Peach Pulse, March 6, 2015


Legislative Update

georgia-capital-buildingYesterday marked the 27th day of the 2015 Legislative Session. Crossover Day, the 30th legislative day and the deadline for a bill to pass its chamber of origin to remain viable for 2015, is set for next Friday, March 13th. Sine Die, the 40th and final legislative day for the year, will be April 2nd.

It has been a big week for health care issues at the State Capitol. GHF brought the consumer perspective to Senate Insurance on Wednesday and shared with the committee through testimony from our Executive Director the challenges that consumers face in obtaining accurate information about provider networks at the time they sign up for health insurance and why setting network adequacy standards is important for consumers. Her testimony was provided as part of the discussion around SB 158. Also this week, legislation was introduced in the Senate that would establish a study committee on preventing youth substance use disorders, the Senate began its work on the FY 2016 budget, and a range of other health care bills were discussed.

The State Budget:  The FY 2016 Budget passed the House of Representatives and is now in the Senate. The Senate expects to finish their revisions to the budget this week and send it back to the House and then to a conference committee.

Medicaid Parity:  Last week, the House of Representatives added $2.96 million in the budget to increase reimbursement for certain OB/GYN services and $1.5 million for reimbursement rate increases for certain primary care services. Because Medicaid parity has been shown to be an effective strategy for improving access to care, GHF supports raising Medicaid reimbursement rates to parity with Medicare rates. We are advocating for a higher appropriation amount for Medicaid reimbursement rate increases as the budget moves through the process.

SBIRT Resolution:  Senate HHS Chairwoman Renee Unterman officially introduced a resolution (SR 407) to form a joint House and Senate Study Committee on preventing youth substance use disorders. Through GHF’s work with the Georgia Council on Substance Abuse, we are advocating for a public health approach to substance use disorders that focuses on prevention. This resolution gets the conversation started about how to do that in Georgia. Please take the time to thank Senator Unterman for her support of this effort and to let your elected officials know you support SR 407.

SB 158 (Sen. Burke) provides certain consumer and provider protections regarding health insurance, including network adequacy language. SB 158 has been referred to the Senate Insurance Committee where it received a hearing on Wednesday, March 3.  GHF Executive Director Cindy Zeldin testified in committee, focusing specifically on the network adequacy component of the bill. GHF also met with committee members individually about the bill after the committee hearing.  While the bill is not expected to move in its current form this legislative session, there will likely be a study committee on the network adequacy component. GHF has identified network adequacy as an important consumer issue and plans to remain engaged on this topic as discussions move forward.

Closing the Coverage Gap: No hearings have been scheduled or are pending to address the possibility of expanding Medicaid in Georgia. Closing Georgia’s coverage gap by expanding Medicaid would open a pathway to health insurance for approximately 300,000 uninsured Georgians, an approach which GHF supports.  Two bills have been introduced to address Georgia’s coverage gap (HR 226 and SB 38), although neither is expected to receive a hearing. Please thank the cosponsors of these bills, Rep. Rahn Mayo and Senator Vincent Fort, for their support and show your support by filling out a postcard that we’ll mail to your legislators!

Tobacco Tax:  No additional standalone proposals have been made to increase Georgia’s tobacco tax (other than HB 445 as previously reported).  The Senate however, may respond to the House proposal on transportation funding by including a tobacco tax increase to the regional average of around 68 cents. Importantly, Alabama’s Governor is proposing an increase in their state tobacco tax to $1.25 per pack, which would increase the regional average.  GHF continues to advocate for an increase to the national average by raising our tobacco tax by $1.23.  Such an increase would generate $585 million per year according to the fiscal note generated by the non-partisan fiscal office at GSU.


Other Bills of Interest

Below is a summary of bills that may impact health care consumers in Georgia, with information about where they are in the legislative process.

SB 1 (Sen. Bethel) provides certain insurance coverage for autism spectrum disorders. SB 1 has passed the Senate and is in the House Insurance Committee.

HB 1 (Rep. Peake) would allow for the limited use of medical marijuana for conditions including cancer, amyotrophic lateral sclerosis, seizure disorders, multiple sclerosis, crohn’s disease, mitochondrial disease, fibromyalgia, parkinson’s disease, and sickle cell disease.  HB 1 passed the House of Representatives and is now in the Senate Health and Human Services Committee.

