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Tag: Medicaid

Moms need Medicaid

Valerie is a mother of three children living in Lamar County. Medicaid covers all three of Valerie’s children, and they rely on the health coverage it provides for their varying health needs. Valerie sometimes has difficulty accessing the care and information the family needs because they live in a rural area, but acknowledges that Medicaid is a lifeline that makes it possible for her to focus on her family’s other needs. Without health insurance through Medicaid, Valerie would have to pay hefty medical bills to ensure her children receive the care they require.

 

Susie is the sole caretaker of her young granddaughter, but she has a hard time caring for herself because she is stuck in Georgia’s coverage gap. She makes more than $6300 annually, so she doesn’t qualify for Medicaid coverage as a caregiver, and she doesn’t make enough to receive financial help to buy health insurance through the Marketplace. Susie is currently undergoing treatment for cancer but because she lacks health coverage, Susie is only able to receive cancer treatments from a doctor that allows her to make low monthly payments. Susie has other chronic health issues that need to be managed but finds it difficult to receive consistent care without insurance. Because Georgia’s elected officials have not extended Medicaid to cover caregivers like Susie, she struggles to care for herself while working to ensure her young granddaughter receives the care and support she needs to grow up healthy and thrive.

Medicaid provides access to needed health care services for low-income soon-to-be-moms, new mothers, and very low-income parents of minor children. For moms like Valerie, Medicaid makes being a mom a little easier by ensuring that their children have access to the health care services they need to grow and stay healthy. For others, Medicaid would help them get or stay healthy so they can best fulfill the responsibilities of being a mothers or caregivers. Over 150,000 uninsured women like Susie would gain health insurance if Georgia’s decision makers extended Medicaid to cover low-income adults (those making less than $16,000 annually for an individual or $20,780 for a family of three).


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For Travis, Medicaid means employment and giving back to the community

Travis suffered from a series of strokes when he was 11 years old that left him with several physical disabilities. He is one of the approximately 250,000 Georgians with disabilities to be covered by Medicaid.

Several years ago, Travis started volunteering with DisabilityLINK because he believes in the power of community and he likes being able to help others. Since then, he was hired as a Independent Living Specialist at the organization, where he connects people with disabilities to community-based resources and assists in coordinating various events at the DisabilityLINK office. He also works alongside other activists on issues such as housing, accessibility and self advocacy.

Travis recognizes that Medicaid is the reason he is able to financially support himself and work for an advocacy organization. Without the support Medicaid provides, Travis explains, he would not be able to help others the way he has been able to through his work at DisabilityLINK. When asked what he wanted others to know about him being able to receive affordable health insurance he replied, “With me working I am able to be a tax paying citizen.”

Medicaid is essential to ensuring that people with disabilities, like Travis, are able to lead fulfilling, independent lives as active participants in their communities. Georgia’s Medicaid program provides almost 2 million low-income children, people with disabilities, seniors, pregnant women, and very low-income parents with access to the health care services that they wouldn’t have otherwise.


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!


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GHF and Step Up Savannah partner to host health advocacy training

Georgians for a Healthy future partnered with Step Up Savannah to host a health advocacy training on Tuesday, April 3rd.  Advocates learned how they could participate and lead health advocacy efforts in their own community and received information about pressing health advocacy issues in Georgia. Representatives from Healthy Savannah and the Chatham County Safety Net Planning Council were also in attendance to share local resources.

The significance of Medicaid was highlighted throughout the event. Participants learned that Medicaid primarily covers low-income children, people with disabilities, seniors, and pregnant women, including 40,000 of Chatham County residents. Alyssa Green, GHF’s Outreach & Education Manager, discussed Georgia’s opportunity close the coverage gap so that 240,000 more Georgians would have access to health insurance coverage. Alyssa shared the story of a Georgia woman who works part-time at DisabilityLINK but is stuck in the coverage gap and, as a result, has trouble managing her high blood pressure.

GHF’s Executive Director Laura Colbert introduced ways that people can advocate for the health care issues that matter most to them, like increased access to healthcare, bringing down health care costs, and protecting the Medicaid program. She explained how to build a relationship with legislator, communicate support or opposition for significant bills, and other forms of advocacy.

