On June 3^rd, 2021, the Centers for Medicaid and Medicare Services (CMS) sent a letter to Governor Kemp requesting additional data on the potential impacts of the Georgia Access Model. The Georgia Access Model was put forward by Kemp in his 1332 private insurance waiver, and the model would end access to healthcare.gov for Georgia consumers.

CMS is requesting additional data from the state because they believe recent changes made by President Biden’s administration to the Affordable Care Act’s health insurance marketplace have made the state’s previous analysis outdated or inaccurate. The Biden administration’s changes include:  

• The COVID Special Enrollment Period (SEP)—through August 15, 2021, almost any American who does not have health insurance through their job can enroll in health coverage at healthcare.gov or by phone at 1-800-318-2596;
• More generous and expanded eligibility for Premium Tax Credits (PTCs)—almost anyone who qualifies for coverage through the ACA is now eligible for a discount on their monthly premium; and
• Increased funding for outreach and marketing for the ACA marketplace and enrollment opportunities.

These actions have led to more Americans, and Georgians, enrolling in Marketplace coverage. In addition, CMS believes that ACA enrollment would likely remain higher through 2023, when the Georgia Access Model is slated to begin.

In the letter, CMS also reasons the increase in enrollment could change insurance market dynamics enough to reduce the private sector’s incentive to enroll consumers. CMS believes with fewer uninsured people to enroll, the private sector may be less motivated to reach uninsured individuals. The idea that the private sector will be incentivized to enroll consumers once the competition of healthcare.gov is gone is a crucial assumption of Kemp’s waiver.

Georgia must now respond with updated data that takes into account the new federal changes. The new data will allow CMS to ensure the Georgia Access Model meets the protections specified in Section 1332 of the Affordable Care Act. These protections are:

1. Coverage must be at least as comprehensive as Marketplace coverage;
2. Coverage and protections against high costs must be as affordable as Marketplace coverage;
3. A similar number of people must have coverage under the waiver as without it; and
4. The waiver can’t add to the federal deficit.

The state may also request to adjust the Georgia Access Model, as needed, to meet waiver requirements in light of the new federal policies.

Once Georgia submits the new data about the Georgia Access Model, Georgia consumers, health advocates, and other stakeholders will have a chance to comment on the proposal again. CMS announced in their letter that they will hold a 30-day comment period after they receive Georgia’s new data. GHF expects the comment period will begin in early July. We will be working with our Cover Georgia partners to help Georgia individuals, organizations, and advocates comment. Stay tuned for your opportunity to weigh in again!

Both of Governor Kemp’s health care proposals were approved by federal health officials in the last two weeks. Unfortunately, both proposals fall short of the bold, evidence-based action that Georgians need their state leaders to take. These plans may impact you or people you know. While some details of the plans are still being sorted out, we have tried to answer some of your early questions here. As we learn more and these plans roll out, GHF will keep you updated with the information you need to get covered, stay covered, and help your loved ones do the same.

Yesterday, the Centers for Medicare & Medicaid Services announced the approval of Georgia’s 1332 State Innovation waiver, title “Georgia Access”. Laura Colbert, Executive Director of Georgians for a Healthy Future has issued the following statement:

“Despite repeated attempts, Governor Kemp’s Georgia Access proposal still fails to explain how a shutdown of the most popular and streamlined health insurance enrollment platform in order to move to a decentralized, privatized enrollment system will address the challenges faced by Georgia consumers, especially those who remain uninsured.

Today Governor Kemp and the Centers for Medicare & Medicaid Services announced the approval of Georgia’s 1115 Medicaid waiver & pending approval of 1332 private insurance waiver. Laura Colbert, Executive Director of Georgians for a Healthy Future has issued the following statement:

“In the midst of a once-in-a-century health crisis, Georgians need & deserve bold action from their leaders. Unfortunately, the Governor’s health proposals miss that mark. The plans approved today are insufficient and ill-advised. Georgians deserve better.

