and information to choose a health insurance plan that best fits their medical needs and their household budgets. Provider directories are the primary tool available to consumers to determine whether the plan they are selecting has a narrow or broad network and to identify which providers are in their plan. As such, these directories should be accurate, up-to-date, and should truly function as a tool. Despite the important role directories play, they are notorious for being rife with errors and for lacking the functionality to help consumers make optimal choices in the market. By drawing upon model legislation from the National Association of Insurance Commissioners (NAIC) and best practices from other states, Georgia can take steps to improve directories. This policy brief:

– explains the role provider directories play as a tool for consumer decision-making

– describes current provider directory provision in Georgia

– describes common problems with provider directories

– outlines recent policy activity around provider directories

– highlights other state examples of provider directory improvements

Download the brief here.

In December, the ACA Implementation Research Network released its Georgia state report at a policy forum held at the Community Foundation for Greater Atlanta. The report provides a detailed look at the key decisions made by Georgia policymakers around the implementation of the Affordable Care Act over the past five years. Georgians for a Healthy Future’s Executive Director Cindy Zeldin participated in a discussion with advocates, policymakers, and stakeholders to reflect on the report’s findings. The conversation ranged from health insurance enrollment best practices to health system reform to what it will take to close the coverage gap in Georgia. The ACA Implementation Research Network is jointly operated by the Nelson A. Rockefeller Institute of Government, the Brookings Institution, and the Fels Institute of Government at the University of Pennsylvania. The Georgia state report was written by Michael Rich, Professor of Political Science and Environmental Sciences at Emory University.  Download the Report.

Georgians for a Healthy Future is excited to release our new enrollment toolkit! The toolkit is a comprehensive compilation of fact sheets, neatly organized, that are designed to walk consumers through each step of the enrollment process – from how to get health insurance (enrollment) to how to use health insurance once they have it (post enrollment). You can download it here.

Need more information like this? You’re in luck! GHF has created the GEAR Network for people just like you. GEAR is the new central hub of resources for Georgia’s enrollment assisters and community partners that are working with people to educate them on their health and health coverage options. We’ll send out weekly emails full of local resources and the information you need to know through OE3 and beyond. For more information on GEAR, check out this presentation.

We  know that closing Georgia’s coverage gap would help adults who are uninsured. But how does it affect families and children in our state? GHF and Georgetown University Health Policy Institute’s Center for Children and Families have teamed up to bring you new research to answer that question. Key findings include:

• Nearly three-in-ten Georgians potentially eligible for coverage should Georgia choose to close the coverage gap are parents with dependent children residing in their home.

• Of those parents that could benefit from expanded Medicaid eligibility, nearly two-thirds (57 percent) are employed. Nearly half of all uninsured parents (46 percent) work in restaurants, retail, or professional service occupations.

Children enrolled in Medicaid are more likely to receive well-child care and are significantly less likely to have unmet or delayed needs for medical care, dental care, and prescription drug use due to cost.

The Taxotere Lawsuit served as a perfect example to prepare everyone involved, read the full report here.

Commentary from Cindy Zeldin, Georgians for a Healthy Future’s Executive Director

The nation’s uninsured rate has plummeted over the past year and a half. Here in Georgia, more than 400,000 people have enrolled in health insurance, bringing our state’s uninsured rate down to 15 percent. While there is still much work to be done to ensure that all Georgians have a pathway to coverage (like expanding Medicaid), it’s also important to make sure that those who are newly covered are able to access needed health care services.

Are newly insured Georgians accessing the care they need? For the most part, the answer seems to be yes. The early evidence shows that most people who signed up for health insurance have been able to find a doctor with relative ease and get an appointment for primary care within a week or two.

This is a development worth celebrating, but there are also some warning signs on the horizon that policymakers should heed: according to a recent study by the University of Pennsylvania, Georgia had the highest percentage of health plans utilizing “narrow networks” of providers. In addition, reports of provider directory inaccuracies and networks too skinny to deliver all of the services in a plan’s benefit package have started to emerge.

