This year’s Health Care Unscrambled will feature a lively discussion with five Georgia policymakers: State Representatives Pat Gardner (D-District 57), Buzz Brockway (R-District 102), and Karen Bennett (D-District 94); State Senator Chuck Hufstetler (R-District 52), and Trey Sivley of the Georgia Department of Insurance. Please bring your health policy questions and don’t forget to register for what has become an annual legislative tradition for Georgia’s health advocacy community!

During the 2013 Legislative Session, our state policymakers passed HR 107, which created a joint study committee on Medicaid reform. The purpose of the committee is to evaluate the state’s Medicaid program, examine best practices in other states, and plan for the future of the program. Many health care advocates monitored the legislation closely during the past Legislative Session because of the important role that Medicaid plays in providing health care services to our state’s most vulnerable citizens. The first meeting date for the study commission has been announced and will be held on August 28th from 10am – 12pm. The location for the meeting has not yet been announced, but more information about the committee is available here.

The 2013 Georgia Legislative Session has ended. The 2014 state budget and dozens of bills now go to Governor Deal for his signature or veto (the governor does have the authority to line-item veto parts of the state budget). Bills that did not pass this year are still viable in the 2014 Legislative Session, which will be the second year of a two-year session. Below is a summary of bills that passed the General Assembly this year that could impact health care consumers. For a complete rundown of how health care-related legislation fared, see Georgia Health News’s recap.

Legislation that could impact Medicaid and PeachCare beneficiaries

The final 2014 budget eliminated proposed rate cuts for health care providers (a 0.74% rate cut had been proposed for non-primary care providers within Medicaid and PeachCare for Kids), eliminated a proposed coding change that would have resulted in cuts for certain providers, and included funds for enrollment growth in Medicaid. This is good news for access to health care services; however, Medicaid, PeachCare, and other public health programs have sustained deep budget cuts in recent years. In future years, if we are to improve the state’s health, additional investments in public health and health care delivery will be needed.

HR 107 would create a joint study committee on Medicaid reform that would study current Medicaid policies and procedures, models in other states, and other aspects of the Medicaid program and report to the General Assembly and the Governor by December 31, 2013 with recommendations. HR 107 passed both the House and the Senate.

SB 62 would create a Federal and State Funded Health Care Financing Programs Overview Committee, a joint committee of the General Assembly. SB 62 has passed both the House and the Senate.

SB 24, which would authorize the Department of Community Health to levy a fee on hospitals to continue drawing down federal funds to support Medicaid and PeachCare for Kids, was passed by both the House and Senate and was signed into law by the Governor back in February. The current hospital fee had been set to expire on June 30, 2013. The renewal of the fee was essential to ensuring Medicaid and PeachCare’s solvency and preserving access to hospital care in Georgia.

Legislation impacting health insurance consumer protections and access to insurance

SB 236 would require insurance companies to send concurrently with any statements sent to consumers that provide notice of premium increases an estimate of the portion of any premium increase that is due to the Affordable Care Act. How this is determined would be left to insurance companies to calculate, and they would not have to disclose their methodology. There would also be no requirement to present information about any other factors leading to premium increases or to notify consumers about available tax credits that may more than offset premium increases or about any cost savings or benefit enhancements they are receiving as a result of the Affordable Care Act. As such, this bill would result in consumers receiving incomplete and potentially misleading information.  SB 236 has passed both the House and the Senate.

HB 198 would require licensing, certification, and training for health benefit exchange navigators and would restrict their ability to assist consumers. While ensuring that consumers receive accurate information from navigators about their health insurance options and protecting consumers is an important goal shared by Georgians for a Healthy Future, HB 198’s restrictive language and potentially duplicative training requirements could deter community-focused nonprofits, whose participation in the navigator program will be essential in reaching vulnerable populations who have historically faced barriers to enrolling in health insurance, from becoming navigators or from providing appropriate consumer assistance. Georgians for a Healthy Future looks forward to working with policymakers to ensure this bill is implemented in a manner that minimizes duplication and encourages participation from community-focused nonprofit organizations. HB 198 has passed both the House and the Senate.

HB 389 would allow insurance companies to terminate, cancel, or non-renew conversion policies or any health insurance policies offered through the health insurance assignment system when guaranteed issue becomes available (with a 90-day cancellation period and a 90-day open enrollment period into new health insurance options made available through the Affordable Care Act). HB 389 has passed both the House and the Senate.

