Tag: health insurance

Your health coverage, health care, and well-being during the COVID-19 pandemic

Updated: September 16, 2020

The Georgians for a Healthy Future team is continuing to monitor the COVID-19 (coronavirus) outbreak closely. As always, GHF strives to be a resource for Georgia consumers. While things continue to change quickly during this health care pandemic, we will share practical advice and actionable information to help you navigate a confusing time and find the answers you need. Here we present information about how to access health care services and what to expect from your health insurance coverage when you do. We will keep the corresponding blog post updated as things change and with links to helpful resources as they become available.


Georgia’s statewide shelter in place ended on April 30, 2020 for most Georgians. Vulnerable populations including those who are medically fragile and elderly should continue to shelter in place until June 12, 2020.

Governor Kemp also extended Georgia’s public health state of emergency through October 10, 2020. He also issued executive orders requiring businesses to operate by strict social distancing and sanitation rules through May 13, 2020. As of June 1, 2020 restaurants are still required to abide by 39 restrictions to open their dining rooms.

We encourage all of you to continue to help prevent the spread of the virus by taking the necessary steps to “flatten the curve” including staying home, avoiding group gatherings, washing your hands, practicing good hygiene, and following the guidance of public health experts.


If you are experiencing symptoms of COVID-19 or may need a test

If you believe that you are experiencing symptoms of COVID-19 or have been exposed to the novel coronavirus, call your primary care doctor or an urgent care clinic. Let them know you think you may have COVID-19, so they can take the proper precautions and direct you to available testing sites. You may also call the Georgia Department of Public Health on their COVID-19 hotline at 844-442-2681. Public health officials are urging people not show up unannounced at a doctor’s office, emergency room or other health care facility.

The Centers for Disease Control and Prevention have a Coronavirus Self-Checker which may be a helpful tool if you think you are experiencing symptoms of the virus.

You can find out more about COVID-19, its symptoms, what to do if you think you are sick, and other COVID-19 information at dph.georgia.gov/novelcoronavirus.

COVID-19 testing is available for all Georgians, regardless of whether you have coronavirus symptoms. Anyone can call their local health department to get scheduled for testing. They can also download the Augusta University ExpressCare app, visit augustahealth.org, or call (706) 721-1852.

Effective May 7, 2020, COVID-19 testing is available to all Georgians who request it, whether they have symptoms or not. Call your local health department to schedule an appointment at a location near you and to inquire if testing is free.


What to expect from your health insurance

If you have insurance, make sure to use it for any testing and medical exams related to COVID-19 and any other medical services you may need during this time.

The COVID-19 crisis has caused many Georgians to lose their jobs and also lose their employer-sponsored health care coverage. If you have lost your coverage or have had a drop in your income, you may be eligible for Medicaid or financial assistance to buy health insurance through the Affordable Care Act. Please read the If You Lose Your Job section below.

If you have Medicaid or PeachCare for Kids

If you and your family have lost your source of income in this crisis, or are in lower-income work with no health coverage, enrolling in Medicaid may be an option for you.

Medicaid provides all “medically-necessary” services to its members. During the national public health emergency period, your Medicaid coverage will cover the cost of a COVID-19 test.  If you are diagnosed with COVID-19 and need medical treatment, Medicaid should also cover those costs. 

Check with your Medicaid insurance company for more information and guidance. Click the name of your Medicaid company to find out more: AmerigroupCareSourcePeachState Health Plan, and WellCare.

If you need other health care services during this time, check with your Medicaid insurance company and doctor to see if you can have a “virtual appointment” using the internet, video call, or telephone call, instead of going in-person.

Georgia’s Department of Community Health (DCH) has announced that Medicaid & PeachCare members will not owe any co-payments for any health service from May 1, 2020 until the end of the national public health emergency.

No one can willingly lose their Medicaid coverage during the public health emergency. If you lose your Medicaid coverage during this time, contact your Medicaid insurance company.

If you have private insurance

If you have insurance through your job, the State Health Benefit Plan, or the Affordable Care Act marketplace (also called healthcare.gov), use it for any testing or medical exams related to COVID-19. The Families First Act requires that health plans and insurers cover testing for COVID-19 so your test should be free. If someone wants to charge you for a test, call the DPH’s COVID-19 hotline.

If you are diagnosed with COVID-19 and require medical treatment, you should expect to pay some out-of-pocket costs like your deductible.

As of March 21, 2020 Cigna, Humana, Aetna, and UnitedHealthcare have waived cost-sharing for COVID-19 treatment. Aetna and Cigna have pledged to waive COVID-19 treatment costs for qualified medical bills until June 1, 2020. Humana has not announced an end date to their COVID-19 cost-sharing policy.

If you purchased coverage outside of the ACA marketplace or you have a short-term plan or health-sharing ministry, call your insurance company to find out how they are covering COVID-19 testing and treatment. The cost-sharing requirement under the Families First Act does not apply to people who are enrolled in non-ACA compliant plans (ex: short-term plans).

If you need other health care services during this time, check with your insurance company and doctor to see if you can have a “virtual appointment” using the internet, a video call, or a telephone call instead of going in-person.

In order to ensure people affected by COVID-19 have access to health care Georgia’s Insurance Commissioner issued a directive on March 20, 2020, that instructed health insurers to refrain from canceling health policies due to non-payment. That directive expires on May 31st. If you are behind on your premium payments or expect to be, call your insurance company right away to see if they can offer a payment plan, financial assistance, or other help to keep you enrolled.