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Peach Pulse, February 27, 2015


Legislative Update

georgia-capital-building

Yesterday marked the 23rd day of the 2015 Legislative Session. We are getting closer to Crossover Day, the 30th legislative day and the deadline for a bill to pass its chamber of origin to remain viable for 2015. Crossover Day is set for March 13th. Sine Die, the 40th and final legislative day for the year, will be April 2nd.

As part of this week’s legislative update, we sat down with Representative Debbie Buckner and spoke with her about access to care in rural communities, Georgia’s coverage gap, and other health care issues on her mind this Legislative Session.

To watch the video, click on the image below.

The State Budget

The FY 2016 Budget passed the House of Representatives this week and now heads to the Senate for hearings. Of note, the House of Representatives added $2.96 million in the budget to increase reimbursement for certain OB/GYN services, $1.5 million for reimbursement rate increases for certain primary care services, $1.3 million to increase the hourly rate for personal support services under the Independent Care Waiver Program, and $500,000 to increase reimbursement for air-ambulance services for adult patients. The House also added in $3 million to implement the recommendations of the Rural Hospital Stabilization Committee. The House removed $22.8 million for new treatment medications for patients with Hepatitis C and $12.1 million for costs to launch a new case management program for enrollees eligible under the Aged, Blind, & Disabled program. Also of note, the House reinstated health coverage for non-certificated part-time school employees; however, local school districts and not the state would be responsible for those costs. Click here for an analysis of the health care provisions in the budget that passed the House from our friends at the Georgia Budget & Policy Institute.

Closing the Coverage Gap

Closing Georgia’s coverage gap by expanding Medicaid would open a pathway to health insurance for approximately 300,000 uninsured Georgians. Two bills have been introduced to address Georgia’s coverage gap (HR 226 and SB 38), although neither is expected to receive a hearing. Please thank the cosponsors of these bills, Rep. Rahn Mayo and Sen. Vincent Fort, and show your support for closing the coverage gap by filling out a postcard that we’ll mail to your legislators!

Tobacco Tax

HB 445 (Carson) represents the first additional or alternative funding proposal to the transportation funding bill (HB 170). While the overall bill includes regressive provisions including an increased sales and grocery tax combined with a reduction in the income tax that GHF does not support, it is notable that a tobacco tax is in the mix in the bill. This keeps the tobacco tax on the radar and provides an opportunity for health advocates to continue to push for an increase to the national average in the tobacco tax to curb smoking rates and bring in much-needed revenue.

Other Bills of Interest

Below is a summary of bills that may impact health care consumers in Georgia, with information about where they are in the legislative process.

SB 1 (Sen. Bethel) provides certain insurance coverage for autism spectrum disorders. SB 1 has passed the Senate and is the House Insurance Committee.

SB 158 (Sen. Burke) provides certain consumer and provider protections regarding health insurance, including network adequacy language. SB 158 has been referred to the Senate Insurance Committee.

HB 1 (Rep. Peake) would allow for the limited use of medical marijuana for conditions including: cancer, amyotrophic lateral sclerosis, seizure disorders, multiple sclerosis, crohn’s disease, mitochondrial disease, fibromyalgia, parkinson’s disease, and sickle cell disease.  HB 1 passed the House of Representatives and is now in the Senate Health and Human Services Committee.

HB 195 (Rep. Cooper) and SB 51 (Burke) provides parameters for substitutions of interchangeable biological products. HB 195 passed the House Health and Human Services Committee and is expected to come out of the Rules Committee next week, and Senate Bill 51 has passed the Senate and has been assigned to the House HHS committee, but is not expected to get a hearing until after crossover day.

HB 482 (Rep. Willard) seeks to eliminate two of the requirements that the Cancer Treatment Centers of America are currently subject to when they were allowed into Georgia as a destination hospital.

