Who doesn’t love to get mail? A hand-written note from a friend? An invitation to a wedding or surprise birthday party? A post-card from a family member enjoying their vacation in an exotic locale? Getting personal mail is not something that happens much this day and age, but still holds a lot of meaning to most people. If someone took the time to write you a letter to ask you to do something, wouldn’t that get your attention more than email? Now imagine that you got multiple letters asking you to do something from your friends, family members, and neighbors. That’s exactly what happened for a majority of Georgia’s state Senate and House members.

In July, Georgians for a Healthy Future mailed out stacks of post-cards to Georgia’s state legislators. These were not any post-cards. These were the postcards that GHF, with the help of the Cover Georgia Coalition, had been collecting over the past few years asking legislators to close the coverage gap. These postcards were signed by Georgians all across the state and were collected through outreach events, online petitions, and even Facebook ads. We collected more than 1100 postcards and sent them to legislators in every corner of the state. Many postcards included handwritten notes to their legislator asking them to close the coverage gap to help themselves, their family members, and fellow Georgians.

It’s not often that constituents are able to feel like they can directly communicate with their elected officials and this postcard project was intended to help give everyday people a voice for a topic that was important to them. More than 300,000 Georgians fall into the coverage gap and are unable to get affordable health insurance. Often these Georgians go without coverage and regular medical care. Many Georgians want to fix this issue and took the time to let their legislators know that they support closing the coverage gap.  These postcards will have an impact as state legislators hear from their constituents that they want all Georgians have access to quality, affordable health insurance.

We will continue collecting postcards and sending them to legislators as we get them. If you haven’t signed a postcard yet, you can still do so by signing our online petition.

It’s been an exciting few weeks for Close the Gap advocates. We are pleased to see that several of Georgia’s leaders  have expressed to the press that they are willing to take a second look at closing Georgia’s coverage gap. By closing the gap, they would help not only hard-working Georgians but also struggling rural hospitals and the communities that rely on them. We hope to work with our state leaders in the coming months to build further support and to find a solution that works for all Georgians. Below you’ll find links to articles covering the conversation happening at the Gold Dome.

Op-Ed: The irrefutable logic of Medicaid expansion for Ga.
AJC | June 22

Louisiana’s expanding Medicaid, and Georgia should too
Flagpole | June 22

Task force aims to reshape Georgia stance on health coverage
Georgia Health News | June 21

Will Louisiana’s Medicaid expansion provide a model for other states?
Georgia Health News | June 20

Why A Ga. GOP chair wants to ‘re-examine’ Medicaid expansion
WABE | June 15

Medicaid expansion remains divisive for Georgia Republicans
Associated Press | June 11

HOW YOU CAN GET INVOLVED

Email your legislator and tell them you support closing the coverage gap!

Did you know that you can find and email your legislators right from the GHF website? Just enter your address and we’ll find your state representative and senator! Send them a brief email telling them that the time has come for our legislature to come together to close Georgia’s coverage gap! Send your email here.

Need more resources on the coverage gap?

These resources will help you understand what the coverage gap is and what it means for you and the state.

Medicaid Chart Book

Georgia Left Me Out

Does your organization support closing the coverage gap?

Your organization can show its support by joining the Cover Georgia coalition. Email our Director of Outreach & Partnerships Laura Colbert for more information.

Georgians for a Healthy Future’s Executive Director Cindy Zeldin sat down with A Spirit of Charity author Mike King to discuss his new book on the role of public hospitals in America. Below is a Q&A that delves into some of the book’s major themes. On July 19th, Georgians for a Healthy Future will hold a book event in Atlanta with Mike King, providing a unique opportunity for the advocacy community to discuss the history and role of public hospitals in America and the direction of health policy in Georgia with the author.

Why did you decide to write this book?

I have been writing and editing stories about medicine and natural medicine like thai kratom powder and health care policy for about 30 years where they use different kind of medicines, you could for example this reach out to one!. When the newspaper business collapsed and I chose to leave it in 2009, I thought I’d just retire and take it easy. But when the Affordable Care Act passed in 2010 I realized I had the time, without daily deadline pressures, to tell a story about the most important effort at reform over the last 50 years and how it might play out right here in Atlanta and at Grady in particular,.

How do public hospitals serve as a window into America’s health system?