On July 9, 2020, Georgia’s Governor announced that his administration had revised his 1332 private insurance proposal. The new proposal consists of two parts:

1. A reinsurance program to lower premiums; and
2. The Georgia Access model—which would separate Georgia from healthcare.gov but would not replace it, instead directing consumers to insurers and web brokers to shop and enroll in coverage.

After a 15-day public comment period during which more than 600 comments were received from the public, Georgia’s Department of Community Health made no changes and submitted the proposal to the Centers for Medicare and Medicaid Services (CMS) for their review on July 31.

CMS deemed the waiver application complete on August 17. The designation began a 30-day public comment period, allowing Georgians, health advocates, and any other interested party to weigh in on the revised proposal. Because of technical difficulties with the comment submission link, the comment period was extended another seven days to September 23, 2020.

More than 1800 individuals and organizations commented during this time, including GHF. You can read GHF’s full comment letter here.

On July 9, 2020, Georgia’s Governor announced that the state was re-opening the public comment period on his 1332 private insurance proposal. The proposal was considerably revised since it was last considered in February of this year. The new plan still consists of two parts:

1. A reinsurance program to lower premiums; and
2. The Georgia Access model—which would separate Georgia from healthcare.gov but would not replace it, instead directing consumers to insurers and web brokers to shop and enroll in coverage.

Other provisions of the previously proposed Georgia Access model were dropped (cap on financial assistance, new kinds of health plans, etc.).

The Governor’s announcement began a 15-day public comment period on the new proposal, allowing Georgians, health advocates, and other interested parties to weigh in. Along with more than 600 others, GHF submitted comments to communicating our deep concerns about the plan’s continued shortcomings. You can read GHF’s full comments here.

On December 23, 2019, the Georgia Department of Community Health (DCH) submitted Governor Kemp’s 1332 private insurance proposal to federal health officials.

The plan consists of two parts:

1. A reinsurance program to lower premiums; and
2. A dramatic erosion of the ACA’s rules and structures, including provisions that privatize insurance enrollment; cap the financial assistance available to low- and middle-income consumers; and erode consumer protections in private insurance

DCH’s submission of the proposal to the Centers for Medicare & Medicaid Services (CMS) comes after a 30-day public comment period, during nearly 1000 Georgians weighed in with their opinions on the plan. Despite the overwhelming opposition to the second part of his plan, Governor Kemp and DCH sent the proposal to federal officials with no meaningful changes.

On February 5, 2020, Governor Kemp wrote a letter to requesting that the reinsurance program be considered separately from the second part of his proposal, and that CMS’s consideration of the second part of the plan be paused. CMS responded to Governor Kemp on February 6 in a letter that deemed the reinsurance program application complete and requested more information about the remaining parts of the Governor’s proposal.

CMS’s response began a 30-day public comment period on the proposed reinsurance program, allowing Georgians, health advocates, and any other interested party to weigh in.

GHF, along with several partner organizations, submitted a comment communicating our support of the reinsurance program, while noting our deep concerns about the remainder of the Governor’s proposal. You can read the full comment letter here.

Legislative Update: Week 4

Legislative session paused amid budget disagreements

The Georgia legislature voted to pause the official legislative calendar last week due to the difficult and sometimes contentious discussions over the state budget. Governor Kemp’s proposed budget cuts for the current and subsequent state budgets have left the legislature to the difficult tasks of finding savings where possible, making cuts to some services and programs, and debating how to bring in sufficient revenue. Speaker of the House David Ralston has instructed the House to hold only budget-related hearings this week. 

The legislature plans to officially reconvene next Tuesday, February 18th for day 13 of this year’s legislative session. According to the legislature’s new calendar, Crossover Day (the day by which a bill has to be approved by at least one chamber in order to remain “alive” for this year) is scheduled for March 12th.

