Tag: Medicaid expansion

Legislative Update: Medicaid coverage for new moms, tobacco tax increase, & action on state budget

Legislative Update: Week 11

Final days of 2020 legislative session set as General Assembly debates budget cuts

Last week legislators returned to the Capitol to complete their work on the FY 2021 state budget and address key legislative priorities. On Friday, the Georgia Senate passed a state budget that cuts $2.6 billion in spending during the upcoming year. This budget includes deep cuts to K-12 education and to critical health care programs, which we have detailed below along with next steps in the budget process.

On Saturday, the General Assembly set the calendar for the remainder of the legislative session. Both chambers will convene every day this week and plan to conclude their 2020 business this Friday, June 26th, likely late in the evening.

Don’t miss the bevy of action alerts in this week’s email. Scroll down for actions you can take to make improve Medicaid coverage for new mothers, increase Georgia’s tobacco tax, and protect Georgia’s budget from drastic cuts.


Surprise Billing Legislation Unanimously Approved By Senate

Surprise billing legislation heads to Governor’s desk

Last week, the Georgia Senate unanimously approved the Surprise Billing Consumer Protection Act (House Bill 888), bringing Georgia one step away from ending onerous surprise medical bills. HB 888 now heads to Governor Kemp’s desk for his signature. The Governor is expected to sign the bill as he pointed to this issue as a high priority during his January State of the State address.

This bill will mark a huge win for Georgians as it will ban surprise billing in emergency and non-emergency situations beginning January 1, 2021. This success comes after years-long debate among Georgia legislators. Georgians for a Healthy Future and Georgia Watch are pleased to work closely with the Governor and Lieutenant Governor’s offices, Chairman Richard Smith, Senator Hufstetler, and Representative Lee Hawkins to finally bring a resolution to Georgia consumers.  Please call these leaders and thank them for their support and dedication to this issue:

  • Gov. Brian Kemp: 404-656-1776
  • Lt. Gov. Geoff Duncan: 404-656-5030
  • Senator Chuck Hufstetler: 404-656-0034
  • Chairman Richard Smith: 404-656-5141
  • Representative Lee Hawkins: 404-656-7855

Legislation to Extend Postpartum Medicaid Coverage Moves Ahead

Postpartum Medicaid coverage bill heads to Senate floor today

HB 1114, sponsored by Rep. Sharon Cooper, would allow new mothers to receive Medicaid coverage for six months after giving birth. After unanimous approval in the Senate Health and Human Services committee last week, this legislation heads to the Senate floor for a vote today. 

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.

Action alert: Contact your state senator now and encourage their support for the passage and funding of this important piece of legislation! The Senate will convene at noon and a vote on HB 1114 is expected soon after.


 Progress on Tobacco Tax Increase

Resolution to increase tobacco tax moves ahead in Senate

On Friday, the Senate Finance Committee approved SR 435, sponsored by Senator Randy Robertson, aimed at increasing the tobacco tax rate from 37 cents to $1.35 per pack. We thank the members of the Senate Finance Committee for their quick action to find and approve new revenue to improve health in Georgia. Raising Georgia’s tobacco tax could bring in as much as $600 million annually and help to lower smoking rates among youth and adults.

Action alert

  1. Please contact members of the Senate Rules Committee and ask them to approve the bill for a vote on the Senate floor.
  2. Call or email your state senator today and encourage their support for this important piece of legislation!


Georgia Senate Passes State Budger that Includes Deep Cuts

Key health programs see cuts of $250 million

Last Thursday, the Senate passed its version of the FY2021 budget, which will begin July 1, 2020. The budget includes deep cuts to many state agencies, including 12 furlough days for staff and hiring freezes. The Georgia Budget & Policy Institute provides a fuller picture of the budget cuts here. State agencies and programs that directly impact the health of Georgians were not spared in the budget cuts:  

  • Department of Behavioral Health & Developmental Disabilities would see a cut of $122 million total, with the biggest cuts focused on services for adults with developmental disabilities, child and adolescent mental health services, (including prevention programs and supported education services), housing vouchers for people with mental illnesses and other adult mental health services, and adult substance use recovery services.
  • Department of Public Health would see a cut of $27.4 million total. More than half of that cut ($13.9 million) would come from a reduction in grants to local health departments and another $4.9 million would be cut from health promotion funds.
  • Department of Human Services (which includes the Dept. of Family & Children Services, Division of Aging Services, and other agencies serving vulnerable populations) would see a cut of $100 million. The funding cut would require 50 Dept. of Family & Children Services office to close and consolidate, exacerbating the limited access of families to food assistance, cash assistance for families with children, and other social services. 
  • Georgia’s Medicaid agency, the Department of Community Health, was able to offset $205 million in cuts because the federal government has increased its support of the Medicaid and PeachCare programs as part of the federal coronavirus relief packages, although some cuts were still made in the DCH budget.