The training concluded with presentations from the Chatham County Safety Net Planning Council and Healthy Savannah. The two Savannah-based organizations provided participants with information and resources to promote and build a healthy local community.

 

If you are interested in hosting a training like this in your community, please contact Alyssa Green at agreen@healthyfuturega.org or 404-567-5016 x 2 for more information.


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New tool available to Georgia health care providers to address the opioid crisis

Laura Colbert, MPH, MCHES

 

Every day four Georgians die from opioid overdose and recent data from the Centers for Disease Control and Prevention confirm that the epidemic shows no signs of slowing. Health care providers, public health professionals, community leaders, and families are all searching for effective strategies to slow and stop this growing public health crisis. Some initial steps have been taken by Georgia policy makers and others to increase access to life-saving drugs like naloxone, improve and expand the prescription drug monitoring program (PDMP) to prevent over-prescribing, and raise public awareness about the risks of opioids and other substances, but more is needed. Solutions must include evidence-based strategies that emphasize prevention and early intervention, as well as timely treatment and support for recovery.

An exciting development within Georgia’s Medicaid program gives health care providers an additional tool to aid in the fight against substance use disorders, especially among adolescents and young adults. Georgia’s Medicaid agency has activated the reimbursement codes for a tool called SBIRT, which stands for Screening, Brief Intervention and Referral to Treatment. SBIRT is a set of tools that identifies people who use alcohol or other drugs at harmful levels and guides follow-up counseling and referral to treatment before serious long-term consequences occur.

Ninety percent of adults who meet the medical criteria for addiction started smoking, drinking, or using other drugs before they were 18 years old. Because Medicaid and PeachCare for Kids cover half of all Georgia children, the activation of the Medicaid reimbursement codes for SBIRT is a powerful opportunity to identify youth substance use and intervene early. Studies show that simply asking young people about drugs and alcohol use can lead to positive behavior changes and that brief interventions reduce the frequency and amount of alcohol or other drug use by adolescents.

This policy change was the product of a sustained advocacy effort by Georgians for a Healthy Future (GHF) and the Georgia Council on Substance Abuse (GCSA). We anticipate it will lead to the screening of an estimated 145,000 Georgia youth annually and that 36,000 of those youth will present substance use behaviors that prompt a brief intervention with a health care provider. Initial data from Georgia’s Medicaid agency demonstrates that some providers are already making use of the SBIRT codes in their practices.

Notwithstanding these exciting results, we have committed to continue our efforts to improve access to screening, early intervention, and recovery services and supports for young people across Georgia. While the Medicaid reimbursement codes allow physicians, physician extenders, and advanced practice registered nurses to provide SBIRT services, we recognize that RNs, LPNs, licensed clinical social workers, and certified peer counselors can and should be able to provide SBIRT to youth and adults. Further, the codes allow SBIRT to be provided primarily in health care settings, but that excludes schools and other community-based settings where most young people spend their time.

We invite you to join our efforts to prevent substance use among young Georgians. Spread the word by giving our new fact sheet to the providers in your clinic, public health department, or hospital. If you are a health care provider, attend a training to develop the skills to implement SBIRT with the people that you care for. Join our on-going advocacy efforts to activate the reimbursement codes for more practitioner levels (including RNs and LPNs) and more settings by contacting us to let us know you are interested.

The opioid and substance use crisis that is sweeping Georgia and impacting communities nationwide will require a full spectrum of solutions that leverage the expertise of health care providers, public and private resources, and community and family supports. SBIRT is an evidence-based tool that can play a significant role in our collective efforts to reduce substance use and create a healthier Georgia for all of us.

To learn more, visit our Keeping Youth on a Healthy Path page.

For health care providers: download our new fact sheet here.

 

 

 


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Sine Die

Thats a wrap for the 2018 Georgia legislative session!

The Georgia General Assembly completed the 2018 legislative session in the early morning hours on Friday. A flurry of significant bills passed in the final days of the session. We are disappointed that agreement could not be reached to protect consumers from surprise out of network medical bills, but are heartened that other legislation passed to improve access to health care for consumers across the state. Check out our summary of the more notable bills below and find a full list of health care related legislation at GHF’s legislative tracker.