Strong surprise billing legislation introduced

Surprise billing legislation would protect consumers in emergency & non-emergency situations

Last week companion legislation 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. 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. If passed, these bills would protect 2.6 million Georgians from surprise medical bills.

SB 359 has been read and reffered to the Senate Health and Human Services committee. HB 888 is in House first readers and in the House Special Committee on Access to Quality Health Care.

Call one or more of these committee leaders to ask for their support of SB 359 and HB 888: 

• Sen. Ben Watson, Chairman of Senate HHS committee,
  404-656-7880
• Sen. Dean Burke, Vice Chairman of Senate HHS committee, 404-656-0040
• Rep. Mark Newton, Chairman of the House Special Committee, 404-656-0254
• Rep. Sharon Cooper, Vice Chairman of the House Special Committee, 404-656-5069

If your state Senator or Representative is on either committee, please call them as well!

House examines mental health and organ transplant issues

Involuntary commitment emerges as theme in mental health legisation

Two pieces of mental health legislation garnered attention from mental health advocates and legislators last week.

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. This bill sits in the House Judiciary committee but the discussions of this issue may instead be moved to a subcommittee of the Behavioral Health Innovation and Reform Commission.

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. This legislation is not supported by mental health advocacy groups because it could lead to involuntary committal for people with mental health issues. The bill now sits in the House Public Safety and Homeland Security committee.

Gracie’s Law would protect organ transplant discrimination for Georgians with disabilities

Rep. Rick Williams has introduced HB 842, titled “Gracie’s Law.” According to the Georgia Council on Developmental Disabilities (GCDD), Gracie’s Law would protect patients with disabilities from being removed from the organ donor waiting list because of their disability. According to an article in GCDD’s Making a Difference magazine, “While the Americans with Disabilities Act (ADA) denies discrimination based on any disability, there is still a lack of federal enforcement,” prompting the need for state action on this issue. This bill has been referred to the House Insurance committee. You can read more about Gracie’s Law here (pg. 12-13).

Thank you!

Health care heroes like you submitted 1,710 comments!

Before the legislative session began, Governor Kemp filed paperwork with health officials in the federal government to move forward with plans to change Medicaid and private insurance in Georgia. When health officials needed your input on the Medicaid plan, more than 1700 Georgians like you stepped up! 
 

We are incredibly grateful for your advocacy on behalf of Georgians and communities who would benefit from Medicaid expansion in Georgia. Thank you for speaking up for your friends, neighbors, and all Georgians! Now your comments become part of a powerful legal record that health officials must take into acocunt as they decide whether or not to approve Governor Kemp’s Medicaid plan.

Stay tuned! Health officials are still reviewing Governor Kemp’s planned changes for private insurance. When the time comes, we will ask you to speak up again by submitting a comment again! Here and at coverga.org, we will let you know what those changes mean for you and your loved ones and when you can comment.

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.

• Sign up for the Georgia Health ActionNetwork (GHAN) to receive action alerts that let you know when there are opportunities for advocacy and action
• Track health-related legislation
• GHF’s 2019-2020 legislative priorities

Legislative update: Week 3

Georgia House continues budget considerations 

Last week the Georgia House of Representatives resumed its budget hearings in earnest. The House Appropriations subcommittee on Health met on Tuesday to hear more from state agency leaders about their amended FY2020 budget requests. The FY2020 budget runs through June 30, 2020, and is sometimes called the “little budget”. 

It was clear during last week’s hearings that the House may not simply agree to the budget cuts requested by Governor Kemp. Many Appropriations committee members expressed concerns about how the agencies’ proposed cuts would impact access to health care in rural Georgia, the availability of mental health and substance use services, and other critical health services and supports.

Both chambers will reconvene today, February 3rd, for the tenth day of the legislative session. Before scrolling to the latest news on emerging bills and other happenings under the Gold Dome, don’t forget to tell officials what you think of Governor Kemp’s Medicaid plan. The comment deadline is this Friday.

Less than a week to go!