 The budget is now being considered by a conference committee made up of members from both the House and Senate. Please contact these conference committee members to let them know that they can avert these steep budget cuts by considering new revenue options. Several common sense proposals (Increasing Georgia’s tobacco tax, expanding Medicaid, reclaiming the health insurance assessmentamong other options) could increase revenue without impacting the amount of taxes paid by the vast majority of Georgia families. Contact the budget conference committee members today!

  • Senator Mike Dugan: 404-656-7872
  • Senator Blake Tillery: 404-656-0089
  • Senate Butch Miller: 404-656-6578
  • Representative Terry England: 404-463-2247
  • Representative Jon Burns: 404-656-5052
  • Representative Jan Jones: 404-656-5072

Pharmacy Benefit Manager Legislation Keeps Moving

Two bills to reform PBM practices in Georgia move forward 

Georgia’s House and Senate continued their efforts last week to better regulate how pharmacy benefit managers operate in Georgia. Pharmacy benefit managers (commonly called PBMs) are companies that manage prescription drug benefits for health insurance companies. After presenting a revised version of SB 313, Senator Dean Burke’s bill was approved by the House Special Committee on Access to Quality Health Care. The revised version requires that PBMs count third-party financial assistance or coupons towards a consumer’s out-of-pocket costs when the medicine is a brand-name that 1) does not have a generic or 2) a patient obtained the prescription through step-therapy, prior authorization, or their health insurance plan’s appeals process. This protection will benefit many Georgians with expensive prescriptions. GHF will detail the other revisions included in SB 313 in future email updates.

Additionally, Rep. Knight’s HB 946 was approved by the Senate Insurance & Labor Committee on Friday and was passed by the full Senate today. The bill will return to the House for an “agree” to the bill’s amendments before it heads to the Governor’s desk.
 

(For an overview of both bills in their original forms, please read our March 2nd legislative update.)


GHF has you covered

Stay up-to-date with the legislative session and COVID-19
 

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.

GHF is dedicated to helping you understand and navigate the effects of the COVID-19 pandemic. We have the information you need to stay up-to-date with the latest developments.





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Legislative Update: Surprise billing moves ahead, budget cuts, & Georgia Can’t Wait!

Legislative Update: Week 10

The 2020 legislative session has resumed

Yesterday Georgia’s General Assembly resumed the 2020 legislative session after being suspended in March due to safety concerns over COVID-19. Legislators returned to the Capitol on Monday to pick up their work on the state budget and key pieces of legislation. The last ten days of legislative session will be dedicated primarily to the FY 2021 state budget to which Governor Kemp has proposed 11% cuts. Read the State Budget Cuts Are Not Inevitable section below to find out how you can take action for a state budget that supports the health and wellness of Georgians.


Senate committee approves surprise billing legislation

Critical surprise billing legislation heads toward finish line

Earlier this year, companion bills (SB 359 and HB 888) 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. In a rare Sunday meeting, HB 888 was approved by the Senate Health & Human Services Committee. The Senate Rules Committee acted quickly today and approved the bill for a vote on the Senate floor tomorrow, Wednesday, June 17th. Please call your state senator today and encourage their support for this important piece of legislation!


New revenue can improve health in Georgia

State budget cuts are not inevitable

Because of the economic slow-down caused by COVID-19, Georgia’s revenues from sales taxes and other sources have dropped substantially. This has prompted the Governor to call for an 11% cut in state spending. Deep cuts to already-skeletal services and programs will disproportionately harm communities of color and rural communities, weaken Georgia’s health care system as it continues to respond to the pandemic, and curb the state’s ability to recover economically. GHF was one of 37 groups to send a letter to Governor Kemp and state lawmakers last week calling on them to raise new revenues rather than slash spending. New sources of revenue that can also improve health for Georgians include: 

  • Raising Georgia’s tobacco tax — an increase of $1 per pack would bring in $400 million each year and reduce smoking rates in Georgia
  • Expanding Medicaid— in addition to providing health coverage to 500,000 Georgians, Georgia would draw down $3 billion in federal funds each year
  • Re-claiming the health insurance assessment—by collecting the revenue from this existing tax, Georgia could bring in $360 million each year to make health insurance more affordable for consumers and small businesses

Ask Governor Kemp and your state lawmakers today to avert budget cuts and improve health in Georgia by raising state revenue!  


