Early voting is underway ahead of the upcoming November 6th Election Day. Georgians across the state are heading to the polls to cast their votes for Governor, Insurance Commissioner, state legislators and other elected positions, and voters’ decisions about the candidates in each race will have a critical impact on consumers health issues in Georgia.

All of Georgia’s state legislative seats are on the ballot this fall and a record number of seats are being competitively contested. The resulting changes in the General Assembly could have a big impact on the future of health and health care for Georgia consumers.

Georgia’s General Assembly is made up of two chambers: the House of Representatives and the Senate. Georgia has one of the largest state legislatures in the nation with a total of 236 members, made up of 56 Senators and 180 Representatives. Every Georgia resident has one Georgia Senator and one Georgia House member, both of whom are up for re-election every two years.

Constitutionally, the General Assembly is only responsible for proposing and passing an annual state budget; however, during the body’s annual 40-day session, legislators also propose, debate, and pass laws for the state of Georgia, including those that regulate health care, health coverage, or that impact health through another sector (like education or transportation).  

All appropriations bills, which designate how state funds are to be spent, must originate in the House. Health care is the state’s second largest expenditure and made up almost 20% of this year’s annual budget. Each year, after the Governor proposes a state budget, the legislative leaders of the House turn the proposed budget into a bill for consideration by the House’s appropriations committee and then by the full chamber. When the House has approved the budget, the budget goes through the same process in the Senate. Once approved by both chambers, any differences are worked out in a conference committee, before sending the budget back to the Governor to be approved or vetoed.

The decisions made during the General Assembly’s budget considerations can have a big impact on health care and coverage for Georgians. For example, the General Assembly has over the last three years approved pay increases for primary care and OB-GYN doctors and dentists treating Medicaid patients, which improves access to care for the almost 2 million Georgians who rely on Medicaid for health coverage.

Members of the General Assembly may also propose laws to address issues of concern for their constituents. These issues can range from surprise out-of-network medical billing to the opioid crisis to Medicaid expansion to Georgia’s health insurance Marketplace. Many legislators receive ideas for legislation from concerns and complaints brought to them by their constituents (an important reason to get to know your legislators!).

Each year, hundreds of bills are proposed and only a fraction successfully pass both chambers. Health-related bills typically pass through the Health & Human Services and Insurance Committees in each chamber. Legislators can consider bills until Sine Die, the 40th and last day of the legislative session. When approved by both chambers, successful legislation goes to the Governor for approval or veto.

One of the most impactful pieces of health-related legislation passed by the state legislature in recent years is HB 990 (2014), which requires the General Assembly to approve any expansion of Medicaid. This bill effectively revoked the Governor’s ability to act independently to close Georgia’s coverage gap, making it more difficult to expand health coverage to low-income adults in Georgia. 

Georgia’s General Assembly will have many new faces after the upcoming election, each of whom will play a role in shaping the state’s health care landscape over the next two years or more. Whether and how the state addresses issues like access to care, health care affordability, the opioid crisis, and the sustainability of the rural health care system may be decided by voters at the ballot box this November.

This blog is part of a series from Georgians for a Healthy Future to educate consumers about the impact of the 2018 election on timely consumer health issues. Please check out our previous blogs in the series:

• Eight questions for health care voters to ask Georgia candidates
• A consumer health advocates guide to the 2018 elections: Georgia’s Governor

*Georgians for a Healthy Future is a non-partisan, 501(c)3 organization. We do not endorse or support any candidates or political party.

Pricilla Epps is a 54-year-old former security guard who lives in Blakely, GA, a rural community in the southwest region of the state.

Two days after having a sudden stroke, Priscilla lost her job because she was unable to work her scheduled shifts as she recovered that week. Priscilla’s health insurance was provided by her employer, so she lost her health insurance coverage when she lost her job, leaving her on the hook for all of the hospital costs that accumulated as she received care for her stroke. After a two-day stay, Priscilla was told she would have to leave the hospital due to her inability to pay for the costs of in-patient care.