As the book hopefully makes clear, the people who show up in the emergency rooms and clinics of America’s public hospitals are the result of all gaping holes, political compromises and unintended consequences of decades of attempts to reform our health care system. Even in our noblest of efforts, we always seem to leave whole segments of our society behind. Donald Trump, in a candid moment earlier in the campaign when the media pushed him for more details about what his alternative to Obamacare would look like, frustratingly blurted, “Look, we won’t let people die in the streets, OK?” In some ways that’s been our baseline as a health care system from the start, which is why public hospitals were created. We don’t let our citizens die in the streets. They get sick in the street but, if they are lucky, we get them to a public hospital that hopefully will rescue them from dying before they return to the streets. That’s a harsh assessment, I know, and we do much better than that in many places thanks to the commitment of engaged local and state leaders, but there are too many places where the local public hospital seems expected to shoulder this burden on its own.

Four of the five hospitals profiled in your book are located in the South, and the role of Southern politicians in crafting U.S. health policy is explored throughout the book. Why a focus on the South?

Because the South is where the most problems are. Texas, Florida and Georgia lead the nation in the dubious distinction of having the most uninsured residents among all 50 states – mostly because all three have refused to expand Medicaid the way the ACA called for. Louisiana is high on the list too, but the new governor there is moving to try to expand Medicaid. Parkland Memorial Hospital in Dallas, Jackson Memorial in Miami, the University Medical Center in New Orleans (the replacement hospital for Charity) and, of course, Grady, all have to contend with a huge percentage of patients who are poor and uninsured and could be, should be, covered by Medicaid. That’s why I chose them.

Some public hospitals like Grady were established during segregation. The 1946 Hill-Burton Act, which catalyzed hospital construction, contained a provision permitting segregation in hospitals receiving federal funds. How does this legacy of segregation impact public hospitals today?

Hill-Burton was the first time federal law actually codified a separate-but-equal funding mechanism and it was inserted into the law specifically to get members of Congress from the South to go along. Rural hospitals around the South and more than a few in the suburbs were built in the 1950s and 60s with Hill-Burton money. Grady was rebuilt as a segregated hospital in 1958. After the enactment the Civil Rights Act in 1964 and Medicare in 1965 that changed. Segregated hospitals – public and private – stood to lose too much money that they would be getting for the care of previously uninsured elderly patients if they stayed segregated. But there is still a legacy to overcome. There’s a reason elderly Atlantans still refer to Grady as the Gradies, going back not that long ago to when there was a Black Grady and a White Grady, with black nurses taking care of black patients and white nurses taking care of white patients. It still complicates the public discussion about how best to finance and administer this particular public hospital. I suspect that goes on in a lot of communities around the South that share a similar legacy.

You write that public hospitals serve as a “pressure release valve” for our nation’s health system. What do you mean by this?

We often refer to these places as safety net hospitals. But I contend they are more than that. The existence of a single hospital in a community that is chartered or required to take in all patients regardless of ability to pay fundamentally alters the medical marketplace in that community. It allows those hospitals that compete with it to measure their anticipated level of charity care against their expected revenue from insured patients and come up with a formula that helps them stay healthy and able to grow. It is not that most of these competing hospitals don’t provide a responsible level of charity care. Most of them do. But it is always at a level they can afford to provide. Public hospitals operate on a totally different business model. They have to take all comers and the only way they can stay open is to get some level of funding from state and local taxes to offset their losses. Here’s another way of looking at it: If Grady had gone belly up in 2007 and 2008, all the uninsured and indigent patients it served would have swamped the emergency rooms of Piedmont, the Atlanta Medical Center, Northside, St. Joseph’s, Emory and DeKalb Medical as well as other hospitals, jeopardizing their ability to provide the level of services their business model calls for. The safety valve would have blown.

Information about Medicaid, the health care program intended to help finance care for low-income Americans, is interwoven throughout your book. How are the histories and fates of Medicaid and public hospitals intertwined?