Georgia Can’t Wait!

Thank you for a successful Virtual Day of Action!

GHF and Cover Georgia welcomed legislators back on to work yesterday by urging them to take action to expand Medicaid. During yesterday’s virtual Day of Action, participants like you sent 500 messages to Governor Kemp and your legislators encouraging them to act immediately to protect the health and financial well-being of 560,000 Georgians by closing Georgia’s coverage gap! Thank you for your advocacy!

If you didn’t get a chance to contact your lawmakers yesterday, call or email today and ask them to act now to close Georgia’s coverage gap!


GHF has you covered

Stay up-to-date with the legislative session and COVID-19

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.

GHF is dedicated to helping you understand and navigate the effects of the COVID-19 pandemic. We have the information you need to stay up-to-date with the latest developments.


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Four ways to celebrate Medicaid Awareness Month with GHF!

April is Medicaid Awareness Month!

Four ways to celebrate Medicaid Awareness Month with GHF

April is Medicaid Awareness Month and GHF is celebrating!

Medicaid covers half of Georgia kids, half of births in the state, and three out of four Georgians in long-term care (like nursing homes). Without Medicaid, low-income Georgia families would have almost no way to enroll in health coverage. Now, Medicaid is proving even more important to Georgia’s health as our state battles the coronavirus. Medicaid is expanding the number of providers available to treat Georgians during the pandemic and keeping Georgians covered when they may have lost their coverage otherwise.

GHF is celebrating Medicaid Awareness Month and we want you to join us! Here are four ways you can celebrate:


Medicaid as Part of the COVID-19 Response

Medicaid is meant for this moment

Medicaid is key to Georgia’s COVID-19 response efforts. Not only is it providing coverage for 2 million Georgians in the midst of this pandemic, but Medicaid is also one of the fastest ways for the federal government to send money to Georgia and health care providers struggling to meet the needs of Georgia patients and families. Medicaid’s flexibility has allowed more doctors and other providers to step up and make themselves available to treat Georgians with and without COVID-19. Medicaid’s flexibility has also allowed new mothers, children, and many other Georgians to keep their coverage for the duration of the public health emergency when otherwise they may have lost it.

Our partners at Voices for Georgia’s Children are tracking the ways that Medicaid is meeting this moment for Georgians. Check out their weekly tracking sheet to keep up! 

Even as Medicaid is helping Georgia respond to COVID-19, it could be doing even more! Before the pandemic, an estimated 500,000 low-income Georgians were uninsured because Georgia has not expanded Medicaid to provide them with health insurance. One million Georgians lost their jobs in the last month, so that number is surely higher now. Governor Kemp and Georgia’s state legislators can easily provide these Georgians with the same health benefits that are available to people in similar situations in 37 other states. Tell Governor Kemp and state legislators to expand Medicaid now.


Need information about Georgia Medicaid? GHF has you covered!

As thousands of Georgians lose their jobs each week, many are also losing their health coverage. Some may qualify for Medicaid as a result. If you, your loved ones, or your patients or clients need information about how to qualify, enroll, and use Medicaid, GHF has the information and resources to get you started:

  • Affordable Health Care for Your Children: This fact sheet is written for parents and provides information about the coverage options available to their children.
  • For Uninsured Parents: Because parents need health care too, this fact sheet helps parents understand how they can access health care services or find coverage. (The information is also applicable to any uninsured adult.)
  • Medicaid in Georgia: Part of GHF’s Get Enrolled. Stay Enrolled toolkit, this fact sheet is meant for individuals and families who may be eligible for Medicaid. It tells you how to apply, what happens after you apply, how to find a doctor, and what health services are covered by Medicaid.
  • Medicaid Income Guidelines for Parents, Caregivers, and Kids: Developed for social workers, nurses, counselors, and other professionals who help people meet their basic needs, this fact sheet lays out the income eligibility guidelines for Medicaid for Georgia children and parent/caregivers. Find out if your patients and clients may qualify for coverage.

