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

Legislation that could impact Medicaid and PeachCare beneficiaries

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

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

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

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

Legislation impacting health insurance consumer protections and access to insurance

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

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

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

The Commission on Mandated Health Benefits, created through legislation passed in 2011 to advise the governor and the General Assembly on the social and financial impact of current and proposed mandated benefits and providers, held its first meeting on March 12th. The meeting was largely an organizational one, but members also discussed how the commission’s work might intersect with aspects of the Affordable Care Act such as essential health benefits and the bills before the General Assembly that would require insurance companies to cover autism, child hearing aids, and medical foods. The next meeting date has not yet been announced.  To read the minutes from the March 12th meeting, click here.

An analysis conducted by Dr. Bill Custer of Georgia State University and released today by the Healthcare Georgia Foundation finds that, if Georgia policymakers choose to accept the $40.5 billion in federal funds available to the state between 2014 and 2023 to expand Medicaid, this infusion of resources would create more jobs in Pensacola FL and 70,000 jobs countrywide, adding an annual $8.2 billion to statewide economic output and generating $276 million in state and local tax revenue annually.

As part of the Affordable Care Act, states can create a new eligibility category for Medicaid for people with incomes up to 138 percent of the federal poverty level, or approximately $15,850 for an individual or $26,950 for a family of three. In Georgia, according to the report, about 694,000 people would gain health coverage under this expansion, mostly childless adults and some parents.

To date, Governor Deal has rejected the offer to expand coverage citing concerns about the cost to the state.  As this new report details, however, expanding Medicaid would be an economic engine for Georgia. Of the more than 70,000 jobs that would be created, just over half would be in the health care sector; however, other industries such as real estate, food services, and wholesale trade businesses would also gain jobs. The report also shows the geographic distribution of jobs created throughout Georgia by state service delivery region. To read the full report, click here.

Each year, Georgians for a Healthy Future develops policy priorities that guide our advocacy work on behalf of health care consumers. Below are the legislative and policy priorities we are supporting in 2013.

Extend health insurance coverage to a substantial portion of Georgia’s uninsured by expanding Medicaid. Approximately 1.9 million Georgians are uninsured, many of whom are low-income working adults without access to an employer-sponsored health plan. An estimated 650,000 of these Georgians could gain health insurance coverage in 2014 at minimal state cost by extending Medicaid to those newly eligible through the Affordable Care Act. The infusion of federal Medicaid dollars into Georgia will both support our state’s health care delivery system and foster economic growth. Georgians for a Healthy Future supports expanding coverage through Medicaid to individuals and families with incomes up to 133 percent of the federal poverty level.

Preserve and strengthen consumer protections for Georgians in private health insurance plans through both federal and state advocacy. The private health insurance marketplace is rapidly evolving, largely as a result of changes spurred by the Affordable Care Act. As these reforms are implemented, it is critical that the consumer perspective is represented in the policy-making process and that rules and regulations incorporate consumer needs. Many of the decisions that would impact health care consumers are currently being made by the U.S. Department of Health and Human Services and the National Association of Insurance Commissioners. To that end, Georgians for a Healthy Future will monitor and advocate on behalf of Georgia consumers on issues including the development of a federal health insurance exchange, essential health benefits, and other private market reforms. At the same time, Georgia policymakers retain authority over many aspects of our state’s health insurance marketplace. Georgians for a Healthy future will continue to support efforts that preserve and strengthen patient and consumer protections and oppose state legislation that places these protections at risk.

Ensure access to quality health care for Medicaid and PeachCare beneficiaries. The Medicaid and PeachCare for Kids programs provide health insurance for our state’s most vulnerable citizens. Georgians for a Healthy Future will monitor legislative and agency level activity and support proposals that facilitate continuous coverage and enrollment, preserve and expand access to care, and improve health outcomes. Because ensuring access to quality care for Medicaid and PeachCare beneficiaries also requires a Medicaid system that is financially sound, Georgians for a Healthy Future will support proposals that ensure the program is adequately funded and will oppose cuts to the program, including cuts to provider reimbursement rates, which jeopardize access to care. We will also continue to monitor the Georgia Department of Community Health’s Medicaid redesign process.