 


Everything you need to know about the 2018 legislative session

Georgians for a Healthy Future and the Georgia Budget and Policy Institute will be presenting “Changes in Health Care and Policy in the 2018 Legislative Session” on Thursday, April 19th at 10:00 AM. Make sure to join GHF and GBPI to hear an overview about the bills, resolutions, and budgets that were passed and that will affect Georgia’s health care system and consumers. Tune in to this webinar to find out how this session’s legislation may affect your work, your health care, or your coverage.


 

WHAT HAPPENED LAST WEEK
HB 683: Amended FY2018 Budget | PASSED

HB 683 makes adjustments to the state budget for the current fiscal year which runs through June 30, 2018. The FY2018 supplementary budget (also called the “little budget”), makes necessary, mid-year adjustments to the current state budget. Governor Deal signed signed the $25.4 billion amended budget on March 9, 2018 at a ceremony in Polk County. The budget included $1.2 million for hospitals to offset costs due to the high number of flu cases.


HB 684: FY2019 Budget | PASSED 

HB 684 is the budget document for the coming state fiscal year which will run from July 1, 2018 to June 30, 2019. The budget, which totals $26.2 billion, includes several new investments in children’s mental health per the recommendations of the Governor’s Commission on Children’s Mental Health, and fully funds and the Maternal Mortality Review Committee’s (MMRC) recommendations at $2 million. For more information on the health care highlights in the proposed FY2019 budget, read the Community Health and Behavioral Health budget overviews from the Georgia Budget & Policy Institute.


HB 314: Surprise billing legislation | DID NOT PASS

Legislators failed to reach an agreement about how to best resolve the problem of surprise out of network billing for Georgia consumers. HB 314 (formerly SB 359) would have prevented consumers from receiving balance bills when they unexpectedly receive care from providers that are not in their insurance plan networks during emergencies. Surprise out-of-network medical bills can be hundreds of thousands of dollars and are more common when insurance plan provider networks are very narrow and restrictive. Georgia’s provider networks are the narrowest in the nation.


SB 357: Legislation to establish Health Coordination and Innovation Council | PASSED

SB 357 establishes the Health Coordination and Innovation Council and an advisory board to the Council. The Council will act as a statewide coordinating platform, bringing together all of health care’s major stakeholders. It’s members will include the Commissioners of several state agencies as well as a primary care physician, a pharmacist, a dentist, and representatives from the academic community, but there are no specifications about who will serve on the Council’s advisory body. The legislation sunsets in 2022 and will have to be reauthorized in order to operate past July 1st of that year.


HB 769: Recommendations from the Rural House Development | PASSED

HB 769 is the result of the 2017 House Rural Development Council’s work. The bill included a number of provisions, most prominently of which was the creation of a Rural Center for Health Care Innovation and Sustainability within the existing State Office of Rural Health. The bill also increases the rural hospital tax credit to 100%, directed the Department of Community Health to streamline and create efficiencies within the state medical plan, allows for the establishment of micro-hospitals, sets up an incentive program for physicians practicing in rural areas, and redefines “rural county”.


HB 827: Rural hospitals tax credit increase | DID NOT PASS

HB 827, introduced by Rep. Trey Kelley, would have expanded the rural hospital tax credit program from a 90% credit to a 100% credit. The tax credit program went into effect last year and has resulted in the donation of about $10 million to rural hospitals thus far. The legislation was tabled late in the legislative session because the tax credit language was included in HB 769.


HB 740: Education legislation impacting behavioral needs of young students | PASSED

HB 740, which requires schools to provide a multi-tiered system of supports for a student in pre-school through third grade prior to expelling or suspending the student for five or more days was passed by the Senate last week. The legislation provides increased opportunities for schools to screen students for a variety of academic and behavioral health needs, and connect them to the appropriate health and other services.


SB 325: Interstate Medical Licensure Compact Act & Step therapy | DID NOT PASS

SB 325 would have allowed Georgia to enter the “Interstate Medical Licensure Compact Act” which allows health care providers to more easily obtain licenses to practice in multiple states. It would also have granted states easier access to investigative and disciplinary information about providers. All of the bill’s original language was removed and substituted with new legislative language that, among other provisions, limits step therapy and sets up a process for physicians to request exceptions (previously HB 519). Step therapy is a requirement by some insurers that patients try a series of lower-cost treatments before the insurer will cover the treatment prescribed by a patient’s physician.


