Consumer groups have supported the legislation. Laura Colbert of Georgians for a Healthy Future said Tuesday that the legislation “is a big step forward for Georgia consumers.’’
GHF surveyed and interviewed enrollment assisters across the state to understand not only the “what,” but also the “why” behind the second open enrollment period. The results of that research have led us to several policy recommendations to maximize health insurance enrollment and retention and to ensure that coverage translates to meaningful access to timely and appropriate medical services for Georgia health care consumers.
- Close the coverage gap in Georgia. Approximately 300,000 Georgians fall into the coverage gap, meaning they do not qualify for Medicaid under existing income eligibility guidelines in Georgia but their income is still too low to qualify for financial assistance (tax credits) to purchase health insurance on the Marketplace. Eligibility for tax credits begins at 100 percent of the Federal Poverty Level, or $11,770 for an individual or $20,090 for a family of three in 2015, while Medicaid eligibility for most adults in Georgia cuts off at income much lower. Thirty states including DC have closed their coverage gaps thus far with promising results. We encourage Georgia policymakers to take this important step as well to ensure all Georgians have a pathway to coverage.
- Set and enforce network adequacy and transparency standards. Many of the plans sold through the Health Insurance Marketplace are Health Maintenance Organization (HMO) plans that feature narrow provider networks. While these narrow networks can help keep premiums down, a trade-off many consumers may be willing to make, consumers do not currently have sufficient information to make this choice. There is no information available to consumers at the point of sale about whether a provider network is ultra narrow, narrow, or broad, and provider directories are routinely inaccurate. More transparency and oversight are needed to ensure that consumers have accurate and useful information to make these choices. It is also important that all provider networks allow for meaningful access to all covered benefits. To ensure this, we support putting in place and enforcing network adequacy standards.
- Encourage public-private partnerships and remove unnecessary restrictions on consumer education and assistance. Many of the enrollment assisters we surveyed indicated that reducing barriers to partnering with state government organizations such as public colleges, universities, and health departments would lead to stronger and more effective partnerships. Specifically, many respondents indicated that improved coordination between enrollment assisters, the Marketplace, and the Georgia Department of Community Health (DCH) to better facilitate PeachCare for Kids and Medicaid enrollment would be helpful. The “Health Care Freedom Act,” passed in 2014 as part of HB 943, prohibits state and local governmental entities from operating a health insurance navigator program and places other limitations on governmental entities. This provision has been counterproductive, creating confusion around what educational and consumer assistance activities local entities can engage in as they work to serve their community members. We recommend lifting these restrictions.
While Georgia has made little progress on closing its coverage gap, the subject is a hot topic elsewhere.
- Montana has closed its coverage gap! As the 29th state to close the gap, Montana will provide 70,000 Montanans with quality, affordable health care coverage. The state is currently working with CMS to gain approval for its expansion proposal.
- Face Off in Florida–The debate over closing the coverage gap is as hot as sunburnt skin after spring break! Floridians have seen a sudden and unexpected adjournment of the legislative session, a stand-off with HHS over the low-income pool (LIP), and their governor file suit against the federal government. The debate is far from over as the legislature plans to reconvene in June to complete their legislative responsibilities.
- Policy makers in both Alaska and Louisiana are discussing if and how to close their coverage gaps. While their legislators debate whether or not to close the coverage gap during a special session, polls show that Alaskans are hugely in favor of the policy. In Louisiana, Gov. Jindal remains opposed to the idea of closing his state’s coverage gap, but legislators are discussing their options.
While Montana closes its gap and other states think through their options, more and more studies are revealing that closing the coverage gap is good for states! It saves money in state budgets and facilitates job growth, especially in the health care sector. Families USA summarized the new data in a recent blog post.
By Em Elliott, Jeff Graham, and Amanda Ptashkin
Georgia Equality and Georgians for a Healthy Future have been working together within the larger Cover Georgia coalition to educate and advocate on the issue of Medicaid in Georgia. Under the Affordable Care Act, states have the option to create a new category of eligibility for Medicaid to cover low-income individuals and families, financed almost entirely with federal dollars. Implementing this expansion is the only viable way to cover Georgia’s low-income uninsured, and it will pump resources into our state’s healthcare delivery system. Many other states are also advocating for expansion and Community Catalyst, a national health care reform advocacy organization, came to us with some questions around advocacy, lessons on collaborative partnerships, and the way this issue effects the LGBTQ community.