Medicaid Matters: Coverage saves lives

Queenesther is the mother of five children living in Albany, GA. She and her children, all under the age of 10, receive health care coverage and care through Medicaid. Last year, Queenesther underwent surgery to remove an ectopic pregnancy that was causing severe health issues and could have been fatal.

“Had it not been for Medicaid I wouldn’t have been able to get it removed and who knows what would have happened,” she said, reflecting on the importance of Medicaid for herself and her family. 

Queenesther is fortunate to have Medicaid coverage because Georgia makes it very difficult for parents to qualify. Read more of Queenesther’s story on our blog or in GHF’s Medicaid storybook, Medicaid Matters to Georgia.

Your story is powerful. Share it with us! Stories put a face to health care issues in Georgia and inform state leaders about what their constituents need as they make policy decisions. When you share your story, you help others understand the issue and you influence how our state responds to this unprecedented moment.


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We are fighting for Georgians

As Georgia faces the public health emergency of COVID-19, it can be hard to be optimistic about our health and our futures. However, Georgians for a Healthy Future believes that our state can successfully overcome this tremendous challenge if Georgians adhere to the advice of public health experts and our state’s leaders swiftly adopt evidence-based policies that protect the health and safety of all Georgians. At the same time, Georgia leaders must look ahead to ways they can promote the health and well-being of all Georgians in the economically challenging months to come. Georgians for a Healthy Future has identified policy priorities that we believe are necessary for success in addressing the immediate public health emergency and the emerging economic consequences. These are the policies that we will fight for as we continue our fight for the health and wellness of all Georgians.

Our recommendations are shaped by feedback from GHF’s board of directors, partner advocacy organizations, local groups helping Georgians in their communities, and stories from Georgians just like you. You can share your COVID-19 experiences with GHF here. Thank you for your generous input.

As the status of this crisis changes and we gather more information, you can find updates to these policy recommendations and actionable information here.



Health system capacity and public safety

GHF supports:

  • Statewide and local shelter-in-place orders and other aggressive social distancing practices to slow the spread of the COVID-19 virus
  • Funding to quickly expand the capacity of Georgia’s Department of Public Health to test and monitor the spread of COVID-19
  • Funding to purchase personal protective equipment for health care workers
  • Funding to purchase equipment for patient care like ventilators and respirators
  • Maximizing the scope of practice for all qualified and licensed health care providers (e.g. physicians assistants, advanced practice registered nurses, registered nurses)
  • Expanding options and health coverage of telehealth and virtual visits in all medically appropriate circumstances

Access to quality, affordable health care for all Georgians

GHF supports:

  • Maximizing Medicaid flexibility and funding to increase access to care by:
    • Expanding Medicaid to all poor and near-poor Georgians (those making less than 138 percent of the federal poverty line)
    • Taking advantage of emergency 1135 waivers to increase the number of providers who can see Georgians with Medicaid coverage
    • Adopting administrative changes to preserve coverage for current Medicaid members and to enroll Georgians who are already eligible but unenrolled, including the expansion of presumptive and retroactive eligibility and a halt on the annual renewal process
    • Expanding coverage of home- and community-based services and long-term services and supports
  • Expanding access and protections in comprehensive private health coverage
    • Promoting enrollment for people who qualify for private insurance, especially among those who are eligible for financial assistance through the Affordable Care Act (ACA) by:
      • Establishing a new Special Enrollment Period for people who wish to purchase health insurance now
      • Easing the enrollment and paperwork requirements for people enrolling in coverage due to job loss or income changes
      • Prohibiting health insurers from canceling a consumer’s coverage, even if they fall behind on premium payments
    • Eliminating cost-sharing for COVID-19 testing (and related tests) and treatment
    • Limiting the sale of plans that do not offer comprehensive benefits or follow the standards set by the ACA
    • Establishing comprehensive surprise billing protections
  • Promoting access to mental health services and substance use recovery supports for all Georgians
  • Easing limits on prescription drugs so that consumers can more easily access 90-day supplies of medications

Equity at the center of the response

This pandemic will hit some Georgia communities harder than others. All federal and state policy remedies should endure to offer the most help to those who are disadvantaged due to income, race or ethnicity, disability or health status, age, geography, and other factors. Georgia’s response must proactively address health equity concerns. Among other strategies, this should include disseminating public health messages that include information about affected groups and communities in languages and contexts they understand and directing additional funding to community health centers and other providers that serve disproportionately impacted communities.