For a bill (except for the state budget) to remain viable, it must pass at least one chamber by the end of Day 30, known as Crossover Day. Crossover Day was last Thursday, March 7th.  Below is a summary of bills that have passed at least one chamber and that Georgians for a Healthy Future is monitoring, as they could have an impact on Georgia health care consumers if enacted into law.

Legislation impacting health insurance consumer protections and access to insurance

A trio of health insurance related bills are moving through the General Assembly. Consumer health advocates are concerned about these bills because they could restrict information and choices for consumers. 

SB 236 would require insurance companies to indicate on statements sent to consumers that provide notice of premium increases the portion of any premium increase that is due to the Affordable Care Act. How this is determined would be left to insurance companies to calculate, and they would not have to disclose their methodology. There would also be no requirement to present information about any other factors leading to premium increases or to notify consumers about any cost savings or benefit enhancements they are receiving as a result of the Affordable Care Act. As such, this bill would result in consumers receiving incomplete and potentially misleading information.  SB 236 has passed the Senate and is in the House insurance committee.

 
HB 198 would require licensing, certification, and training for health benefit exchange navigators and would restrict their ability to assist consumers. While ensuring that consumers receive accurate information from navigators about their health insurance options is an important goal, HB 198’s restrictive language and potentially duplicative training requirements could deter community-focused nonprofits, whose participation in the navigator program will be essential in reaching vulnerable populations who have historically faced barriers to enrolling in health insurance, from becoming navigators or from providing appropriate consumer assistance. HB 198 has passed both the House and and the Senate.

HB 389 would allow insurance companies to terminate, cancel, or non-renew conversion policies or any health insurance policies offered through the health insurance assignment system when guaranteed issue becomes available (with a 90-day cancellation period and a 90-day open enrollment period into new health insurance options made available through the Affordable Care Act). HB 389 has passed the House and is in the Senate Insurance committee.

Legislation that could impact Medicaid and PeachCare beneficiaries

HR 107 would create a joint study committee on Medicaid reform that would study current Medicaid policies and procedures, models in other states, and other aspects of the Medicaid program and report to the General Assembly and the Governor by December 31, 2013 with recommendations. HR 107 has passed the House and is in the Senate Rules committee.

SB 62 would create Federal and State Funded Health Care Financing Programs Overview Committee, a joint committee of the General Assembly. SB 62 has passed the Senate.

SB 163 would direct the Department of Community Health to examine and identify options for reforming Medicaid in Georgia, including but not limited to more use of managed care, with the purpose of bringing savings to the state. SB 163 has passed the Senate and is in the House Health and Human Services committee.

The 2013 Legislative Session continues at a swift pace, with legislators in session today for day 17 of the 40-day session (the legislative calendar is available here). Here are some key health care updates:

• Yesterday, the Health Subcommittee of the House Appropriations Committee heard from the Commissioners of the state’s health-related agencies, including the Department of Community Health and the Department of Public Health, about their proposed FY 2014 budgets. Today, the subcommittee will meet again from 2 – 4pm in Room 506 CLOB to take public comment on the proposed budgets. If you would like to comment, you must sign up in advance in Room 245 of the State Capitol. The Georgia Budget & Policy Institute has released an analysis of the 2014 proposed budget for the Department of Community Health, available here.

• SB 24, which would authorize the Department of Community Health to levy a fee on hospitals to continue drawing down federal funds to support Medicaid and PeachCare for Kids, was passed by both the House and Senate and is expected to be signed into law by the Governor this morning. The current hospital fee is set to expire on June 30, 2013. The renewal of the fee is essential to ensuring Medicaid and PeachCare’s solvency and preserving access to hospital care in Georgia.

• HB 198 would require navigators to be licensed, place certain restrictions on their functions, and would give the Georgia Insurance Commissioner regulatory authority over them. Navigators are organizations or entities that apply for and receive federal grants authorized by the Affordable Care Act to provide individuals and small businesses with impartial information and assistance with enrollment in health coverage in the new health insurance marketplaces, or exchanges. While it is important that navigators are qualified to perform these functions and that there is adequate oversight to protect consumers, consumer advocates are also concerned that overly restricting navigators could have a chilling effect on the community-focused organizations whose participation in the navigator program will be critical in connecting hard-to-reach and vulnerable populations to coverage. Advocates worked with legislators to improve the bill, which passed the House Insurance Committee last week and was passed by the Rules Committee yesterday.