HB 416 (Rep. Rogers): Routinely referred to as the badge bill, HB 416 seeks to provide clarity and transparency for the patient as to the qualifications of the provider that they are seeing.  The bill calls for providers to identify the health care practitioner’s name and the type of license or educational degree the health care practitioner holds. The bill will be heard in the House HHS committee on Monday March 2, 2015 at 3 PM.

HB 34 (Rep. Dudgeon) is known as the “Right to Try” bill and calls for patients with advanced illnesses and in consultation with their doctor to use potentially life-saving investigational drugs, biological products, and devices.


Georgia’s Plan to Strengthen Rural Hospitals

Earlier this week, the Rural Hospital Stabilization Committee (RHSC), created by Governor Deal to address the needs of struggling rural hospitals and find solutions that address those needs, issued its final report. The recommendations in the report include:

  • A four site “Hub & Spoke” pilot program
  • Maintenance and protection of Certificate of Need laws
  • Expanded scope of practice for non-physician providers, like physicians assistants and nurse practitioners
  • More support for school-based health centers

The committee’s work shines a spotlight on the health care access challenges that rural Georgians face and puts forth constructive recommendations.  While we support these recommendations whole-heartedly, we are also disappointed that the committee did not address the coverage gap and Medicaid expansion in its report.

Georgia Health News interviewed Georgians for a Healthy Future’s Executive Director on this issue (click here to read the full article), and in that article she pointed to the early success of states like Kentucky, which recently reported improvements and coverage rates and in health care access due to Medicaid expansion. She also encouraged policymakers to take a comprehensive approach that includes closing Georgia’s coverage gap to help get people into health insurance and provide a reimbursement stream for rural hospitals.

Back in December, Georgians for a Healthy Future, together with several consumer and community-focused organizations including the Georgia Budget and Policy Institute, Georgia Watch, and Families First, submitted a report and provided public comment to the committee making a detailed case for such an approach. You can read that full report here.


Medicaid Minute

Medicaid provides health insurance to low-income families and vulnerable populations in states across the country, allowing them to access necessary health care services. In states that have opted to implement the Medicaid expansion, people are enrolling in the program and uninsured rates are plummeting. Nationwide, 10.8 million Americans gained coverage through Medicaid just between October and December 2014. Unfortunately, these coverage gains vary widely among states. According to the US Department of Health and Human Services, states that expanded Medicaid saw a 27 percent increase in Medicaid and CHIP enrollment in the last year, while non-expansion states saw only a 7 percent increase. Too many Georgians are still stuck in the coverage gap.  Fill out an e-postcard that we’ll send to your legislators letting them know that it’s time Georgia fixed this problem and closed its coverage gap.


What is a 1095-A?
And other burning questions about health insurance and tax filing?

flowchart

If you are a consumer who enrolled in health insurance through the Marketplace with a tax credit, you likely received a 1095-A form in the mail. You may also have some questions about how to complete the health insurance information on your tax filing form. If your organization works directly with consumers, either providing enrollment assistance or helping them with tax preparation, you may also be hearing about the 1095-A and may have some questions about how health insurance and tax filings intersect. Below is a primer, replete with flow chart, which breaks it all down for you.

Where consumers get their coverage—Marketplace, employer, Medicaid—will determine the impact coverage has on their taxes.  Consumers who have health insurance through their jobs will likely see no changes when they file their taxes – they just check the box on their tax forms indicating they had coverage throughout the year.  The same thing applies to consumers who are covered by Medicaid, Medicare, or their parent’s health plan.  Pretty simple!

During this year’s open enrollment period, 536,929 Georgians purchased health insurance through Healthcare.gov and about 90% received financial assistance to help lower the cost of their premiums.  To keep that tax credit, they’ll have to fill out Form 8962, which asks questions about their health insurance and their income. To help complete that form, all consumers that received a tax credit should have received Form 1095-A in the mail from the Marketplace. Consumers can also find this form on their Healthcare.gov account.

The health insurance tax credit is based on income and household size. When consumers applied for coverage, they estimated their income for the coming year and that amount was used to determine their tax credit. If a consumer misestimated their income, the credit they received may be too high or too low. During the tax filing process, the difference between estimated and actual income is reconciled, and the corresponding tax credit may be adjusted up or down.  This means some consumers may get a refund and some consumers may have to pay back part of their tax credit. If a consumer did not apply for a tax credit previously, they can apply for a credit to be included in their tax refund.

