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New federal fix expands the number of Georgia families who qualify for affordable health coverage

Thanks to a move by the Biden administration, 206,000 more Georgia families will qualify for financial help to purchase health insurance under the Affordable Care Act (also called Obamacare). The “family glitch” has plagued working families whose jobs offer affordable coverage for the worker but not for their family members. With the new federal fix, the family glitch will no longer stand between Georgia’s working families and the affordable health coverage and care they deserve.

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GHF participates in visit from U.S. Department of Health and Human Services Secretary Becerra

By: Knetta Adkins

A group of adults standing together wearing masks in front of a sign at Southside Medical Center. They are a mix of Black, White, Latino, and other races.
HHS Secretary Xavier Becerra at Southside Medical Center, Atlanta, GA.

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. 

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Georgia’s health care transportation crisis: James and Lamar County

3 photos of James being active in his community

Having access to transportation is crucial to having access to health care. Each year millions of Americans miss or delay health care because they do not have a way to get there.

Medicaid’s non-emergency medical transportation (NEMT) program helps bridge the gap between home and the doctor’s office for individuals who are covered by Medicaid. In 2018, 396,000 Georgians got to their health visits using the free NEMT benefit.

In partnership with The Arc Georgia and the Georgians in the Driver’s Seat initiative, Georgians for a Healthy Future (GHF) staff have spoken with consumers around the state about their transportation needs and the NEMT program.

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Legislative Update: Insurers weaken consumer protections, bills on tobacco & vaping, telehealth, and more move forward!

Legislative update: Week 10

We are dismayed and saddened over the acts of racism and violence that took place in Atlanta last week. We stand in solidarity with Georgia’s Asian Americans and Pacific Islander (AAPI) community in this difficult time. If you are in a position to help, we hope that you will donate, volunteer, or otherwise support our partner organizations who are focused on dealing with the aftermath of this tragedy. You can take action here:

In this week’s update:
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Legislative Update: Action alerts on lead exposure & prior authorization bills, plus hot housing legislation to watch!

Legislative Update: Week 6

The GHF team prides itself on being able deliver timely and accurate updates on health care happenings at the Capitol. We hope that you enjoy reading our weekly legislative updates and that they help you stay informed and connected. If you enjoy them, please consider supporting our work with a donation today. Thank you for your continued support!
In this week’s update:
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Legislative Update: House finishes little budget, take action for HIV/AIDs, plus new legislation

Legislative update: Week 3

The GHF team loves bringing you these weekly legislative updates, and you have told us that you enjoy reading them! Our team works hard to deliver this service to you in a complete and accurate way every week of Georgia’s legislative session. If you rely on these updates to keep you connected to the health happenings under the Gold Dome, please consider supporting our work with a donation today. Thank you very much!

In this week’s update:

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Sign up for 2021 health coverage before Dec. 15th!

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:


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

Updated: December 18, 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 January 08, 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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