Experiencing dizziness, difficult walking, discomfort in her limbs, and frequent forgetfulness, Priscilla went to see Dr. Kinsell, the only available physician in Clay County, where she still receives the limited follow-up care she can afford. She is still unable to go back to work or live on her own, so Priscilla has been living with her daughter for the time being.

Like Priscilla, 360,000 low-income Georgians, many of whom are uninsured, live in small towns and rural areas across the state. These areas have the most at stake in the debate over whether or not to close the health care coverage gap. According to a new report from Georgetown University’s Center for Children and Families and the University of North Carolina’s Rural Health Project, Medicaid expansions in other states have cut the uninsured rate in rural areas by half, while Georgia has seen a much smaller decline from 43 percent to 38 percent among the same population.

For rural Georgia residents like Priscilla, health coverage would open doors to the physicians and services that they need to stay employed or get back to work. For rural communities like Blakely, more residents with health coverage could make the difference between keeping or losing the few remaining primary care physicians in the area.

Your story is powerful! Stories help to put a human face to health care issues in Georgia. When you share your story, you help others understand the issue, its impact on Georgia, and why it’s important.

Your health care story is valuable because the reader may be your neighbor, friend, someone in your congregation, or your legislator. It may inspire others to share their stories or to become advocates. It is an opportunity for individuals who receive Medicaid or fall into the coverage gap, their family members, their physicians and concerned Georgia citizens to show that there are real people with real needs who will be impacted by the health policy decisions made by Congress and Georgia’s state leaders.

Share your story here!

Early voting began last week ahead of the upcoming November 6^th Election Day. Georgians across the state are heading to the polls to cast their votes for Governor, Insurance Commissioner, state legislators and other elected positions, and voters’ decisions about the candidates in each race will have a critical impact on consumers health issues in Georgia.

One of the most visible positions on the ballot and one that plays a meaningful role in health care policy for the state is Georgia’s Governor. The Governor heads the state’s executive branch, which is broadly responsible for implementing, supporting, and enforcing Georgia’s laws.

As head of the executive branch, the Governor has the authority to appoint and provide direction to the leaders of most of Georgia’s executive branch departments, including the Commissioners of the Departments of Community Health (the state’s Medicaid agency), Public Health, Behavioral Health and Developmental Disabilities, and Family and Children Services. Because most health-related programs in the state are run by one of these agencies, the ability to appoint department leadership provides the Governor with outsized influence on the direction, priorities, and initiatives within each.

Ahead of the state legislative session, the Governor has the added responsibility of proposing an annual state budget for the General Assembly’s consideration. Health care is regularly the state’s second largest expenditure, making up almost 20% of the annual budget. Aside from expected items like Medicaid expenditures, the Governor may propose special investments that promote his/her health-related priorities. For example, Georgia’s FY19 budget includes an additional $21.4 million to improve and expand children’s behavioral health services as recommended to Governor Deal by his Commission on Children’s Mental Health. Once the legislature has considered and passed a budget, the Governor has the power to veto or approve the spending plan.

At the end of each year’s legislative session, the Governor has 40 days to approve or veto (“veto” means “to reject”) legislation. Most laws passed by the General Assembly are approved but a few each year are rejected by the Governor because they are ill-informed, controversial, or contrary to the Governor’s priorities. In recent years, Governor Deal has vetoed some health-related laws like SB 357 in 2018, which would have established a Health Care Coordination and Innovation Council.

Once a bill is approved, the Governor may direct the executive branch agencies about how the law should be carried out. For example, if the Georgia General Assembly approves future legislation to expand Medicaid in Georgia, the Governor may provide the Commissioner of Community Health with instructions about how the expansion should be implemented, including program elements that make it easier or harder for people to enroll in or use their new coverage.

Georgia’s next Governor will have a significant role in shaping the state’s health care landscape over the next four years or more. Whether and how the state addresses issues like access to care, health care affordability, the opioid crisis, and the sustainability of the rural health care system may be decided by voters at the ballot box this November.

This blog is part of a series from Georgians for a Healthy Future to educate consumers about the impact of the 2018 election on timely consumer health issues. Please check out our previous blog, Eight questions for health care voters to ask Georgia candidates, where you can find a list of questions to help health care voters get to know the candidates on their ballots.