Last week, state agency heads presented Governor Deal’s proposed budgets for their respective agencies to the House and Senate Appropriations committees.

Access to care: the good news
Primary care providers will receive an increase in Medicaid reimbursement rates to parity with Medicare rates, funded entirely with federal dollars made available to Georgia through the Affordable Care Act. This can help preserve and strengthen access to care for Medicaid patients seeking primary care and prevention services.

Access to care: the bad news
The Department of Community Health’s proposed budget would reduce provider reimbursement rates within Medicaid by .74 percent for providers other than hospitals, primary care, FQHC, RHC, and hospice providers. This proposed rate cut, if implemented, could jeopardize access to care for Medicaid patients who require services such as dental care, obstetrics and gynecology, and oncology, among other non-primary care services.

The Department of Community Health’s proposed budget can be found here. Please contact your legislators and ask them to preserve access to care by restoring these important funds in the state budget.

Hospital fee renewal moves through the Legislature
SB 24, which would authorize the Department of Community Health to levy a fee on hospitals to continue drawing down federal funds to support Medicaid and PeachCare for Kids, has passed the State Senate and will be before the House of Representatives for a vote today. The current hospital fee is set to expire on June 30, 2013. The renewal of the fee is essential to ensuring Medicaid and PeachCare’s solvency and preserving access to hospital care in Georgia.

Please join us at the Capitol for “Cover Georgia Day” on Tuesday, February 19th from 9AM to 1PM. 

Cover Georgia is a coalition of consumer and patient advocates, providers, and industry stakeholders who have come together around a common goal: covering Georgia’s uninsured by expanding Medicaid.

• We will meet at 9am at Central Presbyterian Church (201 Washington Street, across from the State Capitol) for a training on the importance of health coverage and the opportunity that expanding Medicaid provides for hundreds of thousands of uninsured Georgians.
• Following the training session, we will walk across the street to the State Capitol to meet with our individual State Representatives and State Senators to ask them to support the Medicaid expansion
• At 11:30am, we will reconvene for a press conference and demonstration of support for the Medicaid expansion. We will also hear from individuals whose lives will be affected by this important decision.
• After the press conference, we will walk back over to Central Presbyterian Church to debrief and share information about our individual conversations with legislators.

Don’t miss out on this important event–please join us and make a difference. Help us Cover Georgia.  There is no cost to attend but please RSVP so we have the necessary materials on hand.

To learn more about Cover Georgia and to join the coalition efforts, go to www.coverga.org.

Each year, Georgians for a Healthy Future releases A Consumer Health Advocate’s Guide to the Georgia Legislative Session to provide you with the information you need to take action! Our 2013 guide is now available and features an overview of the legislative process in Georgia; contact information for all state legislators; descriptions and listings for each legislative committee with jurisdiction over health care issues; contact information for state agencies and officials; contact information for health care organizations and associations active in Georgia; key media contacts; and tools and strategies for effective consumer health advocacy. You can either download the guide here or request a hard copy of the guide by e-mailing Georgians for a Healthy Future’s Outreach & Advocacy Director here.

It was a busy first week at the State Capitol, as the Senate passed legislation (SB 24) authorizing the Department of Community Health to assess a fee on hospitals to secure federal matching funds for the state’s Medicaid program. Without the assessment, the Medicaid program faces a budget shortfall.  SB 24 now moves to the House.

The Legislature will not officially be in Session next week but the House and Senate Appropriations Committees will hear from state agencies about their budget proposals. The health-related agencies will make presentations on Thursday morning in Room 341 of the State Capitol. These presentations are open to the public. The Department of Community Health’s presentation is scheduled for 10:15am and the Department of Public Health is at 11:15am on January 24th.

Georgians for a Healthy Future and more than 40 organizations launched an education and advocacy campaign this week is support of expanding Medicaid in Georgia. Below is our announcement about Cover Georgia’s launch. Please contact us if you’d like to join the coalition.

COVER GEORGIA COALITION LAUNCHES EFFORT TO ENSURE THAT THE STATE MOVES FORWARD WITH THE MEDICAID EXPANSION

ATLANTA, Ga., January 10, 2013 – More than 40 organizations – including healthcare providers, hospitals and healthcare advocates – announced today the creation of a coalition in support of expanding Medicaid to Georgians with incomes below 133 percent of the federal poverty level as authorized by the federal health care reform law, the Affordable Care Act (ACA).