Meeting the basic needs of Georgians and their families

As evidenced by yesterday’s job loss statistics, it is imperative that the public health response to the COVID-19 crisis be followed by an ambitious economic response. GHF supports policies that provide equitable opportunities for stability, dignity, and well-being for all Georgia families. While not an exhaustive list, these policies include:

  • Expanded access to Georgia’s unemployment insurance system, including 26 weeks of benefits and the easing of eligibility requirements and activities.
  • A moratorium on foreclosures and evictions, the provision of rental assistance and mortgage forbearance, and other supports that keep Georgians in their homes
  • Improved access to nutritious foods through SNAP, WIC, school system food programs, and other public programs
  • Universal paid family leave that allows workers regardless of income to take time off to care for themselves and their loved ones in times of sickness and crisis
  • A moratorium on utility shut offs, including internet access so that families can keep the lights on and children can continue to learn remotely

GHF will support partner organizations in their efforts to advocate for these policies and supports for Georgia families and individuals.


Some of these policies have been adopted or partially adopted by federal officials, Governor Kemp, and state agency officials. GHF thanks Georgia leaders for the actions they have already taken. In the coming weeks, GHF will track which policies are fully implemented, partially adopted, or not taken up at all, and will provide updates accordingly.

Thank you for your support and advocacy. We wish you health and safety!


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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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The Georgia Access Plan: A Bad Deal for Consumers

Cover Georgia logo

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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Legislative Update: Patients First Act, healthy housing, HIV treatment and prevention bills move forward

Legislative Update: Week 10
Risky health care waiver bill passed by House committee

Last Wednesday, the House Special Committee on Access to Quality Health Care held a hearing on SB 106, the Patients First Act. GHF’s Executive Director, Laura Colbert and several Cover Georgia coalition members testified and emphasized the need for changes in the bill. Read Laura’s full testimony here.

As we have previously reported, the legislation allows for an 1115 waiver to extend Medicaid coverage to some adults making up to 100% of the federal poverty level ($12,100 annually for an individual). GHF and its partners requested that the income cap be lifted to 138% FPL so that it would cover more Georgians at a lower cost to the state. As currently written, the bill would leave out thousands of Georgians who earn just above the poverty line and who would be covered under a traditional Medicaid expansion or a broader 1115 waiver. SB 106 also allows the state to make potentially dramatic changes to private health insurance in Georgia through 1332 waivers with little accountability. The bill now sits in the House Rules committee and is expected to receive a vote on the House floor sometime next week.

There is still time for the House to make changes to SB 106 so that it covers more people and costs less. Read more about SB 106 CoverGA.org and then contact your state representative to let them know that we need to amend this bill to cover every eligible Georgian!


 

Behavioral health commission passes in both chambers
Georgia Mental Health Reform and Innovation Commission passed by Senate

The Senate passed an amended version of HB 514 on Thursday. This bill, sponsored by Rep. Kevin Tanner, would create the Georgia Mental Health Reform and Innovation Commission which would work to analyze and offer improvements to the state’s mental health system. Changes to the bill in the Senate included additions to the make-up of the Commission so that it includes a professional who specializes in substance abuse and addiction, and a representative of a community service board to serve as a nonvoting member of the 23-member panel. The bill will now return to the House to receive an “Agree” on the changes made in the Senate and will then go to the Governor’s desk to be signed.


HIV prevention & treatment bills move forward in the Senate
Two HIV-related bills move forward in Senate committee

Two significant pieces of HIV-related legislation passed the Senate Health and Human Services committee last week. HB 217, which would decriminalize the act of working or volunteering for a syringe services program and HB 290, which would would establish a pilot program to provide preexposure prophylaxis (PrEP) drug assistance or services to persons at risk of being infected with HIV will now go to the Senate Rules Committee to await a vote by the full Senate. A third bill, HB 158 would improve Medicaid coverage but has not yet been taken up by the Senate HHS committee. Georgia currently leads the U.S. in the rate of new HIV cases diagnosed each year and all three bills would contribute to the slowing of the epidemic by preventing new infections and improving care for people currently living with the condition. (For more details on all three pieces of legislation, see our February 26th legislative update).