*Georgians for a Healthy Future is a non-partisan, 501(c)3 organization. We do not endorse or support any candidates or political party.

Georgians for a Healthy Future regularly hosts graduate students from Georgia’s universities to help train and foster the state’s future health advocates. This semester, GHF is hosting two Master of Public Health students who will be working on projects that promote GHF’s policy and advocacy priorities.

Jessica joined Georgians for a Healthy Future in March as the Health Education & Advocacy Intern. In this role, she is responsible for developing an educational curriculum on Georgia’s Medicaid program and related educational materials. She is also assisting in the development of a multi-media curriculum to build advocacy skills in people with disabilities and other invested health advocates. She has a bachelor’s degree in Health Science from Truman State University in Missouri and is currently studying epidemiology in the MPH program at Georgia State University. Before going back to school, Jessica worked in HIV research at Emory University.

Kerris Solomon is pursuing a dual MPH/Juris Masters degree at Emory University. Although born and raised in Georgia, Kerris completed her undergraduate studies at St. John’s University in Queens, NY. After receiving her bachelor’s degree in Communication Science Disorders, she worked two years as a Web Master for a college in the metropolitan Atlanta area. She now uses that knowledge and experience as the Communications Chair on the Rollins Student Government Association’s executive board. Kerris is came to GHF as the Health Communications Intern. One of Kerris’ goals in the field of public health is to implement policy change within the country’s incarceration system. She wants to change how mental health is treated within prisons (solitary confinement, etc.), the difficulties of re-entry for returning citizens, and the cycle that it induces.

We welcome both Jessica and Kerris, and look forward to our work together.

Georgians across the state are being asked to decide how they will cast their votes in November for positions such as Governor, Insurance Commissioner, state senator and state representative. The decisions made by voters about these elected positions will directly impact critical consumer health issues in Georgia like access to health care, affordability of health insurance, the opioid crisis, and the sustainability of the rural health care system.

As candidates crisscross the state or their districts asking for support, voters will consider their stances on a number of important issues including health care. To help voters make their decisions, we put together this list of questions for voters to ask of candidates about five timely and pressing consumer health care issues.

These questions can be used at town halls and candidate forums or posed to candidates via social media or in one-on-one conversations.

Closing the coverage gap

• Over 240,000 Georgians make too little to receive financial help to buy private health insurance but do not qualify for Medicaid, meaning they fall into the Medicaid coverage gap. Many of the families who fall in the gap are hard-working people who work in industries that make up the backbone of our state: trucking, food service, and childcare. Do you support using federal funds to close the Medicaid coverage gap and offer affordable health coverage to these 240,000 Georgians while boosting the Georgia’s economy? Please explain.
• A 2016 Department of Health and Human Services study showed that marketplace premiums were on average 7 percent lower in states that extended Medicaid to low-income residents. Do you support closing the Medicaid coverage gap as one method to reduce health care costs and lower the uninsurance rate for consumers in Georgia? Please explain.

Georgia’s health insurance marketplace

• Health insurance premiums for Georgia consumers will rise by as much as 15 percent in 2019 due to the repeal of the individual mandate by Congress and the elimination of cost-sharing reductions, among other things. If elected, what improvements would you make to our health care system to ensure your constituents have access to high quality, comprehensive and affordable health insurance?
• The federal government has expanded insurance companies’ ability to sell short-term plans that do not cover key services like mental health treatment or prescription drugs. These plans will increase health care costs and roll back consumer protections that many families in our state depend on. How do you think Georgia should regulate these plans?

Opioid/substance use crisis

• In 2016, about three Georgians died each day from drug overdoses and thousands of Georgians live with substance use disorders regularly. To slow this crisis, a broad spectrum of strategies will be needed from prevention and early intervention to expanded access to treatment. If elected, what would you do to address the state’s substance use crisis?