If you have Medicare

Medicare covers the lab tests for COVID-19. You pay no out-of-pocket costs. All necessary hospitalizations are also covered by Medicare, including hospitalizations for quarantine. More information about Medicare’s coverage and services is available here.

If you are uninsured
If you need a COVID-19 test, contact your local public health department to find a testing site and to ask whether the test will be free. Request that they waive any testing costs.

If you need other health care services during this time, find a local community clinic, or apply for financial assistance through a hospital charity care program. Georgians should not let their insurance status get in the way of getting needed testing or treatment.

If you lose your job

Many Georgians across the economy have lost their jobs and may be at risk of losing their coverage. If this is your situation, you can keep yourself and your family covered during this health crisis. You may be eligible for a Special Enrollment Period up to 60 days after losing your job-based health insurance. When you begin the enrollment process, healthcare.gov will ask you about your estimated income for 2020 and will let you know if you qualify for financial help to lower your premiums and other cost-sharing. 

For free help with the enrollment process, contact these organizations:

Coverage through the ACA marketplace (healthcare.gov) covers testing for COVID-19. It will also cover part or all of the costs related to COVID-19 treatment. Call your insurance company for more information.

If you are unable to enroll in a health insurance plan, you may have other options through services such as a community clinic, which can connect you with the care you need.


Resources for you and your loved ones

During this uncertain time, many of our partner organizations are doing the hard work of finding and centralizing the information that you and your loved ones may need. Here are a few that we think are most helpful. We will continue to update this list with actionable resources and information so you can stay healthy, safe, and well. 

  • COVID-19 guidance and information
    • Information from public health experts: Visit the Georgia Department of Public Health’s website for the latest guidance and updates about COVID-19 in Georgia.
    • Coronavirus resources for people who are not strong readers: Georgia State University has published a library coronavirus materials for people who may not have strong reading or literacy skills. They have included materials up to a 9th-grade reading level.
  • COVID-19 guidance and information for people who do not speak English as a first language
    • The GSU School of Public Health’s Prevention Research Center has compiled COVID-19 information sheets (from CDC & the International Rescue Committee) in 25 languages
  • Make sure your basic needs and finances are taken care of:
    • If you need help finding food:
    • Food Bank of Northeast Georgia: Visit www.foodbanknega.org, click “Need Help”. Call the office at (706) 354 8191
    • Atlanta Community Food Bank: Text the word FINDFOOD to 888-976-2232 with your ZIP code and street address and you will be sent a list of the three closest distribution centers.
      Text service also available in Spanish, using the word COMIDA
    • Georgia Mountain Food Bank: uses the same system as Atlanta Community Food Bank
    • Golden Harvest Food Bank Visit www.goldenharvest.org, click on ‘Find Help’ at the top of the page, you will be taken to a map where you can enter your zip code to find the nearest food distributor
    • Middle Georgia Community Food Bank–Call 211 and you will be connected with an associate who will be able to tell you where you can find food
    • Feeding the Valley Food Bank: Visit feedingthevalley.org, on the front page, enter your zip code into the ‘Need Food’ box and you will be shown the closest food pantries to your location
    • America’s Second Harvest of Coastal Georgia: Visit helpendhunger.org, select ‘Find Food’ on the homepage, you will be taken to a map where you can enter your zip code or county to be shown the nearest food distribution centers
    • Second Harvest of South Georgia: Visit feedingsga.org, select ‘Find Help’ in the ‘Learn’ section at the top of the page, you will be taken to a map where you can find the closest distributors to you


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Legislative Update: Crossover & COVID-19 edition 2020

A statement from Georgians for a Healthy Future regarding COVID-19


Like many of you, our team is monitoring the COVID-19 (coronavirus) outbreak closely. We hope you and your loved ones are healthy and well during these uncertain times. 

We are grateful for the actions of Georgia leaders to protect the health and safety of individuals and communities across the state. We encourage all of you to help prevent the spread of the virus by staying home, avoiding group gatherings, washing your hands, practicing good hygiene, and following the guidance of public health experts.

Unfortunately, this outbreak has exposed the many shortcomings of our nation’s health care system while reinforcing how important it is for all Georgians and people across the country to have access to health coverage and care. While our policymakers and health system leaders are acting quickly to expand Georgians’ pathways to testing, treatment, and care, many Georgians currently lack health care coverage or are at risk of losing it as a result of the virus. Georgia’s elected leaders should act immediately to close Georgia’s coverage gap and extend Medicaid coverage to all low-income Georgians. Closing the Medicaid coverage gap supports good health by ensuring that people confronting COVID-19 do not go untracked and untreated. This is one of several critical steps Georgia leaders should take to promote the health and economic security of all Georgians during this unprecedented health crisis.
 

We will continue to monitor the spread of COVID-19 and encourage state leadership to take effective action to provide access to health care for all Georgians. Thank you for your continued support.


