Laura Colbert, executive director of Georgians for a Healthy Future, agreed the issues of drug prices and transparency, coupled with the role PBMs play in the equation, will come up…
Tag: health insurance exchange
By: Knetta Adkins
On August 2nd, I had the opportunity to meet with Secretary Xavier Becerra, the 25th Secretary of the Department of Health and Human Services. During his August trip to Georgia, Secretary Becerra hosted a roundtable with community leaders to hear about the health care concerns and challenges most affecting Georgians. Congresswomen Carolyn Bordeaux, Lucy McBath, and Nikema Williams, state Representative Matthew Wilson, and Mayor Keisha Lance Bottoms participated in the roundtable, as well as representatives from Community Catalyst, Protect Our Care Georgia, and others. It was an exciting moment to represent Georgians for a Healthy Future and share on behalf of the marginalized Georgians for whom we advocate.(more…)
On June 3rd, 2021, the Centers for Medicaid and Medicare Services (CMS) sent a letter to Governor Kemp requesting additional data on the potential impacts of the Georgia Access Model. The Georgia Access Model was put forward by Kemp in his 1332 private insurance waiver, and the model would end access to healthcare.gov for Georgia consumers.
CMS is requesting additional data from the state because they believe recent changes made by President Biden’s administration to the Affordable Care Act’s health insurance marketplace have made the state’s previous analysis outdated or inaccurate. The Biden administration’s changes include:
- The COVID Special Enrollment Period (SEP)—through August 15, 2021, almost any American who does not have health insurance through their job can enroll in health coverage at healthcare.gov or by phone at 1-800-318-2596;
- More generous and expanded eligibility for Premium Tax Credits (PTCs)—almost anyone who qualifies for coverage through the ACA is now eligible for a discount on their monthly premium; and
- Increased funding for outreach and marketing for the ACA marketplace and enrollment opportunities.
These actions have led to more Americans, and Georgians, enrolling in Marketplace coverage. In addition, CMS believes that ACA enrollment would likely remain higher through 2023, when the Georgia Access Model is slated to begin.
In the letter, CMS also reasons the increase in enrollment could change insurance market dynamics enough to reduce the private sector’s incentive to enroll consumers. CMS believes with fewer uninsured people to enroll, the private sector may be less motivated to reach uninsured individuals. The idea that the private sector will be incentivized to enroll consumers once the competition of healthcare.gov is gone is a crucial assumption of Kemp’s waiver.
Georgia must now respond with updated data that takes into account the new federal changes. The new data will allow CMS to ensure the Georgia Access Model meets the protections specified in Section 1332 of the Affordable Care Act. These protections are:
- Coverage must be at least as comprehensive as Marketplace coverage;
- Coverage and protections against high costs must be as affordable as Marketplace coverage;
- A similar number of people must have coverage under the waiver as without it; and
- The waiver can’t add to the federal deficit.
The state may also request to adjust the Georgia Access Model, as needed, to meet waiver requirements in light of the new federal policies.
Once Georgia submits the new data about the Georgia Access Model, Georgia consumers, health advocates, and other stakeholders will have a chance to comment on the proposal again. CMS announced in their letter that they will hold a 30-day comment period after they receive Georgia’s new data. GHF expects the comment period will begin in early July. We will be working with our Cover Georgia partners to help Georgia individuals, organizations, and advocates comment. Stay tuned for your opportunity to weigh in again!
Healthcare.gov is open for business from November 1 to December 15, 2020. Georgians can now shop for comprehensive, affordable health plans and enroll in coverage. Nine out of 10 Georgians qualify for financial help to lower their premiums and other costs! Make sure that you are covered in 2021!
Most Georgians who qualify for health insurance & financial help through the Affordable Care Act (also called “Obamacare”) are still uninsured. If you or people you know need more information about how health insurance works, how to enroll in coverage, or what to do after you have signed up, we have you covered! Check out and share these tools so you and your networks can get covered and stay covered:
Sean “Saifa” Wall is an Atlanta-based intersex justice activist. He is currently enrolled in a health plan with Ambetter through the Affordable Care Act’s health insurance marketplace (also called healthcare.gov).