 Communities left behind

• Seven rural hospitals in Georgia have closed since 2010. Rural hospitals are often the largest employer in the area and are the economic engines that help to support local small businesses (like the flower shop or pharmacy). If elected, what will you do ensure that rural communities have adequate access to quality, affordable health care?
• People of color in Georgia have shorter life expectancies, higher rates of chronic disease, and are more likely to be uninsured and live in medically underserved areas. The causes of these outcomes are complex and linked to reduced access to quality education, fewer economic opportunities, discrimination, and other social and economic factors. As (Governor/Insurance Commissioner/other position title), how would you address the health disparities experienced by people of color in Georgia?

Defending health care gains

• Over the past two years Congress has repeatedly attempted to repeal the AffordableCare Act (ACA) and slash federal Medicaid funding that our state relies on, despite the fact that 74 percent of the public view the Medicaid program favorably. If elected, will you support/continue to support the program in the face of threats? Please explain.

Did you ask one of these questions to a candidate? Let us know! We want to know which questions were most helpful and how candidates are responding. Email Michelle Conde at mconde@healthyfuturega.org with your feedback.

*Georgians for a Healthy Future is a non-partisan, 501(c)3 organization. We do not endorse or support any candidates or political party.

Georgians for a Healthy Future hosted another Georgia Voices for Medicaid training on Friday, August 10^th in partnership with the Athens Clarke County Library. The Georgia Voices for Medicaid trainings are designed to give participants the knowledge and skills they need to advocate for timely, important health care issues impacting Georgians.

At last week’s training, participants learned that Georgia’s Medicaid program provides health insurance for half of Georgia’s children, and that it also covers low-income people with disabilities, seniors, and pregnant women. In Clarke and Barrow counties, 15,830 and 10,845 residents respectively are covered through Medicaid. Alyssa Green, GHF’s Outreach & Education Manager, shared testimonials from several Georgians who are covered by Medicaid to demonstrate the real benefits of coverage to training participants. Alyssa also introduced ways that participants can advocate for the health care issues that matter most to them, like protecting and improving the Medicaid program or bringing down health care costs.

The training concluded with an invitation for attendees to continue their health care advocacy work with GHF’s new Georgia Health Action Network (GHAN) program. GHAN is a volunteer-led program that fosters and supports grassroots health advocates who work alongside GHF to reach a day when all Georgians have access to the quality, affordable health care they need to live healthy lives and contribute to the health of their communities.

If you were unable to attend this Georgia Voices for Medicaid event, check out our upcoming trainings or contact Alyssa at agreen@healthyfuturega.org or 404-567-5016, ext. 2 to schedule a training in your community. You can also contact Alyssa learn more about GHF’s new Georgia Health Action Network.

Georgians for a Healthy Future hosted its Georgia Voices for Medicaid training on Thursday, July 19^th in partnership with the Central Outreach & Advocacy Center.  The Georgia Voices for Medicaid trainings are designed to give participants the knowledge and skills they need to advocate for timely, important health care issues impacting Georgians.

At this week’s training, participants learned that Georgia’s Medicaid program provides health insurance for half of Georgia’s children, and that it also covers low-income people with disabilities, seniors, and pregnant women. In Fulton and DeKalb counties—Georgia’s two most populous counties–118,755 and 107,340 residents respectively are covered through Medicaid. Alyssa Green, GHF’s Outreach & Education Manager, shared testimonials from several Georgians who have Medicaid, including the story of a Georgia man who credits Medicaid as the reason he is able to financially support himself and work in his community.

GHF’s Executive Director Laura Colbert introduced ways that participants can advocate for the health care issues that matter most to them, like protecting and improving the Medicaid program or bringing down health care costs. Participants were given the opportunity to practice their advocacy skills by sending an introductory email to their state legislators that communicated what they learned at the training.

The training concluded with an invitation for attendees to continue their health care advocacy work with GHF’s new Georgia Health Action Network (GHAN) program. GHAN is a volunteer-led program that fosters and supports grassroots health advocates who work alongside GHF to reach a day when all Georgians have access to the quality, affordable health care they need to live healthy lives and contribute to the health of their communities.