Legislative Update: Week 9

Crossover Day brings action before suspension of legislative session

Last Thursday, March 12th was the 28th day of the Georgia legislative session, which is also referred to as Crossover Day. Crossover Day is the final day for a bill to cross from its chamber of origin to the opposite chamber to remain viable for this legislative session. The General Assembly finalized changes to the current state budget (FY2020) before suspending the legislative session on Friday, March 13th due to safety concerns about COVID-19. Lieutenant Governor Geoff Duncan and House Speaker David Ralston have committed to resuming the 2020 legislative session when public health concerns subside.
In the sections below, you will find a rundown of consumer health legislation and their statuses following Crossover Day. Those that “crossed over” remain viable and those that “did not cross over” are considered dead for this year. You can see a list of all the bills we’re tracking here

The General Assembly convened this morning for a one-day special session. They are expected to pass a resolution approving Governor Kemp’s declaration of a public health emergency. With this action, Governor Kemp will have additional power and authority to manage the state’s response to COVID-19.


Our priorities

Surprise billing legislation companion bills cross over

Companion bills were introduced in the House and Senate last month to ban surprise out-of-network medical billing (also called surprise billing) in emergency and non-emergency situations. SB 359 and HB 888, sponsored by Senator Hufstetler and Representative Hawkins respectively, both contain strong consumer protections and set a fair payment resolution process that takes consumers out of fights between insurers and health care providers. Both bills have crossed over from their chambers of origin to the opposite chamber. 


Legislation to extend postpartum Medicaid coverage crosses over

HB 1114, sponsored by Rep. Sharon Cooper, would allow new mothers to receive Medicaid coverage for six months after giving birth. Currently, pregnant women covered by Medicaid are covered only up to 60 days after their birth or miscarriage. Due to restrictive Medicaid eligibility requirements for Georgia parents and because Georgia has not expanded Medicaid to all low-income adults, many mothers who try to apply for Medicaid after the 60 days are ineligible and become uninsured. HB 1114 was approved by the House last Tuesday.


Crossover Day recap

HB 792: Amended FY 2020 Budget | SENT TO GOVERNOR
 

HB 792 makes adjustments to the state budget for the current fiscal year which runs through June 30, 2020. The “little budget” has passed both chambers of the General Assembly and has been sent to the Governor.
 



HB 793: FY 2021 Budget | CROSSED OVER
 

HB 793 is the budget document for the coming state fiscal year which will run from July 1, 2020 to June 30, 2021. For more information on the health care highlights in the proposed FY 2021 budget, read the Community HealthBehavioral Health, and Public Health budget overviews from the Georgia Budget & Policy Institute. 



HB 511: Rural transit bill | CROSSED OVER
 

HB 511, sponsored by Representative Kevin Tanner, would create a new division within the Georgia Department of Transportation (GDOT) that would, among other things, oversee rural transit programs including Medicaid’s non-emergency medical transportation (NEMT) services. The bill would divide the state (except for 13 metro-Atlanta counties) into eight regions in which counties could collaborate to raise revenue for and coordinate rural transit services. 
 



HB 544: Mental health emergency involuntary treatment | DID NOT CROSS OVER
 

HB 544, sponsored by Rep. Chuck Efstration, would make changes to how people in mental health or SUD crises can be committed to emergency involuntary treatment. This legislation could have negative consequences for people with substance use disorders who could be involuntarily committed to treatment under certain circumstances.
 


HB 719:  Effort to modernize HIV laws | CROSSED OVER
 

HB 719, sponsored by Rep. Deborah Silcox, would modernize Georgia’s HIV-related laws and make progress towards decriminalizing HIV. Current Georgia law deems it a felony for people living with HIV to have sex or donate blood without disclosing their status, or for spitting at or using bodily fluids on a law enforcement officer. Under HB 719 only the act of having sex without disclosing a person’s HIV status would remain illegal.
 


HB 731: | Tobacco tax increase | DID NOT CROSS OVER
 

HB 731, sponsored by Rep. Ron Stephens, would raise Georgia’s tobacco tax to $1.87 from its current level of $0.37.


HB 760: Mental health; peace officer authorization  | DID NOT CROSS OVER

HB 760, sponsored by Rep. Sharon Cooper, would give peace officers the authority to take a person to a physician or emergency department for emergency examination under certain circumstances.


HB 842: Gracie’s Law – organ transplant discrimination| CROSSED OVER

HB 842, sponsored by Rep. Rick Williams, would protect people with disabilities from being removed from organ donor waiting lists because of their disabilities.


HB 864: | Excise tax on vaping products | DID NOT CROSS OVER

HB 864, sponsored by Rep. Bonnie Rich would add a 7% excise tax to vaping products and would require businesses that sell vaping products to register with the state for a $250 fee. 



HB 918: Restricts onerous PBM audits of pharmacies | CROSSED OVER

HB 918, sponsored by Rep. Sharon Cooper, puts in place limits on the practices of PBMs within these audits so that pharmacies can more easily meet audit requests and the benefit of the doubt is given to pharmacies when small or innocuous mistakes are discovered.



HB 946: Increases accountability for PBMs | CROSSED OVER
 

HB 946, sponsored by Rep. Matt Knight, would increase fines on PBMs when they “steer” consumers to specific pharmacies and would prohibit PBMs from paying affiliated pharmacies more than independent ones. The bill would require PBMs to pass along rebates to insurers (who would presumably pass those savings on to consumers) and would ban programs called “co-pay accumulators.” Co-pay accumulators increase out-of-pocket costs for consumers who need prescription drugs, especially those with expensive medications and those with high deductibles and other cost-sharing.