SB 351: Changes for APRNs | DID NOT PASS

SB 351 would have expanded from four to eight the number of advanced practice registered nurses a physician is allowed to supervise and would allow APRNs to order radiographic imaging for patients if their supervising physician delegated the authority. The legislation was significantly diminished from the original proposal which would have granted APRNs a greater scope of practice.


SB 352: Legislation to establish Commission on Substance Abuse & Recovery | DID NOT PASS

SB 352 establishes a Commission on Substance Abuse & Recovery, headed by a director and charged with coordinating data among relevant government entities; informing strategies to combat the opioid crisis within the Departments of Public Health and Education, the Attorney General’s Office, and other state entities; consulting with the Governor’s office on a potential Medicaid waiver related to opioid abuse; and developing and informing other efforts to expand access to prevention, treatment, and recovery support services across the state.


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House Study Committees Release Final Reports Regarding Health Care

Earlier this week, GHF provided a summary of the recommendations from several Senate study committees and how their findings may affect the health care system and consumers in the state. The Georgia House of Representatives also convened study committees to examine issues directly related to health care, and two of these committees recently released their final recommendations.

The House Study Committee on Georgians’ Barriers to Access to Adequate Health Care (HR 240) examined a broad array of health care issues with a focus on the burden of chronic disease in Georgia. The committee, chaired by Representative Sharon Cooper, issued an exhaustive final report that included several legislative recommendations that could impact consumers. The most pertinent recommendations include:

Increasing access to immunizations: Allow schools to require the second dose of the meningitis vaccination in 12th grade; require hospitals and nursing homes to offer shingles and flu vaccinations; allocate an additional $1 million to the Department of Public Health for additional staff and screenings for the viral hepatitis program; require the Department of Juvenile Justice to check vaccination records and offer vaccinations for juveniles in their care.

Improving testing and treatment for HIV/AIDS: Rewrite state laws to focus criminalization on intention to transmit HIV, as opposed to knowledge of HIV infection; ensure access to HIV treatment regimens for sexual assault victims; increase funding to the Department of Public Health to expand their ability to test for HIV; encourage state-funded health care programs such as Medicaid to expand their outreach for HIV testing.

Facilitating continued enrollment in Medicaid: Engender a policy shift that would allow for the suspension of Medicaid benefits, as opposed to outright termination, for people entering incarceration in the state.

Addressing respiratory diseases: Build upon the existing state asthma plan, which expires in 2018, to include a broader scope of chronic respiratory diseases; expand the screening process for people at risk of COPD to help confirm additional diagnoses.

Expanding access to mental health services: Expand funding for the Department of Behavioral Health and Development Disability’s community service boards; allocate funding for psychiatric residents who specialize in mental health treatment; encourage the use of e-prescriptions for opioid medications in an effort to curb opioid abuse.

You can read the full committee report here.

The House Rural Development Council (HR 389) closely examined a variety of issues that impact rural communities in Georgia and a recurring theme across the state was a need for increased access to quality health care. After 18 meetings in all parts of rural Georgia, the council released several recommendations that could have a significant impact on rural health care consumers.

One of the most noteworthy recommendations encouraged the Department of Community Health to apply for an 1115 Medicaid waiver that would allow participating hospitals and community providers to form a closed network in order to provide care to a set number of uninsured community residents. This waiver would allow Georgia to pull down additional federal funds to provide health care to some of the state’s uninsured population and to test out new ways to deliver high quality care at a lower cost. Unfortunately this idea falls far short of expanding Medicaid, which would provide health coverage to low-income, uninsured Georgians statewide and is the most significant step our state could take in improving access to care for rural Georgians. (Note: the council report refers to this capitated, value-based delivery model as a “block grant,” but this waiver would differ from a block grant in some nuanced, but important ways.)

Like the Senate Study Committee on Barriers to Georgians’ Access to Adequate Healthcare, the council heard a significant amount of testimony on the dearth of practicing medical professionals in rural counties and, as a result, their final recommendations mirror those of the Senate committee. They suggest expanding the scope of practice for mid-level practitioners to allow them to perform certain medial services not currently allowed and implementing a preceptor tax credit program to incentivize medical practitioners to train future healthcare professionals in rural areas.