Strengthen Georgia’s public health system. Our state’s public health system plays a critical role by vaccinating children, monitoring and preventing epidemics, ensuring safe food and water, and providing both clinical and community-based preventive services. Despite an increasing need for these services and a growing awareness of the importance of social determinants to community health outcomes, Georgia’s per capita public health spending is among the lowest in the nation. Georgians for a Healthy Future supports a robust, adequately funded public health system to meet the needs of our state.

Increase the tobacco tax. The current funding environment demands evidence-based policy solutions that both advance the health of our state and generate needed revenue. In recent years, even the most basic, vital, and cost-effective programs have been subject to deep budget cuts. Georgians for a Healthy Future opposes further cuts to these vital programs and supports budget solutions such as a substantial increase in the state’s tobacco tax of at least a dollar per pack. Tobacco taxes are a proven strategy with the dual benefit of bringing in additional state revenue and improving the health of Georgians by reducing adult and youth smoking.

Support policies and practices that advance health equity. In addition to overall health outcomes and indicators that consistently place Georgia in the bottom tier nationally, our state has considerable health disparities between communities. Racial and ethnic minority communities, rural and low-income urban communities, and those with disabilities and chronic mental illness, all experience worse health and worse opportunities for health than their peers. Georgians for a Healthy Future will continue to support policies and practices that advance the opportunities for optimal health for all Georgians.

Georgians for a Healthy Future is spearheading Cover Georgia, a new coalition in support of expanding Medicaid in our state to cover the uninsured.  As part of this on-going effort, we will explore what is at stake for Georgia families and consumers as policymakers weigh this option in the coming months.

In 2014, Georgia consumers with incomes between 100% and 400% of the federal poverty level (FPL), or roughly between $11,170 and $44,680 for an individual, will be eligible for tax credits to purchase health insurance through the new federally facilitated health insurance exchange. Adults with incomes below 100% FPL, however, will not be eligible for these tax credits. This is because the Affordable Care Act envisions individuals with incomes this low becoming eligible for Medicaid through an expansion of that program.

If Georgia fails to adopt this expansion, this would create a “coverage gap,” leaving many Georgians with no options for affordable health coverage. This infographic helps explain how this would play out for two Georgians: Jan would make too much money to be eligible for Medicaid but would not make enough to access tax credits to purchase affordable private health insurance (a typical health insurance policy would consume nearly her entire income).  Meanwhile, John would be able to purchase insurance in the exchange with a tax credit, making health insurance reasonable for his budget.  This is simply not fair. All Georgians should have a pathway to affordable health care coverage. To learn more about Cover Georgia and to join our efforts, click here.

Georgians for a Healthy Future’s Executive Director Cindy Zeldin was named a consumer representative to the National Association of Insurance Commissioners (NAIC) again for 2013. The program provides a structured way for health care consumer and patient advocates from around the country to provide input from the consumer perspective. Having representation from Georgia’s health advocacy community in this program helps to ensure the voices of health care consumers in Georgia are heard as important decisions about health insurance and consumer protections are made.

Through the NAIC, state insurance regulators establish standards and best practices, conduct peer review, and coordinate their regulatory oversight. The work of the NAIC is particularly timely and important this year because they are developing model rules and regulations for implementation of the private health insurance reforms associated with the Affordable Care Act. To that end, earlier this year the NAIC consumer representatives collaboratively released “Implementing the Affordable Care Act’s Insurance Reforms: Consumer Recommendations for Regulators and Lawmakers,” available for download here. To view the NAIC press release announcing the 2013 consumer representatives, click here.

Approximately 1.9 million Georgians are uninsured, among the highest in the nation. Our new interactive resource, Mapping Georgia’s Uninsured, visually displays detailed information on Georgia’s uninsured population by age, income, and region. Click on the shaded regions within each map to see the total number of uninsured by age and income, uninsured rate, and the number of Georgians who would be eligible for Medicaid within each region if Georgia policymakers chose to expand the program. This mapping resource is part of our Cover Georgia initiative to educate policymakers and the public about Georgia’s uninsured, the benefits of coverage, and the opportunity the Medicaid expansion presents for Georgia patients, consumers, providers, and the state’s economy. To view the interactive maps, click here.