HB 947: Examining the costs of PBMs in Medicaid | CROSSED OVER
 

HB 947, sponsored by Rep. Matt Knight, would require Georgia’s Department of Community Health to complete an independent study to find out if Georgia would save money by removing the current PBM structure from its Medicaid plans. If the estimated savings are more than $20 million annually, Georgia would eliminate PBMs from most of the state’s Medicaid plans.


HB 1079: Authorizes full Medicaid expansion through an 1115 waiver  | DID NOT CROSS OVER

HB 1079, sponsored by Rep. Kim Schofield, would allow the state to submit a new 1115 waiver that would expand Medicaid to all Georgians making less than 138% of the federal poverty line.


HB 1114: Extending postpartum Medicaid coverage | CROSSED OVER
 

HB 1114, sponsored by Rep. Sharon Cooper, would allow new mothers to receive Medicaid coverage for six months after giving birth. Currently, pregnant women covered by Medicaid are covered only up to 60 days after their birth or miscarriage. Due to restrictive Medicaid eligibility requirements for Georgia parents and because Georgia has not expanded Medicaid to all low-income adults, many mothers who try to apply for Medicaid after the 60 days are ineligible and become uninsured.
 


HB 1151: Network adequacy | DID NOT CROSS OVER

HB 1151, sponsored by Rep. Kim Schofield, would increase consumer access to health care by imposing quantitative standards on insurance companies’ provider networks. Georgia has the narrowest provider networks in the country, forcing people to pay more to find care outside of their insurance plan’s approved providers. Network adequacy standards would ensure that consumers can access a provider in their insurance  network for all covered benefits.


HB 1153: Short-term limited duration plans | DID NOT CROSS OVER


HB 1153, sponsored by Rep. Kim Schofield, would limit short-term health plans to 3 months and provide consumer protections like protections for people with pre-existing conditions.


HR 1280: Addressing childhood lead exposure | DID NOT CROSS OVER
 

HR 1280, introduced by Rep. Katie Dempsey, establishes a Joint Study Committee on Childhood Lead Exposure to address the issue of thousands of Georgia children under six years of age who were found to have lead poisoning, which is irreversible and can cause speech, language, and behavioral problems, lower IQ levels, and nervous system damage.

*Note: Because this is a resolution (rather than a bill), this resolution is still viable for passage and could be used to establish a House study committee.


SB 298: Raising age to purchase tobacco and vaping products| DID NOT CROSS OVER

SB 298, sponsored by Sen. Renee Unterman, would increase the age at which Georgians are allowed to purchase tobacco and vaping products to 21 years of age, among other things. 


SB 303: Georgia Right to Shop Act | CROSSED OVER

SB 303, sponsored by Senator Ben Watson, Chairman of the Senate Health & Human Services committee, would require that health insurers to put on their website an interactive feature that allows consumers to estimate their out of pocket costs for a particular health care service and compare quality metrics between providers, among other things. Insurers would also have to provide a phone number that consumers can call to get the same information. 



SB 313: Benchmarking for prescription drug prices | CROSSED OVER
 

SB 313, sponsored by Senator Dean Burke, had its second hearing in the Senate Insurance and Labor committee last Wednesday. This bill would update Georgia’s oversight of pharmacy benefit managers and add important consumer protections.



SB 348: Consumer Right to Access Act | DID NOT CROSS OVER

SB 348, sponsored by Senator Kirkpatrick, is aimed at addressing network adequacy. The bill includes similar language to SB 352 (below) and also directs Georgia’s Insurance Commissioner to set quantitative network adequacy standards to ensure Georgia consumers have adequate access to care within their insurance plans.


SB 352: Online provider directories | CROSSED OVER

SB 352, sponsored by Senator Burke, would allow consumers to see providers at in-network rates for their entire plan year, if the provider is listed as in-network at the time a person enrolls in their health plan. The providers included in a consumer’s insurance plan network changes regularly throughout the year and this bill would assure that the provider network advertised at the time of enrollment is the provider network they are able to access all year long.


GHF has you covered

Stay up-to-date with the legislative session

GHF will be monitoring legislative activity on a number of critical consumer health care topics. Along with our weekly legislative updates and timely analysis of bills, we have the tools you need to stay in touch with health policy under the Gold Dome.


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A statement from Georgians for a Healthy Future regarding COVID-19

Like many of you, our team is monitoring the COVID-19 (coronavirus) outbreak closely. We hope you and your loved ones are healthy and well during these uncertain times.

We are grateful for the actions of Georgia leaders to protect the health and safety of individuals and communities across the state. We encourage all of you to help prevent the spread of the virus by staying home, avoiding group gatherings, washing your hands, practicing good hygiene, and following the guidance of public health experts.

Unfortunately, this outbreak has exposed the many shortcomings of our nation’s health care system while reinforcing how important it is for all Georgians and people across the country to have access to health coverage and care. While our policymakers and health system leaders are acting quickly to expand Georgians’ pathways to testing, treatment, and care, many Georgians currently lack health care coverage or are at risk of losing it as a result of the virus. Georgia’s elected leaders should act immediately to close Georgia’s coverage gap and extend Medicaid coverage to all low-income Georgians. Closing the Medicaid coverage gap supports good health by ensuring that people confronting COVID-19 do not go untracked and untreated. This is one of several critical steps Georgia leaders should take to promote the health and economic security of all Georgians during this unprecedented health crisis.