As an activist, Saifa’s income is generated exclusively through contractual work, which means that his employers do not provide health benefits. He talks to people about issues that affect the intersex community. He also serves as a public health researcher that consults with racial justice and domestic violence organizations.
Saifa enrolled in coverage in 2016 with the help of a GHF health insurance navigator after being uninsured for over two years. (He was also able to purchase dental coverage.) Saifa pays a premium of $63 per month after a $500 tax credit helped to lower his costs. His coverage allows him access to hormone therapy and behavioral health services, among other essential health benefits. He loves his medical provider and receives high quality treatment as an intersex person who is hormone dependent.
Saifa was recently diagnosed with osteopenia, which means his bones aren’t as dense as they need to be to prevent breaks and other injuries. Saifa will need comprehensive medical care as he works to build bone mass; much or all of that care will be covered by the comprehensive insurance plan he purchased through the ACA.
Like Saifa, 450,000 Georgians rely on the ACA marketplace to access comprehensive, affordable health coverage. Many more Georgians are eligible for marketplace coverage but remain uninsured for a variety of reasons.
Georgia’s new law, called the Patients First Act or SB 106, may bring changes to private health insurance in the state but Georgia leaders have not yet spelled out what changes they plan to seek. An effective way to use their new flexibility would be to maintain the protections and financial help that Georgia consumers enjoy while building a “reinsurance program” to bring down premiums for everyone. (This approach has been successfully tried in seven other states.) If premiums fall or remain steady, this could attract more Georgians to the marketplace and get more people covered.
When Saifa was asked what he would tell legislators about having health coverage, he replied: “As an intersex activist, I believe health care is a human right.” While this belief isn’t yet reflected in Georgia’s state health laws, the ACA allows consumers like Saifa to take advantage of comprehensive, affordable coverage options and protections from discrimination in the health system, among many other advances.
Georgians for a Healthy Future released its 2019 policy priorities at this morning’s ninth annual Health Care Unscrambled legislative breakfast. These annual priorities outline the issues that GHF believes are most pressing for Georgia consumers and are best addressed by the state legislature. GHF will work to move all of these issues forward by engaging state policy makers, consumers, and coalition partners throughout the legislative session and the remainder of the year.
1. Increase the number of Georgians with health insurance.
Georgia’s uninsured rate hit a historic low of 12.9% in 2016, but remains one of the highest uninsured rates in the country because Georgia has not accepted federal funds to cover low-income Georgians. Approximately 240,000 Georgians remain stuck in the resulting coverage gap. These Georgians do not qualify for Medicaid under current rules and do not earn enough money to qualify for financial help through the Marketplace. Georgians for a Healthy Future supports closing this gap by extending health insurance to all Georgians with incomes up to 138 percent of the federal poverty level.
2. Stabilize Georgia’s health insurance Marketplace
Almost half a million Georgians are enrolled in health care coverage through the health insurance Marketplace. While Georgia’s Marketplace has proven robust, the last two years have brought declines in enrollments, as federal policy changes have undercut its stability. Other states have taken steps to shore up their markets by implementing state reinsurance programs, instituting state-level consumer protections and enforcement mechanisms, limiting the sale of short-term junk plans, and investing in outreach & enrollment. Georgians for a Healthy Future supports policies that promote affordable, comprehensive coverage and a competitive, stable Marketplace.
3. Ensure access to care and financial protections for consumers purchasing private health insurance.
When consumers enroll in a health insurance plan, they should have reasonable access to all covered services in the plan. As narrow provider networks become more common, health care consumers are at increased risk of not being able to access the medical services and providers they need without going out-of-network and receiving surprise out-of-network medical bills. In 2015, the National Association of Insurance Commissioners adopted a network adequacy model act for states. Georgians for a Healthy Future supports using this act as a foundation to develop quantitative standards for Georgia. Georgians for a Healthy Future further supports legislation that will hold consumers harmless when consumers end up with out-of-network bills despite making appropriate efforts to stay in network or because inadequate provider networks require them to go out of network to receive the services that they need.