If a consumer went without health care coverage at any point in the year, they may need to fill out an additional Form 8965 to determine whether or not they will need to pay a fine. This year the maximum fee per family will be $285, but fines will increase each year, up to 2% of a person’s annual income.  If a person falls into Georgia’s coverage gap, they will not have to pay the fine, but will need to file the appropriate documents to prove they do not have access to affordable coverage

Household, family, and income changes should be reported throughout the year to Healthcare.gov in order to avoid surprises at tax time.

If you have questions about how your health coverage may affect your taxes, consult a tax professional.  Our partners at Georgia Watch can connect you with free tax preparation help—just click here.


So You Have Coverage…Now What?

If you have recently gained health insurance through the Health Insurance Marketplace, it may seem like you need to learn a whole new language to understand your coverage. Health insurance can be confusing, especially if you have never had it before or haven’t had it in a while. Just understanding a few key terms, such as premium, deductible and co-pay, will go a long way in helping you use your health insurance effectively. Click here for a simple guide to help you understand your new coverage. Additionally, if you are having trouble using your health insurance you can contact Whitney Griggs, GHF’s Consumer Education Specialist, at wgriggs@healthyfuturega.org or at (404) 567-5016, extension 5.


Action Alert: CHIP in Danger

Federal funding for the Children’s Health Insurance Program (CHIP), known as PeachCare for Kids in Georgia, expires in September 2015.  More than 200,000 Georgia kids rely on this program for access to health care services.  The U.S. Congress has signaled that it is willing to consider extending CHIP funding. This is great news. However, some of the discussion include provisions that provide access barriers.  Some concerning provisions include the removal of protections that were included in the ACA, an optional 12-month waiting period for coverage, and cuts to CHIP funding for certain groups of children in some states. (Click here for a full analysis of the draft plan.)  You can help by telling your legislators to pass a clean renewal of CHIP funding that does not impose barriers to enrollment and coverage for kids.  Here are some ways to get in touch:

  • Write a letter or call your congressman. Click here to see suggested language from our partners, Voices for Georgia’s Children.  Click here to find your congressman, senator and their contact information.
  • Tweet at your representatives in congress. See the list below for their Twitter handles.  Use the hashtags #ExtendCHIP #keepkidscovered and #CHIPWorks
  • Share this image from Voices for Georgia’s Children (@georgiavoices) on social media to spread the word.

CHIP_monkey

Senate

Johnny Isakson

@SenatorIsakson 200,000 GA kids rely on PeachCare to receive the critical care they need. #ExtendCHIP so we can #keepkidscovered #CHIPWorks (Click here to tweet this)

David Perdue

@sendavidperdue 200,000 GA kids rely on PeachCare to receive the critical care they need. #ExtendCHIP so we can #keepkidscovered #CHIPWorks (Click here to tweet this)

House

Buddy Carter (1st District)

@RepBuddyCarter 200,000 GA kids rely on PeachCare to receive the critical care they need. #ExtendCHIP so we can #keepkidscovered #CHIPWorks (Click here to tweet this)

Sanford Bishop Jr. (2nd District)

@SanfordBishop 200,000 GA kids rely on PeachCare to receive the critical care they need. #ExtendCHIP so we can #keepkidscovered #CHIPWorks (Click here to tweet this)

Lynn Westmoreland (3rd District)

@RepWestmoreland 200,000 GA kids rely on PeachCare to receive the critical care they need. #ExtendCHIP so we can #keepkidscovered #CHIPWorks (Click here to tweet this)

Hank Johnson Jr. (4th District)

@RepHankJohnson 200,000 GA kids rely on PeachCare to receive the critical care they need. #ExtendCHIP so we can #keepkidscovered #CHIPWorks (Click here to tweet this)

John Lewis (5th District)

@repjohnlewis 200,000 GA kids rely on PeachCare to receive the critical care they need. #ExtendCHIP so we can #keepkidscovered #CHIPWorks (Click here to tweet this)

Tom Price (6th District)