Finally, the council recommended establishing a Rural Center for Health Care Innovation and Sustainability, which will be responsible for promoting a curriculum of best practices for rural health care. The center will also be used to provide mandatory training for the executive leadership and boards of rural hospitals.

You can read the full committee report here.

As always, you count on GHF to keep you up-to-date on how these recommendations may turn into legislative action when the General Assembly convenes in January. Stay tuned!

 


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Medicaid celebrates 52nd anniversary

At the center of Congress’s recent health care debates has been Medicaid, the government health insurance program for low-income children, seniors, people with disabilities, and pregnant women., and significant support for the program from the public and elected officials is one of the primary factors in the demise of several health reform bills in the U.S. Senate. Since its enactment in 1965, Medicaid has provided millions of Americans with critical health care coverage and services, and it is the largest source of federal funding in state budgets.

In Georgia, Medicaid provides critical support for the health, education, family life, ability to work, and aging of people across the state. Our state’s Medicaid program:

  • Provides health insurance for half of all Georgia children, including 100% of foster children;
  • Ensures almost 40,000 people with disabilities can live and work in their communities rather than in institutions;
  • Supports healthy mothers and babies by covering half of all Georgia births;
  • Assists more than 70,000 low-income seniors by covering their Medicare co-pays and deductibles;
  • Keeps kids in hvac training school san jose by providing needed supports for the 118,000 students with disabilities statewide and funding for school nurses;
  • Is the primary payer for 75% of Georgia’s nursing home stays;
  • Connects people with substance use disorders to life-saving treatment; and
  • Provides health insurance for around 2 million Georgians (20% of the state).

On July 30th, we celebrated the 52nd anniversary of Medicaid (and Medicare), and despite the overwhelming evidence that the program works, its future has been called into jeopardy. Efforts to cut and dismantle Medicaid, wrapped in the cloak of repealing the Affordable Care Act have so far been derailed, but the threat has not yet subsided. Medicaid beneficiaries and supporters alike must continue to oppose any such efforts. If we want to ensure that Medicaid will have another 52 years to contribute to Georgia’s health and prosperity, we have to continue to let our elected officials know we fully support the program and will not accept cuts, caps, block grants or any other proposal that would jeopardize the care of millions and throw our state budget into chaos. We must continue to communicate Medicaid’s importance and put forth evidence-based, patient-centered proposals that strengthen the program and enhance its value for Georgia. We hope you will join us as we work to ensure Georgians can count on Medicaid for another 52 years and more.

For more information about Georgia’s Medicaid program, check out GHF’s Medicaid chart book.


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A win for Georgians

Early this morning, the U.S. Senate’s newly released Health Care Freedom Act was defeated on the Senate floor in a very close vote, bringing to a close a months’ long attempt to dismantle Medicaid and repeal major parts of the Affordable Care Act. This outcome is a victory for Georgians in every corner of the state.

At various points, Congress’s proposed legislation would have forced unconscionable cuts in health care services for vulnerable children, people with disabilities, and seniors who rely on Medicaid, made health insurance unaffordable for low and middle income Georgians, and stripped consumers of critical protections that ensure access, equity, and fairness. The passage of any of the debated proposals would have set Georgia’s health care system back 50 years and put significant strain on our state budget. Instead, we are relieved that these immediate threats have been overcome leaving in place Medicaid and the Affordable Care Act on which so many Georgia consumers rely.

This success would not have been possible without advocates like you. You worked to educate Georgia’s policymakers, mobilize your communities, and stand up for health care for all Georgians. We recognize the hard work that you have invested over the last several months and are grateful to have worked alongside you in this effort. Thank you for your dedication and your advocacy!

Our work is not over

While we celebrate today, we know our work is not over. Too many Georgians remain uninsured, continue to be burdened by high health care costs, face persistent health disparities or cannot access care when and where they need it. Now it’s time for Georgia’s policy makers, health advocates, consumers, and health care stakeholders to come together and find solutions for these problems. We must build on the progress that has been made as a result of Medicaid and the Affordable Care Act so that all Georgians have the coverage and care that they need. We look forward to working towards these goals with you to create a healthier future for all Georgians.