What happened last week
Recess legislation passes in Senate committee

The Senate Education and Youth committee voted to pass HB 83 last Thursday. This bill would require a daily 30-minute recess for all students in grades K-5 unless they have already had a physical education class or structured activity time in the day. This bill now sits in the Senate Rules committee and awaits a vote on the Senate floor. To learn more about the impact of recess on children’s physical and mental health, read this fact sheet from Voices for Georgia’s Children.


Healthy housing legislation makes progress in Senate

Georgians for a Healthy Future is a member of the Healthy Housing Georgia coalition because evidence shows the strong and direct influence housing has on a person’s health. The coalition supports HB 346 which passed with amendments by the Senate Judiciary committee last week. This bill would prohibit retaliation by a landlord against a tenant for complaining to Code Enforcement about unsafe or unhealthy housing conditions like the presence of mold, radon, rodents, insect infestations, or lead. Georgia is the only state in the country that does not protect tenants against unsafe and uninhabitable housing conditions with a “warranty of habitability.” The Senate Rules committee will now decide when the legislation may receive a vote on the Senate floor. (For more details on the legislation, see our March 5th 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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GHF testifies on Patients First Act (SB 106)

GHF’s Executive Director Laura Colbert provided testimony to the House Special Committee on Access to Quality Health Care on SB 106 and the risks this legislation poses for consumers as it is currently written.

Testimony of Laura Colbert, GHF’s Executive Director
March 20, 2019

“Thank you Chairman Smith and members of the committee.  My name is Laura Colbert and I am the ED of GHF. We represent health care consumers across Georgia and work to build a future in which all Georgians have the quality, affordable health coverage and care they need to live healthy lives and contribute to the health of their communities.

First, we want to thank Governor Kemp, Senator Tillery and Representative Lott for your work on this bill. We are excited that this very important conversation is moving forward. We appreciate your open door and on-going dialogue with us on this issue.

Like my colleagues before me, GHF agrees with the goals of this bill and we are pleased by the prospect of meaningful coverage for 240,000 Georgians who live below the poverty line. We are to balance that with our consternation that 200,000 uninsured Georgians who make just more than the poverty line may remain uncovered by this bill as it’s written.

Georgians with insurance coverage are healthier, better able to work and go to school, have less medical debt and better credit scores, and have healthier families, among other benefits. While Georgians below the poverty line are sure to reap these benefits after gaining coverage, those just above it likely will not if SB 106 is not amended to specifically include them.

Based on other states’ coverage expansions and the affordability information provided to you by Ms. Haynes at Georgia Watch, it is clear that many near-poor constituents are likely to face significant cost-related barriers to health care, even with the ACA’s financial assistance. While Georgians in this income range can afford more than those below the poverty line, it is unrealistic to expect them to pay as much as 20% of a person’s $14,000 yearly wage or a family of four’s $30,000 salary for health care. An investment that large for families barely making ends meet effectively keeps them locked out of the health care system, only experiencing the benefits of coverage in emergency situations. The financial protection and access to care provided by Medicaid can better serve as the stepping stones for these families to climb into Georgia’s middle class.

Georgia is at the table now, and we have the opportunity to get this right for all Georgians on the first try.

That is why we recommend that this committee amend the bill to expand eligibility to 133% FPL and cover more Georgians for fewer state dollars. Georgia is at the table now, and we have the opportunity to get this right for all Georgians on the first try. Or consider removing the percentage provision altogether so that the bill is silent on the exact income limit, providing flexibility to the state to negotiate the waiver specifics that work best for Georgians and Georgia’s budget, particularly in the likely event that CMS is unable to provide an enhanced match rate for a partial expansion.

I also want to briefly turn to the second part of the bill concerning Section 1332 State Innovation waivers. A 1332 waiver to establish a reinsurance program would help thousands of Georgians by reducing insurance premiums and attracting more insurers to the marketplace. GHF stands in support of such efforts. However, the legislation as currently written is so broad that it leaves the door open to many more changes, some of which could destabilize Georgia’s marketplace and jeopardize access to care for Georgians covered by individual or small-group health insurance.