Narrow networks offer a limited choice of providers in exchange for a lower premium. While many Georgians are willing to make this trade-off, others need a broader network to meet their health needs. And everyone deserves the tools and information to make that choice and to know that they can access services for all covered benefits.

Health care consumers now have access to standardized information about premiums, benefits, deductibles, and other health plan features that make it easier to pick the right plan. Yet provider network size and composition remain a black box for consumers, holding them back from making the best, most informed decision they can. Combined with a rapid trend toward narrow networks, this could put some consumers at risk of not being able to access all of the providers and services they need (or at risk for high medical bills if they have to go out-of-network).

These trends are being examined as part of the Senate Study Committee on the Consumer and Provider Protection Act (SR 561). I was honored to be appointed to this committee to represent Georgians for a Healthy Future and to bring the consumer perspective to the committee. The committee’s third meeting, slated for the morning of November 9^th at the State Capitol, will focus on network adequacy, or whether there are adequate standards in place to ensure that consumers enrolled in a health plan have reasonable access to all covered services in the plan.

As a committee member, it is my goal to make sure the voices and needs of consumers are heard and considered. It is becoming clear that consumers don’t yet have 1) access to all of the information they need to select a health plan that best meets their needs and 2) protections that ensure their health plan will provide timely and meaningful access to all covered services. Fortunately, these are problems we can address.

I will be supporting enhancements to provider directories that give consumers the information they need and deserve (such as enhanced search functionality and a simple way to report inaccuracies) as well as network adequacy standards for Georgia that ensure no insured Georgian has to travel an unreasonably long distance or wait an excessive amount of time to access the care they need. I’ve also learned a great deal about this issue by watching the National Association of Insurance Commissioner’s work in this area, and was happy to sign on in support of the policy recommendations around network adequacy that the NAIC’s consumer representatives issued last year.

I am excited about this opportunity to make our health system work better, and GHF will keep you posted on new developments. If you’re interested in providing testimony to the committee, please let us know and we can forward your request to Senator Burke, who chairs the study committee.

Georgians for a Healthy Future and the Georgia Budget and Policy Institute are proud to release our joint publication: Understanding Medicaid in Georgia and the Opportunity to Improve It. Inside you will find infographics, new data, and compelling charts that simplify the complex issue of Medicaid in Georgia. 

Part one explains who gets Medicaid in Georgia, how Medicaid protects Georgians during economic downturns, how Medicaid controls costs in the state, and more.

Part two outlines Georgia’s opportunity to close the coverage gap.  Here you’ll find out what Georgia’s health insurance coverage gap is, how we can use Medicaid to close it, and who stands to benefit detailed by job sector, demographics, and veteran status.

Part three details economic and social benefits of closing the coverage gap. Why is closing the coverage gap a good deal for Georgia and the state’s economy? What are the savings other states realize by closing the gap? How does coverage affect a person’s financial and physical health? 

Download the chart book here.

Do you or does your organization work directly with consumers to help get them covered? Do people in your community come to you with questions about how to make sense of their health insurance? If so, GEAR is for you! Please join us for a webinar to introduce the new Georgia Enrollment Assistance Resource Network — GEAR! GEAR is the new central hub of resources for Georgia’s enrollment assisters and stakeholders who work to educate people on their health and health coverage options. GEAR is full of handouts, interactive consumer tools, important updates, and other materials that will help enrollment assisters and community organizations better educate Georgians on health insurance enrollment, health insurance literacy, and more.

Want to learn more about GEAR and how you and/or your organization can benefit?  Join us on October 19th for a webinar where we will demonstrate how to access GEAR and review some of the materials that can be found there. We will also get your feedback about other resources you would like to see included on GEAR in the future. GEAR is built to help more Georgians connect to health coverage and we want it to work for you!

You can register for the October 19th GEAR webinar here.

This column was authored by Cindy Zeldin, Georgians for a Healthy Future’s Executive Director, and originally appeared in the Atlanta Journal-Constitution on September 28th, 2015.

Earlier this month, the Georgia Department of Community Health announced that it had abandoned plans — at least for now — to seek flexibility in Georgia’s Medicaid program to allow for expanded coverage and an innovative delivery-of-care model for the patient populations served by Grady Health System in Atlanta and Memorial Health in Savannah.