@RepTomPrice 200,000 GA kids rely on PeachCare to receive the critical care they need. #ExtendCHIP so we can #keepkidscovered #CHIPWorks (Click here to tweet this)

Rob Woodall (7th District)

@RepRobWoodall 200,000 GA kids rely on PeachCare to receive the critical care they need. #ExtendCHIP so we can #keepkidscovered #CHIPWorks (Click here to tweet this)

Austin Scott (8th District)

@AustinScottGA08 200,000 GA kids rely on PeachCare to receive the critical care they need. #ExtendCHIP so we can #keepkidscovered #CHIPWorks (Click here to tweet this)

Doug Collins (9th ,District)

@RepDougCollins 200,000 GA kids rely on PeachCare to receive the critical care they need. #ExtendCHIP so we can #keepkidscovered #CHIPWorks (Click here to tweet this)

Barry Loudermilk (11th District)

@RepLoudermilk 200,000 GA kids rely on PeachCare to receive the critical care they need. #ExtendCHIP so we can #keepkidscovered #CHIPWorks (Click here to tweet this)

Rick Allen (12th District)

@RepRickAllen 200,000 GA kids rely on PeachCare to receive the critical care they need. #ExtendCHIP so we can #keepkidscovered #CHIPWorks (Click here to tweet this)

David Scott (13th District)

@repdavidscott 200,000 GA kids rely on PeachCare to receive the critical care they need. #ExtendCHIP so we can #keepkidscovered #CHIPWorks (Click here to tweet this)

Tom Graves (14th District)

@RepTomGraves 200,000 GA kids rely on PeachCare to receive the critical care they need. #ExtendCHIP so we can #keepkidscovered #CHIPWorks (Click here to tweet this)

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Peach Pulse, February 20, 2015


Legislative Update

georgia-capital-buildingToday marked the 19th day of the 2015 Legislative Session (almost at the halfway point)! Crossover Day, the 30th legislative day and the deadline for a bill to pass its chamber of origin to remain viable for 2015, is set for March 13th. Sine Die, the 40th and final legislative day for the year, will be April 2nd.

As part of this week’s legislative update, we caught up with Senator Chuck Hufstetler and spoke with him about his proposal to increase the state’s tobacco tax by $1.23, which would bring Georgia up to the national average.  According to a fiscal note released this week by Georgia State University at legislative request, this increase would yield more than $500 million in new revenue. To read more about the tobacco tax, download our one pager.  To see the media coverage, check out our “In the News” page.


Other issues we’re watching include:

The State Budget

Our friends over at the Georgia Budget & Policy Institute have put together an analysis of the health care spending within the proposed 2016 state budget. Click here to read GBPI’s health care budget overview.

 

Medicaid Payment Parity

cindy on medicaid parityThis week, the House Appropriations Health Subcommittee held a hearing on the FY 2016 Budget. A range of organizations and individuals provided testimony in support of payment parity, citing the evidence that shows provider rate increases result in better access to care for patients and consumers. Georgians for a Healthy Future spoke in support of payment parity at the hearing.

 

Closing the Coverage Gap

Closing Georgia’s coverage gap by expanding Medicaid would open a pathway to health insurance for approximately 300,000 uninsured Georgians. Two bills have been introduced to address Georgia’s coverage gap (HR 226 and SB 38), although neither is expected to receive a hearing. Please thank the cosponsors of these bills for their support and show your support by filling out a postcard that we’ll mail to your legislators!


More than half a million Georgians enroll in Marketplace health insurance

Open Enrollment for the Health Insurance Marketplace ended Sunday and over half a million Georgians enrolled in plans through the Marketplace! Georgia’s enrollment was the fourth highest of states using the Federally Facilitated Marketplace, trailing only behind Texas, Florida, and North Carolina. The state’s enrollment numbers passed the 500,000 mark in large part due to a last minute surge in sign-ups. This year’s enrollment numbers greatly exceed last year’s exchange enrollments of 316,543. Nationally, 11.4 million Americans selected plans or were automatically re-enrolled through the Marketplace. Click here to learn more about Georgia’s enrollment numbers.