We will continue to monitor the spread of COVID-19 and encourage state leadership to take effective action to provide access to health care for all Georgians. Thank you for your continued support.


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Legislative Update: House passes little budget & Senate to vote on surprise billing today

Legislative Update: Week 6

Legislative session has resumed

After more than a week-long break to consider the state budget, the Georgia General Assembly resumed its normal schedule last week. The House of Representatives approved the amended FY20 budget on Wednesday and continues its consideration of the FY2021 budget. Even as the budget takes center stage, health-related legislation is beginning to make progress in both the House and Senate. 

Today marks Day 17 (out of 40) of this year’s legislative session.


Senate vote expected today on surprise billing legislation

Senate committee approves legislation, House committee will reconsider surprise billing bill

Companion bills were introduced in the House and Senate last month to ban surprise out-of-network medical billing (also called surprise billing) in emergency and non-emergency situations. Last Tuesday the House Special Committee on Access to Quality Health Care heard testimony from insurers, advocates, and medical providers about the House legislation, HB 888. While the bill was narrowly passed by the committee that day, the House Rules committee has since sent the bill back (or “recommitted”) to the committee for further consideration.

The companion bill, SB 359, was approved on Wednesday by the Senate Health and Human Services committee. The Senate bill, sponsored by Sen. Chuck Hufstetler, includes changes that better protect consumers from receiving surprise bills from hospitals after emergency situations. (The bill already included physicians in emergency situations.) The Senate is expected to vote on SB 359 this morning, and if approved, the bill will move to the House for its consideration.


Amended FY20 budget passed by House

House makes sizeable changes to Gov. Kemp’s proposed budget

The House of Representatives voted on Wednesday to approve the amended FY2020 state budget, which ends June 30th of this year. The version passed by the House erases many of Governor Kemp’s proposed cuts including funding reduction to the Georgia Poison Center, Mercer and Morehouse Schools of Medicine and the Rural Health Systems Innovation Center at Mercer. Cuts to local county health departments across the state were reduced from $6.3 million to $3.7 million. 

The Department of Behavioral Health and Developmental Disabilities (DBHDD) saw $9 million in cuts restored in the areas of intensive family support services, adult crisis stabilization beds, behavioral health core services, and other areas. DBHDD will still see a net loss of $25.7 million under this budget, but that cut is down from $34.4 million.

You can see the changes made by the House in the FY20 Track Sheet. The Senate will now take up this year’s amended budget and the House will turn its attention to the FY2021 budget which takes effect July 1, 2020.


Vaping and organ transplant bills move forward

Bills to raise the age of purchase for tobacco & nicotine products approved by Senate committee

Multiple pieces of legislation were introduced this year that would change the way Georgia regulates tobacco, vaping devices and other nicotine products. SB 298, sponsored by Sen. Renee Unterman, would increase the age at which Georgians are allowed to purchase tobacco and vaping products to 21 years of age, among other things. The Senate Regulated Industries and Utilities committee approved SB 298 last week. The bill must now be passed by the Senate Rules committee in order to receive a vote by the full Senate. (For an overview of the bill, please read our Jan. 21st legislative update.)


Gracie’s Law passed by House Insurance committee

Gracie’s Law (HB 842), which would protect people with disabilities from being removed from organ donor waiting lists because of their disabilities, was approved by the House Insurance committee last week. Sponsored by Rep. Rick Williams, the bill is supported by The Arc of Georgia, the Georgia Council on Developmental Disabilities, and other disability advocacy organizations. The bill is expected to receive a vote by the full House of Representatives this week. (For more on this bill, please read our earlier legislative update.)


GHF has you covered

Stay up-to-date with the legislative session
 
GHF will be monitoring legislative activity on a number of critical consumer health care topics. Along with our weekly legislative updates and timely analysis of bills, we have the tools you need to stay in touch with health policy under the Gold Dome.


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Legislative Update: Transportation and movement on surprise billing

Legislative Update: Week 5

Legislative session resumes this week

After a brief pause last week due to budget disagreements the Georgia legislature will resume its normal schedule today, February 18th. Today is day 13 (out of 40) of this year’s legislative session. According to the legislature’s new calendar, Crossover Day (the day by which a bill has to be approved by at least one chamber in order to remain “alive” for this year) is scheduled for March 12th.


Surprise billing legislation set for committee vote

Senate and House action expected on surprise billing legislation this week

Last month, companion pieces of legislation were introduced in the House and Senate to ban surprise out-of-network medical billing (also called surprise billing) in emergency and non-emergency situations. SB 359 and HB 888, sponsored by Senator Hufstetler and Representative Hawkins respectively, both contain strong consumer protections and set a resolution process that allows insurers and health care providers to settle payment disputes while keeping consumers out of the middle.
 

The Senate Health and Human Services committee heard testimony from insurers, advocates, and medical providers at a hearing on SB 359 last Tuesday. GHF’s Executive Director testified on the bill saying, “the consumer protections in this bill are fair and reasonable. For these reasons, we support (SB 359) and hope to see its successful passage by both chambers during this session.”

HB 888 is scheduled to be heard in the House Special Committee on Access to Quality Health Care today at 2pm.