While this pilot program would have been fairly limited, it was designed with the changing health care landscape in mind and in the spirit of making the health system work better for patients. The proposal relied on an integrated care model with primary care medical homes, care coordination, data sharing and a focus on prevention. The costs to the state would have been nominal — negligible, even — as Grady offered to foot the bill. That this effort is not moving forward is a disappointment, but it should not be a conversation-ender.

For years, the nation’s uninsured rate appeared stuck at a stubbornly high level. This had implications for individuals and families who couldn’t access the care they needed, for communities and health systems that experienced spillover effects, and for overall health and productivity. Over the past year and a half, the tide has turned. The uninsured rate has steadily declined, and in some states it has plummeted to less than 5 percent.

It is a time of tremendous change in health care, yet this change is being felt unevenly. According to a recent Gallup-Healthways survey, states that both established their own health exchange (or a partnership exchange) and expanded Medicaid saw greater declines in their uninsured rates than states that did neither. States that viewed the changing health care landscape as an opportunity, and the Affordable Care Act as a toolbox, to improve coverage saw far better results than those who did not.

Many states taking this “opportunity and toolbox” approach are now building on the foundation of high coverage rates to invest in prevention, improve access to care and enhance value for consumers, often in collaboration with local health care stakeholders.

Kentucky, for example, has reduced its uninsured rate from over 20 percent to 9 percent since 2013. Combined with an intentional focus on prevention, this has translated to a more-than doubling of the number of screenings for breast, cervical and colon cancer and of dental and physical exams. Other states like Oregon are developing initiatives to contain costs, improve quality and achieve better price transparency for consumers.

Of course, not every promising initiative will be a smashing success, but the pace of innovation and advancement is historic for American health policy. Here in Georgia, approximately 500,000 people enrolled in coverage through the Health Insurance Marketplace, an exciting development that has helped bring our state’s uninsured rate down to just above 15 percent. In normal times, with all else being equal, this would be extraordinary.

And while this achievement is transformative for the people and communities impacted, these are not normal times for the health system. Georgia’s uninsured rate remains among the nation’s highest, and our health outcomes, among the nation’s poorest. Without a more deliberate focus on coverage, access, value and outcomes, Georgia risks falling further behind other parts of the country. We cannot continue to do less with less.

The demise of the Grady experiment, while a disappointment, should be a conversation starter about moving Georgia towards an “opportunity and toolbox” mindset. To date, our state has stayed on the sidelines while others have moved forward, but we don’t have to remain there.

The evidence is beginning to pour in from around the country, and we can take the most promising initiatives out there and use them to inform a uniquely Georgia approach. The clearest evidence we have shows us the decision by the majority of states (30 and counting) to expand Medicaid is foundational in transforming the health system. The Grady initiative, while not Medicaid expansion, was at its heart a delivery system reform that was predicated on moving its target population into coverage as a first and necessary step.

We cannot make progress as a state if 15 percent of our population is uninsured. Too many Georgians fall into a coverage gap our leaders can fix. Medicaid expansion should be on the table, not as a perfect solution, but as a necessary first step.

During the 2015 Legislative Session, the State Senate established the Consumer and Provider Protection Act Study Committee. This committee will review and make recommendations around several health insurance practices, including network adequacy. GHF has identified network adequacy, or the sufficiency of the health care providers patients can access when they enroll in a health insurance plan, as an important emerging consumer health issue. Our Executive Director, Cindy Zeldin, is a member of the study committee and looks forward to bringing the consumer perspective to the committee’s work. Cindy also recently appeared on WABE and Top Docs Radio to talk about network adequacy and participated in a panel discussion along with several state legislators at the Medical Association of Georgia’s Summer Legislative Education Seminar to discuss this important issue. Stay tuned for study committee agendas, updates, and opportunities to weigh in!

Study Committee Schedule:

September 14, 9:00 – 12:00

State Capitol, Room 450

October 26, 2:00 – 5:00

Tift Regional Healthy System, Tifton

November 9, 9:00 – 12:00

State Capitol

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

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