The comment period ends on Friday! Take action now!

Before the legislative session began, Governor Kemp filed paperwork with health officials in the federal government to move forward with their plans to change Medicaid and private insurance in Georgia. Now those health officials need your input, beginning with the Medicaid plan! 

Governor Kemp’s Medicaid plan will leave thousands of low-income Georgians with no meaningful way to get health insurance. Instead of expanding Medicaid to cover 490,000 Georgians, this plan would cover only 50,000 people and cost three times more per person.

We need you to step up AGAIN and become a health care hero by telling national officials what you think of the Medicaid plan! The deadline for comment is Friday, February 7th. Visit coverGA.org to comment today!

Did you submit a comment in November? Please submit a comment again so federal officials can hear directly from you.

Senate starts with prescription drugs & price transparency

SB 313: Updating how Georgia regulates pharmacy benefit managers

Senator Dean Burke has introduced SB 313, a law that would update Georgia’s oversight of pharmacy benefit managers and add important consumer protections. Pharmacy benefit managers (PBMs) are companies that manage prescription drug benefits on behalf of health insurers, and are a new favorite focus of policy makers who want to address rising health care costs. 

SB 313 requires PBMs to charge health insurers the same price for a drug as it receives from the drug manufacturer and that PBMs pass all rebates from the manufacturer to the health plan. (Ideally, these savings are then passed along to consumers.) The bill also disallows PBMS from building drug formularies (lists of covered medicines) in a way that discriminates against people with prescription drug needs. The bill also strengthens the Insurance Commissioner’s ability to hold PBMs accountable to state laws and regulations.

This bill is complex and GHF will continue to report on it through the legislative session. The bill has been referred to the Senate Insurance Committee.

SB 303: Georgia Right to Shop Act

SB 303 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. The legislation is sponsored by Senator Ben Watson, Chairman of the Senate Health & Human Services committee. It has been referred to the Senate Insurance Committee and is expected to be heard this week. 

Focus on nicotine & tobacco continues

Legislation would tax vaping products

Representative Bonnie Rich introduced HB 864 last week, which 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. This bill is one of at least three pieces of legislation that would change how Georgia taxes and regulates tobacco or other nicotine products. HB 731, sponsored by Rep. Ron Stephens, would raise Georgia’s tobacco tax to $1.87 from its current level of $0.37. SB 298, sponsored by Sen. Renee Unterman, would increase the age that Georgians are allowed to purchase tobacco products to 21 years of age, among other things.

Both House Bills have been referred to the House Ways & Means committee and SB 298 has been referred to the Senate Regulated Industries committee.

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.

• Sign up for the Georgia Health ActionNetwork (GHAN) to receive action alerts that let you know when there are opportunities for advocacy and action
• Track health-related legislation
• GHF’s 2019-2020 legislative priorities

On December 23, 2019, the Georgia Department of Community Health (DCH) submitted Governor Kemp’s Medicaid waiver proposal to federal health officials.

The Governor’s proposed 1115 Medicaid waiver, called Georgia Pathways plan, would allow Georgians with incomes below the poverty line to enroll in Medicaid coverage but only if they can meet monthly work requirements (at least 80 hours per month of work, school, training, or volunteering per month). The plan would cover only a fraction of those who could be covered by a full Medicaid expansion.

DCH’s submission of the proposal to the Centers for Medicare & Medicaid Services (CMS) comes after a 30-day public comment period, during nearly 1000 Georgians weighed in with their opinions on the plan. Despite the overwhelming opposition to the plan, Governor Kemp and DCH sent their proposal to federal officials with no meaningful changes.

On January 8, 2020, officials at CMS determined Georgia’s application was complete, which kicked off a second 30-day public comment period. The public comment period allows Georgians impacted by this plan, health advocates, and any other interested party to weigh in.

Along with more than 1700 others, GHF submitted comments to communicating our deep concerns about the plan’s shortcomings. You can read GHF’s full comments here.