Call one or more of these committee leaders to ask for their support of SB 359 and HB 888: 

  • Sen. Ben Watson, Chairman of Senate HHS committee,
    404-656-7880
  • Sen. Dean Burke, Vice Chairman of Senate HHS committee, 404-656-0040
  • Rep. Mark Newton, Chairman of the House Special Committee, 404-656-0254
  • Rep. Sharon Cooper, Vice Chairman of the House Special Committee, 404-656-5069

If your state Senator or Representative is on either committee, please call them as well!


Prescription drug legislation heard by senate committee

SB 313: Pharmacy benefit managers, the middlemen for prescription drugs

SB 313, sponsored by Senator Dean Burke, had its second hearing in the Senate Insurance and Labor committee last Wednesday. This bill would update Georgia’s oversight of pharmacy benefit managers and add important consumer protections. Pharmacy benefit managers (PBMs) are companies that manage prescription drug benefits for health insurance companies and in that role are charged with negotiating lower costs for the company and consumers.

At Wednesday’s hearing, patients, doctors, pharmacists and representatives of pharmacy benefit managers offered detailed testimony on the bill. No further action was taken on the bill last week and it is unclear if the Senate Insurance committee will consider it again this week. GHF will continue to report on the bill through the legislative session. (We provided an overview of the bill in an earlier legislative update.)


Rural transit bill could bring changes to Medicaid transportation

Revisions to transit bill attract support from more stakeholders

Adequate transportation is important to the health of Georgians because in most cases people need to go to a location outside of their homes to receive health care. Without access to reliable, safe transportation, Georgians may be forced to skip health appointments and go without medication, or they may not be able to access other things (like healthy foods or good schools and jobs) that would help them stay healthy.

HB 511, sponsored by Representative Kevin Tanner, would create a new division within the Georgia Department of Transportation (GDOT) that would, among other things, oversee rural transit programs including Medicaid’s non-emergency medical transportation (NEMT) services. The bill would divide the state (except for 13 metro-Atlanta counties) into eight regions in which counties could collaborate to raise revenue for and coordinate rural transit services. The purpose of the proposed “mobility zones” is to eliminate restrictions on crossing county lines for health appointments and other services for seniors, low-income families, and other needy Georgians, and extend transportation services to those who do not have access to local transportation options.

Advocates for Georgia seniors supported earlier versions of the bill and recent revisions to the bill have earned the support of GDOT and Uber. HB 511 has not been scheduled for a hearing but GHF will report on the legislation as the session progresses.


GHF has you covered

Stay up-to-date with the legislative session
 

GHF will be monitoring legislative activity on a number of critical consumer health care topics. Along with our weekly legislative updates and timely analysis of bills, we have the tools you need to stay in touch with health policy under the Gold Dome.


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Legislative Update: Surprise billing, mental health, & Gracie’s law

Legislative Update: Week 4

Legislative session paused amid budget disagreements

The Georgia legislature voted to pause the official legislative calendar last week due to the difficult and sometimes contentious discussions over the state budget. Governor Kemp’s proposed budget cuts for the current and subsequent state budgets have left the legislature to the difficult tasks of finding savings where possible, making cuts to some services and programs, and debating how to bring in sufficient revenue. Speaker of the House David Ralston has instructed the House to hold only budget-related hearings this week. 

The legislature plans to officially reconvene next Tuesday, February 18th for day 13 of this year’s legislative session. According to the legislature’s new calendar, Crossover Day (the day by which a bill has to be approved by at least one chamber in order to remain “alive” for this year) is scheduled for March 12th.

Strong surprise billing legislation introduced

Surprise billing legislation would protect consumers in emergency & non-emergency situations

Last week companion legislation were introduced in the House and Senate to ban surprise out-of-network medical billing (also called surprise billing) in emergency and non-emergency situations. SB 359 and HB 888, sponsored by Senator Hufstetler and Representative Hawkins respectively, both contain strong consumer protections and set a fair payment resolution process that takes consumers out of fights between insurers and health care providers. If passed, these bills would protect 2.6 million Georgians from surprise medical bills.

SB 359 has been read and reffered to the Senate Health and Human Services committee. HB 888 is in House first readers and in the House Special Committee on Access to Quality Health Care.

Call one or more of these committee leaders to ask for their support of SB 359 and HB 888: 

  • Sen. Ben Watson, Chairman of Senate HHS committee,
    404-656-7880
  • Sen. Dean Burke, Vice Chairman of Senate HHS committee, 404-656-0040
  • Rep. Mark Newton, Chairman of the House Special Committee, 404-656-0254
  • Rep. Sharon Cooper, Vice Chairman of the House Special Committee, 404-656-5069

If your state Senator or Representative is on either committee, please call them as well!

House examines mental health and organ transplant issues

Involuntary commitment emerges as theme in mental health legisation

Two pieces of mental health legislation garnered attention from mental health advocates and legislators last week.

HB 544, sponsored by Rep. Chuck Efstration, would make changes to how people in mental health or SUD crises can be committed to emergency involuntary treatment. This legislation could have negative consequences for people with substance use disorders who could be involuntarily committed to treatment under certain circumstances. This bill sits in the House Judiciary committee but the discussions of this issue may instead be moved to a subcommittee of the Behavioral Health Innovation and Reform Commission.