4. Set and enforce standards that provide for equitable coverage of mental health and substance use treatment services by health plans.
The 2008 passage of the Mental Health Parity and Addiction Equity Act (Parity Act) required that health plans cover behavioral health services as they would physical health services. The Parity Act is only meaningful if health plans are implementing it well, consumers and providers understand how it works, and there is appropriate oversight. GHF supports legislation that sets standards and oversight procedures to ensure that Georgia consumers receive the coverage for mental health and substance use disorder benefits to which they are entitled by law and for which they have paid.
5. Prevent nicotine use and addiction by young Georgians
Georgia has one of the lowest tobacco taxes in the country at just 37 cents per pack, which makes tobacco much more accessible to youth in Georgia than in many other states. Moreover, Georgia does not apply an excise tax on the nicotine-delivery devices (e.g. e-cigarettes, vaping pens) that are preferred by young people today. For price-sensitive young people, increasing the price of tobacco and nicotine products decreases use and addiction, and the burden of chronic disease in Georgia. Georgians for a Healthy Future supports legislation to increase Georgia’s tobacco tax by at least $1 and to add an equitable excise tax on all nicotine delivery devices.
6. Support partners in integrating health and equity in the policies across every sector to address social determinants of health that prevent equitable access to care and equitable health status.
Factors outside the health system such as adequate housing, education, and economic opportunity impact the health of individuals, families, and communities. Left unaddressed, these and other complicating factors can inhibit the effectiveness of approaches that are strictly within the health system. Georgians for a Healthy Future supports policies that aim to advance health and health equity by addressing the social determinants of health.
To download GHF’s 2019 policy priorities, click here.
Georgians for a Healthy Future has a new resource available to help low-and middle-income consumers navigate the often confusing and opaque health care, health insurance, and social services systems. The My Health Resource Guide provides consumers with an understandable, easy-to-use tool to help them better understand the health and social services systems that impact their health and connect with needed resources.
Included in the guide are sections about health insurance, finding a health care provider, and accessing mental health and substance use treatment services. The guide also points consumers to social services that fulfill other basic needs like transportation to and from health appointments, housing and food assistance, and legal support. All of the resources referenced in the guide are provided for free or at low-cost by community-based organizations or public agencies.
GHF developed the My Health Resource Guide to be distributed to and used by consumers, but we also anticipate it will be useful to professionals who know and work with low- and middle-income Georgians. We invite enrollment assisters, community health workers, social workers, clinicians, and others to use it as a reference or to distribute it directly to clients, patients and family members.
With four open enrollment periods completed and a fifth one beginning in the coming weeks, the Health Insurance Marketplace has become established as the avenue for purchasing coverage for thousands of Georgians who do not have access to have insurance at work. The fourth open enrollment period differed from the first three in several important ways, and understanding these variations will be important in ensuring that the Marketplace continues to serve consumers who seek access to affordable comprehensive health insurance. This report examines the characteristics of the consumers enrolled in the Georgia Marketplace, compares open enrollment 4 to the previous three enrollment periods, and provides a preview for open enrollment 5.
Inside you’ll find:
– Key themes in consumer and assister experiences during the 2017 open enrollment period
– A look forward to open enrollment 5
– Policy opportunities to increase enrollment, ensure access to care, address affordability issues, and facilitate continued consumer education and supports
Today the U.S. House of Representatives narrowly passed the American Health Care Act, a disappointment for health care consumers across Georgia. At a minimum, we know that the bill decimates Georgia’s Medicaid program, cutting more than $4 billion over 10 years, and would result in at least 560,000 more uninsured Georgians within a decade. Through unconscionable cuts and a restructuring of Medicaid, it will put many of our most vulnerable Georgians at risk, including children, people with disabilities and pregnant women. Children from low-income families could be denied critical preventive services including screenings for vision and hearing, immunizations and treatment for mental health issues. People battling cancer or addiction could lose coverage and access to life-saving treatment. Georgia’s budget would be put under severe pressure, which could lead to sharp cuts in the services older adults and persons with disabilities need to remain in their own homes, some which may have bad eyesight and are going to need to visit https://dittmaneyecare.com/cranberry/ for help and it may lead to having them need to find another audiologist such as audiologist nyc which is out of state.