They are the key to understanding each other because Medicaid patients make up a large portion of the patients who go to these hospitals. When Medicaid was enacted in 1965 the theory was that with a health insurance program now in place for the poor and with Medicare available to the elderly, our nation’s public hospitals would finally start getting paid for many of the services they had been providing on a charity basis. But unlike Medicare, Medicaid was hampered – I would argue fundamentally flawed – by a series of compromises to get it through Congress. States were given a much bigger role in determining how poor you had to be to qualify for Medicaid, how much they wanted to pay doctors and hospitals to provide services for Medicaid patients and indeed whether they wanted to participate in the program at all. (Arizona didn’t join Medicaid until the 1980s.) The result was a checkerboard of health care programs for the poor around the country, based largely on what the states decide. And in the South, Medicaid has been chronically underfunded at the state level and treated more like a welfare program. This is how Southern politicians get away with calling it a failure. They starve it for funds, make it difficult for low-income people to get covered by it, grossly underpay doctors and hospitals that take patients covered by it and then decry the program for not working and being inefficient.

America’s health system is characterized by fragmentation. Why do you think this is and what is the role of public hospitals in a fragmented system?

We’ve all heard it before. America has a sick care system, not a health care system. And that system is based on who pays for sick care, not necessarily how we can more effectively pay for care to help keep people healthy. The good news is that the ACA is moving in the direction of breaking down some of the silos that have developed over the decades in how we deliver and pay for health care, with an emphasis on moving away from paying a fee for specific services and toward paying for overall wellness. That’s good. But it will take years to see results. Public hospitals will need to move in this direction as well – and some of them are. Cook County’s Medicaid Program (County Care) is coordinating care with its community hospital and clinic network and the federally funded community health centers in Chicago. The initial results look encouraging. If it works it will not only save lives but help control the rise in costs. But public hospitals must adapt to these new models and remain, in most large cities, the sole providers of costly essential services like trauma, HIV/AIDS and behavioral health for those who are still uninsured.

You write that, if public hospitals didn’t exist, “We would have to invent them.” What would an America without public hospitals look like?

It would be fascinating to see, wouldn’t it? Public hospitals were created one hundred to one hundred and fifty years ago when it became obvious that the charitable institutions in large American cities could not meet the demand for care caused by yellow fever, cholera, pestilence and other public health threats, not to mention the population growth in cities after the Civil War. The almshouses and infirmaries, often staffed by religious women and funded by churches and community groups, just could not keep up. I suspect the same would happen today if we came to rely exclusively on the nonprofit sector to take over the responsibility for caring for the poor and uninsured. Even if we became enlightened and created a system of true universal insurance for all Americans, there would still be a need for expensive specialty areas. Trauma care, infectious disease programs, severe, chronic mental health services – these essential services now almost exclusively provided by public hospitals – I would suspect they would require some level of local and state financing at a public facility that would go beyond what they can expect in the way of revenue from a public insurance plan.

Grady is featured prominently throughout the book. What did you learn about Grady by writing this book that you didn’t know before?

That it is even bigger and more complicated and harder to manage than I ever dreamed. I think the current administration there is doing a really good job at getting the hospital positioned to be everything it can be. The quality of the specialty services there – trauma, neuroscience, neonatology, burn care, sickle cell, infectious disease – has probably never been better, and they get well informed visiting Litchfield Neurofeedback to learn about the benefits of Neurofeedback Therapy. The cancer program there, in addition to being first rate at the acute care level, is making great strides in the community in the much-needed area of early detection and treatment. That will go a long way toward reducing the disparities that exist in morbidity and mortality between white and black, affluent and poor residents of our community. But the hospital is still heavily reliant on the business and philanthropic community to grow, especially when it comes to capital improvements and equipment. That’s all been private money since the comeback started. State and county officials have yet to step up to the plate to help. If they are willing to help the Braves and the Falcons build new venues, they must be willing to step up to help Georgia’s most important hospital build and grow and provide essential services.

What role does Grady serve in health care policy in the state of Georgia?

The state needs to recognize Grady is a statewide institution, if for no other reason than it is the training ground for about one in every four doctors practicing in Georgia. I’ve often wondered whether the state’s relationship with Grady would be different if it had been affiliated with a state medical school instead of Emory and Morehouse – two private medical schools. Perhaps then it would have paid more attention to it. Even though Grady gets patients from almost every one of Georgia 159 counties, it isn’t realistic to think the state must subsidize indigent patient care there, but it could do much better and providing funding for the specialty services that Grady provides to all Georgians – trauma care, burn care, infectious diseases, etc. And, of course, it should expand Medicaid coverage so that Grady and all other hospitals in the state that have a heavy load of uninsured patients will at least have an opportunity to recoup some of their costs.