We recommend that this committee consider narrowing the scope of an allowable 1332 waiver by specifying that the state is authorized to establish a reinsurance program or, if other proposals may be considered, lay out criteria that any innovation waiver must meet. Georgians for a Healthy Future has laid out four criteria that we believe are critical to ensuring that any 1332 waiver benefits consumers without putting vulnerable groups at risk.

We appreciate your consideration of our suggestions and hope that we can act as a resource for the state as it drafts these waivers. Thank you very much for your time and your efforts on behalf of all of the health care consumers in your districts.”


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Bill analysis: SB 106 aims to improve access to health care but falls short

For the first time in Georgia, there is widespread and bipartisan agreement among Georgia’s Governor and legislative leaders about the pressing need to provide health insurance to more Georgians. To address the state’s rising uninsured rate, Governor Brian Kemp has put forth a bill, SB 106 (also called the Patients First Act), that would allow the state to submit two kinds of health care waivers:

  • A Medicaid 1115 waiver that could be used to extend coverage to more low-income Georgians, among other reforms; and
  • 1332 State Innovation waivers that would make changes to Georgia’s private health insurance marketplace.

(Waivers allow a state to set aside or “waive” certain requirements imposed by the federal government and try new models of providing health coverage and care.)

While the legislation’s goal to extend affordable, quality coverage to more Georgians is one with which GHF wholeheartedly agrees, the bill currently falls short by limiting the number of people who would benefit, increasing the likely costs to the state, and leaving to door open to an erosion of critical consumer protections.

SB 106 limits a future 1115 Medicaid waiver to cover only adults making up to 100% of the federal poverty line (FPL) ($12,490 for an individual and $21,330 for a family of three per year). While this would cover 240,000 more Georgians than are currently eligible for Medicaid, the cut-off leaves out an estimated 200,000 uninsured Georgia adults making just more than poverty-level wages (up to 138% FPL). These Georgians make up to $17,296 for an individual and $29,435 for a family of three.

The Affordable Care Act envisioned that all adults making up to 138% FPL would be covered by Medicaid and provides states with an incentive to do so. States that extend coverage to these newly-eligible adults pay only 10% of the costs and the federal government picks up the rest (90%) in perpetuity.

If Georgia’s leaders approve SB 106 in its current form and leave out the adults just above the poverty line, our state will miss out on the ACA’s “enhanced match rate”. Wisconsin is the only other state that has opted to take this route, and as a result, has paid $1.1 billion more to cover 80,000 fewer people.

A small change to the language in SB 106 would give the state the flexibility to increase coverage to people up to 138% FPL, allowing the state to cover an estimated 440,000 Georgians at a lower cost.

The second part of SB 106 allows Georgia to submit at least one 1332 State Innovation waiver. These innovation waivers were created by the ACA to allow states to test different approaches for providing primarily private health insurance to their residents. At the same time, the law established “guardrails” for 1332 waivers to ensure consumers were sufficiently protected. Unfortunately, these guardrails have been greatly weakened in recent months leaving consumers at risk.

From Kaiser Family Foundation

So far, all eight states with approved 1332 waivers have carried out plans that benefit consumers—and Georgia could too. However, the broad language in SB 106 as currently written allows for proposals that could also create sizable and risky changes that harm consumers. For example, Georgia could allow the ACA’s financial help that is now available to consumers to buy coverage to be used instead for the purchase of junk insurance plans. This would likely draw healthy consumers out of the ACA Marketplace to cheaper, low-quality plans and send insurance premiums into an upward spiral for consumers with pre-existing conditions who need comprehensive coverage.

Georgia’s legislators could narrow the scope of allowable 1332 waivers by specifying that the waiver must be used for a specific beneficial reason, like establishing a reinsurance system to lower insurance premiums, or by laying out a set of principles that the waiver must meet to ensure Georgia consumers are fully protected. (GHF’s Executive Director proposed a set of consumer-friendly principles when she testified to the Senate Health & Human Services Committee in February.)

Georgia’s leaders have taken an encouraging step forward by proposing changes to state law that aim to increase access to care and address affordability concerns for Georgia families. A few small, meaningful changes to SB 106 would assure a path to affordable, quality health coverage exists for all Georgians.


Want to learn more? Here are a few resources that you may find helpful:

Follow changes and updates about SB 106 in GHF’s weekly legislative update emails.


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