HB 760, sponsored by Rep. Sharon Cooper, would give peace officers the authority to take a person to a physician or emergency department for emergency examination under certain circumstances. This legislation is not supported by mental health advocacy groups because it could lead to involuntary committal for people with mental health issues. The bill now sits in the House Public Safety and Homeland Security committee.

Gracie’s Law would protect organ transplant discrimination for Georgians with disabilities

Rep. Rick Williams has introduced HB 842, titled “Gracie’s Law.” According to the Georgia Council on Developmental Disabilities (GCDD), Gracie’s Law would protect patients with disabilities from being removed from the organ donor waiting list because of their disability. According to an article in GCDD’s Making a Difference magazine, “While the Americans with Disabilities Act (ADA) denies discrimination based on any disability, there is still a lack of federal enforcement,” prompting the need for state action on this issue. This bill has been referred to the House Insurance committee. You can read more about Gracie’s Law here (pg. 12-13).

Thank you!

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Health care heroes like you submitted 1,710 comments!

Before the legislative session began, Governor Kemp filed paperwork with health officials in the federal government to move forward with plans to change Medicaid and private insurance in Georgia. When health officials needed your input on the Medicaid plan, more than 1700 Georgians like you stepped up! 
 

We are incredibly grateful for your advocacy on behalf of Georgians and communities who would benefit from Medicaid expansion in Georgia. Thank you for speaking up for your friends, neighbors, and all Georgians! Now your comments become part of a powerful legal record that health officials must take into acocunt as they decide whether or not to approve Governor Kemp’s Medicaid plan.

Stay tuned! Health officials are still reviewing Governor Kemp’s planned changes for private insurance. When the time comes, we will ask you to speak up again by submitting a comment again! Here and at coverga.org, we will let you know what those changes mean for you and your loved ones and when you can comment.

GHF has you covered

Stay up-to-date with the legislative session
 

GHF will be monitoring legislative activity on a number of critical consumer health care topics. Along with our weekly legislative updates and timely analysis of bills, we have the tools you need to stay in touch with health policy under the Gold Dome.


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Honoring Dawn Alford, 2020 Linda Smith Lowe Health Advocacy awardee

Dawn Alford and the GCDD team at GHF’s 2017 Consumer Health Impact Awards

In 2019 Georgia’s health advocacy community lost several colleagues and friends. As we mourn those who passed, we strive to honor their lives by continuing to build the healthy, equitable future they each envisioned.

This year’s Linda Smith Lowe Health Advocacy Award will honor the work of one such Georgian. Dawn Alford is this year’s award recipient for her advocacy on behalf of Georgians with disabilities.

Dawn Alford was the Public Policy Director for the Georgia Council on Developmental Disabilities from 2013 until her unexpected passing in July 2019. In this role, Dawn led advocacy efforts to improve and protect access to quality health care, increase opportunities for accessible education, and to expand opportunities for people with disabilities to live full lives in their communities.

Dawn brought her own life experience to her work. As she educated legislators on important policy issues, she told stories about her health care, education, and family supports to illustrate the need and impact of policy change. She regularly led efforts to bring Georgians with disabilities to the state Capitol to do the same. Dawn’s ability to create change by leveraging the power of her own and others’ voices illustrates why GHF has chosen to recognize her as this year’s awardee.

Dawn’s former colleague and friend Eric Jacobson submitted her award nomination and reflected on Dawn’s legacy:

“It now only makes sense that we promote young people with disabilities to take her role and build upon it. While only 41 when she passed, she had begun developing a network of young people with disabilities who saw her as a mentor, coach and friend. She prepared them not only to become better advocates but to take leadership roles in the Disability Rights Movement.

She was an extraordinary advocate for people with disabilities who fought so that all Georgians with disabilities could live full and meaningful lives in the community.”

For her advocacy work on behalf of Georgians with disabilities, we are proud to honor Dawn Alford with the Linda Smith Lowe Health Advocacy Award.

We hope you will join us on January 14th as we recognize Dawn! RSVP here.


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The Georgia Access Plan: A Bad Deal for Consumers

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On November 4, 2019, Governor Brian Kemp released a draft plan that, if approved, would drastically undermine comprehensive coverage for the 417,000 consumers who now have comprehensive coverage through the marketplace. Federal law allows states to make changes to the Affordable Care Act (ACA) so long as a comparable number of Georgians have coverage that is at least as comprehensive and affordable as they would have under the ACA, and the changes do not increase the federal deficit. Even under the most forgiving interpretation of these guardrails, Governor Kemp’s proposal fails to meet the test.

Fortunately, there’s still time to fight back! The state is required to seek public comments on this plan and will be accepting comments until December 3, 2019. Comments can be submitted online at CoverGA.org, at in-person comment hearings. This is an opportunity for Georgians to tell state leaders how this plan will impact their health and finances, and the health and finances of their loved ones.

Instead of undermining the coverage that so many Georgians rely on, state leaders should focus on preserving critical consumer protections, strengthening comprehensive coverage, investing in outreach and enrollment to Georgia communities, and working to address the rising health care costs for low-and middle-income Georgians. 


Hannah, a Georgia mom who says “My family can’t survive without the ACA.”

Disrupts coverage for more than 400,000 Georgians with a privatized marketplace 

Governor Kemp’s proposal seeks to expand coverage to approximately 30,000 out of more than one million uninsured Georgians at the peril of those consumers currently enrolled in comprehensive coverage using a risky new program. 