As part of the Affordable Care Act, beginning in 2014 all new individual and small group health insurance plans must cover a core set of health care services and items across ten broad categories including hospitalization, prescription drugs, maternity and newborn care, and preventive services, among others. This core set of services and items is known as Essential Health Benefits.

The benefits that health plans are currently required to cover vary by state. To ease the transition to essential health benefits in 2014, the U.S. Department of Health and Human Services (HHS) set out a process for each state to select a benchmark health insurance plan (which would include all benefits currently mandated in that state) that would then be supplemented to fill in any gaps and ensure health benefits across all ten categories are covered.

Last week, HHS issued a proposed rule outlining each state’s benchmark plan.  HHS is accepting public comment on all states’ proposed benchmark plans, including Georgia’s benchmark, until December 26th, 2012 (instructions for how to comment are included within the proposed rule). You can view the proposed benchmark plan for Georgia here. For additional information about the Essential Health Benefits process, see a recent Health Affairs article here. For additional information through a Georgia lens, see a recent Georgia Health News story on Essential Health Benefits here.

This afternoon, Governor Deal announced that Georgia would not move forward with a state-based health insurance exchange. Instead, Georgia will have, by default, a federally facilitated exchange. While a state-based exchange would have been more easily tailored for Georgia and could have been more responsive to the needs of Georgia’s health care consumers, a federally facilitated exchange will still provide information, decision tools, and access to tax credits to help consumers find and purchase meaningful and affordable health insurance.

As the federal exchange gets built out, it will be important that federal officials consider the needs of consumers in states like Georgia. To that end, earlier this week Georgians for a Healthy Future joined with consumer advocates in states across the country to submit a letter to the U.S. Department of Health and Human Services recommending that federal officials create a robust stakeholder planning process, ensure in-person consumer assistance programs meet consumers’ needs, and ensure that qualified health plans available on the exchange protect consumers and meet their needs. You can learn more about health insurance exchanges in Georgia by visiting Georgians for a Healthy Future’s health insurance exchange resource page here. We look forward to working with policymakers to ensure that the federally facilitated exchange is successful in Georgia and that consumers have better access to meaningful and comprehensive health coverage for themselves and their families.

Georgians for a Healthy Future is excited to announce that Jonathan Cohn of The New Republic will be the keynote speaker for our third annual Health Care Unscrambled policy breakfast on January 10, 2013! We hope you’ll join us for this important event that brings together health care consumer advocates, stakeholders, and policymakers for a look ahead to the biggest health policy issues facing Georgia in the coming year. Jonathan’s full bio is below.

Jonathan Cohn covers domestic policy and politics for The New Republic, with a particular emphasis on social welfare, labor, and health care. He is also the author of Sick: The Untold Story of America’s Health Care Crisis—and the People Who Pay the Price.

Jonathan has been recognized in the pages of the Washington Post as “one of the nation’s leading experts on health care policy” and in the New York Times as “one of the best health care writers out there.” An item from Time suggested he “may be the smartest, most well-sourced health care writer in the country.”

Jonathan has won the Sidney Hillman and Harry Chapin media awards. He has also been a finalist for the Robert F. Kennedy Book Award, the New York Public Library’s Helen Bernstein Book Award, and the Livingston Award for Young Journalists. Jonathan, who is presently a member of the National Academy of Social Insurance, has been a senior fellow with Demos, a media fellow with the Kaiser Family Foundation, and a Griffith Leadership fellow at the University of Michigan. He is a frequent public speaker and radio/television analyst.

Jonathan grew up in South Florida, where he became a devoted fan of the Miami Dolphins, and graduated from Harvard University, where he became a devoted fan of the Boston Red Sox. But his biggest devotion is to his wife and two children, with whom he lives in Ann Arbor, Michigan.