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We can still stop this bill!

Senate votes to open debate on health care bill 

Yesterday, the Senate voted to open debate on health care legislation that cuts and caps Medicaid and repeals major portions of the Affordable Care Act. Both Senators Isakson and Perdue voted in favor of the motion to proceed. The Senate will now begin a required twenty hours of debate followed by consideration of a lengthy list of amendments. There is a lot that still needs to happen before a final vote can be taken.

We can still stop this bill!

The foundation for the Senate debate is made up of proposals that would result in more than 20 million Americans losing coverage, the dismantling of Medicaid on which 2 million Georgia children, people with disabilities, and seniors rely, and the erasure of critical consumers protections. This legislation cannot be fixed with amendments and patch work funding. As the Senate proceeds with its debate, it is incumbent upon us to be vocal and visible in our insistence that these proposals cannot be made better.

We must ensure that Senators Isakson and Perdue hear from Georgians about what is best for our health and health care. There is still time to influence our Senators’ positions before the final vote as Senate leaders have not yet garnered the 50 votes they need for passage of any proposal. Here are three ways that you can make your voice heard in this critical time:

  1. Call Senators Isakson and Perdue. If you called yesterday or if you’ve never called, pick up the phone now. Ask that your Senators reject any bill that 1) results in coverage losses for Georgians; 2) cuts and caps our Medicaid program; 3) guts consumer protections for people with pre-existing conditions; or 4) makes health insurance less affordable for low- and middle-income Georgians. (None of the Senate proposals meet these standards.)
    • Senator Isakson: 202-224-3643 or 770-661-0999
    • Senator Perdue: 202-224-3521 or 404-865-0087
  2. Show Up! Stop by the local offices of Senators Isakson and Perdue to share your health care story and deliver your message in person. Both Senators have offices in metro-Atlanta:
    • Senator Isakson: 3625 Cumberland Blvd, Suite 970, Atlanta, GA 30339
    • Senator Perdue: 3280 Peachtree Rd. NE, Suite 2640, Atlanta, GA 30305

If you are a person of faith, attend a health care pray-in today at noon. No matter where in Georgia you live, you can put your faith into action  and stand up for health care for all Georgians. Click here for details from our partners at the Interfaith Children’s Movement.

3. Ask others to join you. Ask five friends and family members to contact Senators Isakson and Perdue. All Georgians will be impacted by our Senators’ decisions over the next few days. Now is the time for all of us to speak up for what we want (and don’t) in health care reform.

 


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The future of prevention and recovery in Georgia

We know that helping people with substance use disorders get into recovery is hard and requires a lot of resources—a strong support system, the will to recover, and access to necessary health care services and supports.  The prevention of substance use disorders in the first place can take just as much work and requires similar resources.

We also know that the health care bill being considered by the Senate this week, puts recovery and prevention efforts at risk for millions of people, including thousands of Georgians.

The Senate’s proposed legislation would undermine guarantees that private insurance cover treatment for substance use disorders and mental illness. The bill’s $2.5 billion cut to Georgia’s Medicaid program would mean youth in low-income families could be denied critical preventive health services like screenings for depression or substance use disorders or even something as simple as immunizations or avoid seasonal affective disorder with the Best SAD Lamps from SadLampsUSA. People who need treatment services could lose coverage and access to life-saving treatment.

Congress is trying to mask the damage they are doing to our communities by setting up an emergency opioid response fund as part of the health care bill. This fund is insufficient and is no replacement for reliable health care coverage. This proposed “opioid fund” would not make up for deep cuts in Medicaid and a return to private insurance policies that discriminate against people with pre-existing conditions, including substance use disorders. We can’t afford to return to a time when many state Medicaid programs and private insurers covered only short-term, minimal treatment for substance use disorders, if they covered it at all.

The Senate is set to vote on their health care bill this week and Georgia’s senators need to hear from you. Call Senator Johnny Isakson today! Tell him to oppose the legislation because it would harm people in treatment and recovery, handicap prevention efforts that avoid addiction in the first place, and decimate Georgia’s ability to respond to the ongoing opioid crisis.

Call 202-224-3643 today!

(Don’t know what to say when you call? Here’s some help.)


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