Furthermore, the AHCA does nothing to improve affordability or quality of care for Georgia consumers. Instead, it opens the door from katy texas locksmith to discrimination against people with pre-existing conditions, skimpier insurance coverage for everyone and higher health care costs for Georgians. The bill even turns back the clock to a time when insurers could deny coverage for life-saving treatments by imposing annual and lifetime caps.
“Should it become law, the American Health Care Act will have a devastating effect on Georgia,” says Cindy Zeldin, Executive Director. “It will cause more than half a million Georgians to lose their coverage entirely while doing nothing to improve affordability or quality of care. This hastily thought out legislation will lead to higher deductibles while stripping consumers of critical protections. According to http://www.ahealthyjalapeno.com/lose-weight-garcinia-cambogia-and-apple-cider-vinegar-together-diet/, it will force unconscionable cuts in health care services for vulnerable children, people with disabilities, and seniors who rely on Medicaid for their most basic health needs. We urge Senators Isakson and Perdue to weigh the impact this legislation will have on people all across Georgia whose basic access to care hangs in the balance and to reject this harmful legislation.”
As this bill moves to the Senate, we call on Senators Isakson and Perdue to stand up for Georgia’s children, seniors, people with disabilities, pregnant women, families and those with pre-existing conditions who will pay a dangerous price if this ill-conceived bill becomes law. They should reject this bill and any bill that cuts coverage, reduces protections, and raises costs for Georgians.
We need you to #ProtectOurCare
We know how hard you all have worked over the last several weeks to defeat the AHCA. We want to thank you for your time and advocacy, but our work continues. It is imperative that Senator Isakson and Senator Perdue hear a swift and powerful message from their constituents–you! Call them today to tell them to reject the American Health Care Act.
Senator Isakson: 770-661-0999
Senator Perdue: 404-865-0087
Georgians for a Healthy Future’s Executive Director Cindy Zeldin attended the Spring Meeting of the National Association of Insurance Commissioners (NAIC) in her role as a consumer representative to the NAIC. At the meeting, a group of health-focused consumer representatives presented an overview of a new report authored by a diverse group of patient and consumer advocates highlighting the need to ensure that any changes to the health care system do no harm to consumers, minimize market disruption, and maintain common-sense consumer protections. The report, The Need for Continued Consumer Protections and Stability in State Insurance Markets in a Climate of Federal Uncertainty, conveys the perspective of consumer advocates on the need for continued access to high-quality health insurance products—regardless of whether and how changes are made at the federal level—and the likely impact that some proposed Affordable Care Act replacement policies will have on consumers and state insurance markets. The report discusses:
• What consumers want when it comes to private health insurance;
• The progress that has been made in reducing the uninsured rate since 2010 and the risks of full or partial repeal of the Affordable Care Act;
• Key principles—such as insuring the same number of consumers with the same quality of coverage and minimizing market disruption—that we urge policymakers to apply when considering further changes to the market; and
• Concerns about the impact of potential changes on consumers and state markets, with an emphasis on high-risk pools, continuous coverage requirements, high-deductible health insurance products, association health plans, the sale of insurance across state lines, the loss of essential health benefits protections, and the need for continued nondiscrimination protections.
An overview of the report was provided to state insurance commissioners during the NAIC/Consumer Liaison Committee meeting on Monday, April 10th during the National Association of Insurance Commissioners (NAIC) Spring 2017 National Meeting in Denver, Colorado. The authors of the report serve as appointed consumer representatives to the NAIC and members come from national organizations such as the American Cancer Society Cancer Action Network, the American Heart Association, Consumers Union, and the National Alliance on Mental Illness; state-based advocacy organizations such as the Colorado Consumer Health Initiative, Georgians for a Healthy Future, and the North Carolina Justice Center; and academic centers such as Georgetown University and Washington & Lee School of Law.
The full report is available here.