If you were unable to attend this Georgia Voices for Medicaid training, join us for our next training event in Athens or contact Alyssa at agreen@healthyfuturega.org or 404-567-5016, ext. 2 to schedule a training in your community. You can also contact Alyssa learn more about GHF’s new Georgia Health Action Network.

Queenesther is a 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.

Queenesther recently underwent surgery to remove an ectopic pregnancy that was causing severe health issues and could have proved 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. Because she was able to have the ectopic pregnancy removed quickly, Queenesther has been able to focus on caring for her young family and earning her degree.

Queenesther is fortunate compared to many low-income parents because Georgia makes it very difficult for parents to qualify for Medicaid coverage. Because Georgia’s Governor and the state legislature have so far refused to extend health coverage to most low-income parents (and other poor adults), parents must make less than 36% of the federal poverty line ($7656 annually for a family of three) to qualify for insurance through Medicaid. Parents who make between 36% and 100% of the federal poverty line ($9096-$25,100 annually for a family of four) are stuck in the coverage gap with no pathway to affordable coverage.

In Dougherty County, where Queenesther and her family live, 5,472 people, 22% of whom are parents, are stuck in the coverage gap but could be covered if Georgia’s policy makers extended insurance to this group. Like Queenesther, gaining coverage would enable them to better care for their children, pursue an education, and support their families.

For more on how parents and families would benefit from extending health insurance coverage, please revisit the Many Working Parents and Families in Georgia Would Benefit from Extending Medicaid Coverage report from GHF and the Georgetown Center on Children and Families.

Your story is powerful! Stories help to put a human face to health care issues in Georgia. When you share your story, you help others understand the issue, its impact on Georgia, and its importance.

Your health care story is valuable because the reader may be your neighbor, friend, someone in your congregation, or your legislator. It may inspire others to share their stories or to become advocates. It is an opportunity for individuals who receive Medicaid or fall into the coverage gap, their family members, their physicians and concerned Georgia citizens to show that there are real people with real needs who will be impacted by the health policy decisions made by Congress and Georgia’s state leaders.

Share your story here!

Teresa began working as a teacher for the Headstart preschool program in 1994 but retired in 2010 because multiple health conditions made it difficult for her to work. Now her family’s only source of income is her husband’s monthly disability check, which is too high to allow him to qualify for Medicaid and too low to allow them to qualify for financial help to purchase private insurance through the Affordable Care Act. (Teresa cannot qualify for Medicaid no matter how low her income is because she does not have a disability or a child under the age of 18.) Both of them fall in Georgia’s coverage gap.

Teresa and her husband are just two of 197 of the Georgians in Clay County that are uninsured because Georgia’s decision makers have not extended health insurance coverage to low-income adults in Georgia (those making less than $16,000 annually for an individual or $20,780 for a family of three.)

Teresa struggles to manage multiple health conditions, the worst of which is a jaw condition that has caused her teeth to rot. Because Teresa has not had health coverage since 2009, she has had to find alternative, insufficient treatments for her jaw condition. She would have to pay $5000—almost four months of income—to receive the necessary medical remedies to alleviate her pain and stop the dental deterioration. If Georgia were to close the coverage gap, Teresa would be able to see her doctor on a regular basis without having to forgo appointments and services that would otherwise be too costly.

Georgia’s Governor and legislature have so far rejected the option to close the state’s coverage gap, leaving people like Teresa and her husband uninsured. Until Georgia’s policymakers extend health insurance to all low-income Georgians, Teresa, her husband, and 240,000 other Georgians will likely continue to skip health care appointments and forgo needed care because they have no pathway to coverage.

Your story is powerful! Stories help to put a human face to health care issues in Georgia. When you share your story, you help others understand the issue, its impact on Georgia, and its importance.

Your health care story is valuable because the reader may be your neighbor, friend, someone in your congregation, or your legislator. It may inspire others to share their stories or to become advocates. It is an opportunity for individuals who receive Medicaid or fall into the coverage gap, their family members, their physicians and concerned Georgia citizens to show that there are real people with real needs who will be impacted by the health policy decisions made by Congress and Georgia’s state leaders.

Share your story here!