At the center of his plan, Governor Kemp aims to decentralize how consumers currently enroll in individual market coverage in favor of private web brokers and insurers. This means that consumers would no longer have an unbiased place to compare plan options and instead would be forced to rely on private entities who would have the incentive to enroll consumers in plans that offered the highest commission and not necessarily the plan that best fits their health needs.

Likely result: Georgia consumers will struggle to navigate numerous websites, translate the sales lingo of insurers, and disentangle conflicting information. For many, it may be harder to find in a plan that they feel good about.


Limits financial assistance, increasing out-of-pocket costs

Along with dismantling healthcare.gov, Governor Kemp plans to restructure financial assistance in a way that would raise premium costs for comprehensive coverage and likely cause many Georgians to lose coverage altogether. Under his plan, consumers could use financial assistance to purchase skimpier coverage, like short-term plans, that don’t have to meet the ACA’s minimum standards. Additionally, his plan doesn’t address whether or not cost-sharing reductions would be required, which currently help to lower deductibles and other out-of-pocket costs for certain low-income consumers. As a result, Georgia consumers should expect to pay more out-of-pocket to get the care they need.

To make matters worse, because financial help is based on premiums for comprehensive coverage that will likely become more expensive under this plan, providing financial help to all eligible Georgians will cost more than what is currently budgeted. This means that some consumers who currently receive (or are eligible for) financial help would lose this valuable benefit.

Likely result: Premiums for comprehensive coverage will rise. At the same time, fewer Georgians will receive financial help to purchase coverage. Georgians will pay more out-of-pocket when they need health care.


Katherine, a Georgian with a pre-existing condition and ACA coverage

Weakens consumer protections

In order to allow private companies to run enrollment, the Governor’s plan seeks to eliminate crucial consumer protections. The protections that may be suspended include the requirement that insurance plans include enough doctors and hospitals so people can get care (called “network adequacy”); requirements about what information insurers must provide to consumers and how that information is presented; and mental health parity, which requires insurers to cover mental health services in a similar way as other health care. The Governor’s plan assumes these new skimpy plans will provide 90% of the benefits that comprehensive coverage under the ACA provides. There is no explanation or evidence to support this assumption.

Removing the requirement to cover the ten essential health benefits and mental health parity threatens access to critical services for many consumers with pre-existing conditions. For example, treatment and recovery services for people with substance use disorders would be threatened at a time when the state continues to struggle with opioid-related deaths and substance use disorders in general. These consumer protections enable people with mental illness and substance use disorders to obtain insurance that covers their conditions without bankrupting them. Without them, consumers will have to pay out-of-pocket for life-saving care, opening them up to thousands of dollars of medical debt.

Likely impact: Skimpy plans that do not offer basic health services like prescription drugs, maternity care, or mental health services will become commonplace. As a result, Georgians will have a harder time accessing needed care and will pay more out-of-pocket.


The bottom line is Governor Kemp’s plan is terrible for Georgians. Any rational analysis will find it doesn’t meet even the laxest requirements of federal law. Georgians should weigh in today to reject this plan!   


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Philip’s story: Rural Georgians continue to struggle without health coverage

Philip is a 57 year old part-time roofer who resides in Fort Gaines, Georgia, a rural community in the southwest region of the state.

Philip suffered a knee injury along with a herniated disc in his back while repairing a roof. Because he is uninsured he has been repeatedly refused medical care because of his inability to pay. Despite making financial sacrifices to see several doctors and specialists, he has been unable to receive adequate help and get the treatment he needs. Philip says that if he had health coverage he would find the right specialist, get an MRI, and have his back fixed so he would no longer be in severe pain every day.

For the time being, Philip is able to see Dr. Karen Kinsell, the last practicing physician in Clay County. Dr. Kinsell is a volunteer physician who provides medical care to approximately 3,000 patients in a small office building that once served as a Tastee Freeze stand. Dr. Kinsell has advised Philip to stop roofing in order to ease the pain in his back but roofing is currently his family’s only income and Philip says there are no other viable job options for him in the area.

Philip believes access to health care is important and that significant changes need to be made so more people can access care. “Fix the issue, fix the problem, health insurance isn’t affordable for low-income people trying to work. Help us.”

Like Philip, 360,000 low-income Georgians, many of whom are uninsured, live in small towns and rural areas across the state. These areas have the most at stake in the debate over whether or not to close Georgia’s health insurance coverage gap. For rural Georgia residents like Philip, health coverage would open doors to the physicians and other health services that they need to stay employed or get back to work. For rural communities like Fort Gaines, more residents with health coverage could attract another primary care physician to the area.

Right now, Georgia’s policy makers are drafting two health care “waivers”. One of the waivers could be used to extend coverage to all low-income adults, including Philip and his southwest Georgia neighbors. Or state leaders could continue to ignore the needs of low-income, rural Georgians with a more limited plan.

The details of these waivers will be announced in the coming weeks and state leaders must offer online and in-person opportunities to hear public feedback. GHF will keep you up-to-date about what the waivers will mean for Georgians like you and Philip, and help you weigh in during the public comment periods!


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 why it’s important.

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!


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How marketplace health coverage keeps activist Saifa going

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.


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