Where do you think Georgia is headed on health care policy? 

I think we’ll expand Medicaid. Eventually. After President Obama is in the rear view mirror. We’ll call it something else so it doesn’t sound like it is part of Obamacare. But we will have squandered $3 to 5 billion and 100 percent federal funding to make this impetuous political statement, and no telling how many Georgians – one study puts it at 1,200 lives a year – who died because they lived in a state where they should have, but were kept from, enrolling in Medicaid. With a little political vision – and the help of advocates and experts – my hope is that we could create a Medicaid program that isn’t so fragmented; that fully integrates primary care and acute, hospital care; that reorganizes local hospitals and health departments into a true public health system that helps people stay healthy and when they get sick have no barriers to the care that they need. That shouldn’t be a pipe dream in a country as wealthy and smart as ours. That should be a working reality. On the other hand, try to visit what is a medium.

WEEK 6

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

WHAT HAPPENED THIS WEEK

The Provider Directory Improvement Act (SB 302)

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

Closing Georgia’s Coverage Gap

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

Surprise Out-of-Network Billing

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

Medicaid Payment Parity

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

HB 919

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

LET’S CHAT

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

WEEK 5

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

WHAT HAPPENED THIS WEEK

Improving Provider Directories

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

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

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

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

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

Sen. Gail Davenport 404-463-5260

Sen. Marty Harbin 404-656-0078

Sen. Ed Harbinson 404-656-0074

Sen. Burt Jones 404-656-0074

Sen. Josh McKoon 404-463-33931

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

Sen. Larry Walker 404-656-0081

Surprise Out-of-Network Billing

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

Network Adequacy 

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

Closing Georgia’s Coverage Gap

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

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

LET’S CHAT

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

WEEK 4

The first month of session is behind us and there is still so much to do! We’re excited about the discussion and movement around provider directory transparency. If you’re interesting in receiving action alerts as important legislation moves through the legislative process and small advocacy actions you can take, join the Georgia Health Action Network(GHAN)!

To see a full list of bills we’re following, click here.

WHAT HAPPENED THIS WEEK

Improving Provider Directories

SB 302, the Improving Provider Directories Act, will be heard, and possibly voted on, in the Senate Insurance and Labor Committee this Thursday.

Please call or email the members of the committee to let them know that you support the Improving Provider Directories Act!

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

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

Sen. P.K. Martin (bill sponsor) 404-656-3933

Sen. Gail Davenport 404-463-5260

Sen. Marty Harbin 404-656-0078

Sen. Ed Harbison 404-656-0074

Sen. Burt Jones 404-656-0082

Sen. Joshua McKoon 404-463-3931

Sen. Renee Unterman (bill co-sponsor)

Sen. Larry Walker 404-656-0081

Network Adequacy 

GHF supports updating Georgia’s network adequacy standards. We don’t expect to see legislation this year, but there are conversations happening in both chambers and in both parties. GHF will be advocating for a study committee to meet during 2016 so that the legislature will have enough information during the 2017 legislative session to debate the best standards for Georgia. To read more about network adequacy and why it matters to Georgia, check out our new policy brief.

Surprise Out-Of-Network Billing

In both the House and Senate we are still hearing strong interest in addressing surprise out-of-network billing. It is probable that we will soon see a bill that adresses this issue and we will keep you updated on any such developments.

Closing Georgia’s Coverage Gap

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

If you want to get involved in the movement to close Georgia’s coverage gap you can share this video with your social network and sign this petition.

LET’S CHAT

This week we are highlighting in our Consumer Health Advocacy Today video series a conversation with Representative Debbie Buckner on her health priorities for the 2016 legislative session.

Several health-related study committees met during the summer and fall months, and most of them are wrapping up their work. The Consumer and Provider Protection Act Study Committee held its final open meeting in November with a focus on network adequacy and provider directories. Claire McAndrew from Families USA, a national consumer health advocacy organization, and Georgians for a Healthy Future’s Health Policy Analyst Meredith Gonsahn delivered testimony on the importance of setting network adequacy standards and ensuring provider directory accuracy and usability. Look out for a final report from the committee later in December!