Called Cover Georgia, the coalition is spearheaded by Georgians for a Healthy Future and is comprised of a wide range of healthcare stakeholders, including the Georgia Rural Health Association, the Georgia Academy of Family Physicians, AARP Georgia, the American Cancer Society, among many others.

Enacted by Congress in 2010, the Affordable Care Act included the Medicaid Expansion provision, which would provide the states with billions of dollars in new federal funds to enroll currently uninsured citizens in their Medicaid programs.  In Georgia, expanding the program is projected to cover approximately 650,000 Georgians and to bring approximately $33 billion in federal funds into the state over ten years.  For the first three years of the expansion, the federal government will fund 100 percent of the new cost; after that, the states would be required to cover no more than 10 percent of the total cost from 2020 onward.

Cover Georgia will make the case that expanding Georgia’s Medicaid program and leveraging the billions of dollars in federal resources will improve access to care, strengthen the state’s health care delivery system, and bolster Georgia’s economy.  “This is an unprecedented opportunity to impact the lives of hundreds of thousands of Georgians and we simply cannot pass up this opportunity,” said Amanda Ptashkin, outreach and advocacy director for Georgians for a Healthy Future, the organization spearheading the coalition work.

 
When the U.S. Supreme Court decided the constitutionality of the ACA in 2012, it ruled that states could not be compelled to participate in the Medicaid Expansion.   So far, Governor Deal has said he does not plan to move forward with the expansion in Georgia, expressing concerns about the state budget and the long-term fiscal outlook at the federal level.

“Cover Georgia is a statewide education and advocacy campaign focused on spotlighting both the critical role that Medicaid plays within Georgia today and the opportunity that implementing an expansion of the program presents for consumers, the health care system, and our state’s economy,” said Cindy Zeldin, executive director of Georgians for a Healthy Future. “Covering the lowest-income uninsured through Medicaid will provide access to the basic prevention and treatment services that uninsured Georgians lack today and will pump an infusion of federal dollars into our state’s health care economy.”

“Other states across the country are saying yes to the Medicaid expansion and are investing in their state’s health care delivery systems with federal taxpayer dollars paid by Georgians. Georgia cannot afford to maintain the status quo while other states invest heavily in their health systems. Doing so will further compound regional health disparities and limit Georgia’s ability to compete in the long-run.”

Matt Caseman, of the Georgia Rural Health Association, agrees that in addition to the overall economy, the expansion will help rural Georgia. “Expanding Medicaid will provide thousands of rural Georgians, who don’t have health insurance, access to a primary care doctor and preventative medicine. It will help reduce the burden of uncompensated care and keep the doors open for our safety net providers. This initiative is critical to not only the health of Georgia’s rural communities, but our state’s overall economic success as well.”

Tim Sweeney, of the Georgia Budget & Policy Institute, believes that access to affordable health coverage is one of the most pressing health care issues facing the state. “Expanding Medicaid to cover hundreds of thousands of low-income Georgians is one of the most cost-effective ways to address the issue. Implementing the expansion will enable more Georgians to access needed health care, while boosting Georgia’s economy by bringing billions in new federal funding for doctors, hospitals, pharmacies and other health care providers throughout the state.”

The consequences of this decision will affect hundreds of thousands of Georgians.  AARP Georgia State Director, Greg Tanner, points out that, “there are 127,000 Georgians in their 50s or early 60s who make less than $15,000 a year and have no health insurance. Expanding Medicaid to cover them would make them more productive and in the first three years pump $8 billion into Georgia.  That money will go directly to doctors, hospitals, clinics and other health care providers.  We can’t afford not to expand coverage.”

If the state decides to forgo expanding the Medicaid Expansion, those individuals who earn more than our current eligibility levels but less than 100% FPL (Federal Poverty Level) will have no options for coverage and would not qualify for subsidized coverage in the state’s health insurance exchanges.  Those individuals will fall into a coverage gap.

The Cover Georgia coalition will continue to work on educating the public, key decision-makers and others on the importance of the expansion and what it means for our citizens.  Individual consumers, health care professionals, policy-makers and others can learn more about Georgia’s Medicaid program and what the expansion would mean for thousands of Georgians by visiting Cover Georgia’s website at www.coverga.org.