For Georgians who begun the enrollment process prior to the deadline but, due to issues with either healthcare.gov or call centers, were unable to complete their enrollment, CMS has extended a Special Enrollment Period (SEP).  These people are “in line” and still eligible to enroll this year.  This SEP will end February 22nd.  If you or someone you know thinks they qualify for this extended enrollment period visit HealthCare.gov or call the Marketplace Call Center at 1-800-318-2596.


Miss open enrollment? You may still be able to get coverage!
Open Enrollment has officially ended but some Georgians that missed signing up during the three month period may be able to still get coverage. Those “in line” during this last three days of Open Enrollment who were unable to select a plan due to long call center wait times or technical issues have until Sunday, February 22 to enroll. In this circumstance, coverage will begin March 1st.  Otherwise, consumers who have a “qualifying event” may be able to get coverage through a Special Enrollment Period. Special Enrollment Periods can occur at any time during the year and are usually triggered by specific events. These events include life changes such as a marriage, birth, change in eligible immigration status and a permanent move. Another type of event that could qualify consumers is a loss of other health coverage. These types of events could include an involuntary loss of employer coverage, loss of Medicaid coverage, and a death or divorce that results in a loss of coverage. In most cases, the Special Enrollment Period lasts for 60 days after the qualifying event occurs. To learn more about what types of events could trigger a Special Enrollment period, click here. If you think you may qualify, visit https://www.healthcare.gov/get-coverage or https://localhelp.healthcare.gov/ to find in-person assistance in your area.

Additionally, the Centers for Medicaid and Medicare Services just announced a Special Enrollment Period for tax season for consumers who were penalized for not having coverage in 2014 and are not currently enrolled in health insurance. To qualify for this Special Enrollment Period consumers must also attest that they were not aware of the penalty for not having health insurance until after the end of Open Enrollment (February 15th , 2015) because they filed their 2014 tax return after that date. This Special Enrollment Period will begin March 15th and end April 30th, 2015. Click here to learn more about the announcement.


 GHF welcomes new Consumer Education Specialist

WhitneyWhitney joined Georgians for a Healthy Future this week as our Consumer Education Specialist. In this role, Whitney will educate consumers who have questions about how to understand and use their health insurance as well as assist consumers who encounter problems with their insurance plan. Whitney will also be on the lookout for patterns that can help inform GHF’s policy and advocacy work in the area of private health insurance. Whitney comes to GHF from the Healthy Mothers Healthy Babies Coalition of Georgia, where she was lead health navigator. As a health insurance navigator, Whitney provided enrollment assistance for the Health Insurance Marketplace to consumers in rural Georgia. In this role she also conducted extensive outreach throughout the state to inform consumers about the Affordable Care Act and the new health insurance options available under the law. Prior to her role as a navigator, Whitney worked for Healthy Mothers Healthy Babies as an Information and Resource Specialist for their health care referral service, called the Powerline. In this position she helped find and verify health care providers throughout the state for the referral line. Whitney has also worked in the Child Life Division at Children’s Healthcare of Atlanta. Whitney earned her B.S. in Psychology with a focus on Biological Psychology from Clemson University. Whitney can be reached at wgriggs@healthyfuturega.org.  Please welcome her to Georgians for a Healthy Future!


National partner features our collaboration with the Diverse Elders Coalition and the Bhutanese Association of Georgia

351Check out Community Catalyst’s blog featuring the collaboration between GHF, the Diverse Elders Coalition, and BAG to help Bhutanese refugees living in Clarkston, Georgia enroll in health insurance!


Medicaid Minute

Kentucky_beforeKentucy_After

New data released from Kentucky show the success of Kentucky’s Medicaid expansion program.  Here are a few quick highlights.

  • 375,000 Kentuckians got covered
  • Hospitals gained more than $500 million in just the first year
  • 12,000 new jobs were created (with an additional 28,000 jobs expected over the next 7 years)
  • Uncompensated care in hospitals fell 60%
  • Estimated costs of expansion in current and subsequent biennial budget are more than offset by savings and new revenues generated from economic activity resulting from new health care spending
  • Choosing not to expand would have cost the state about $100 million

Fill out our survey and tell your legislators know it’s time for Georgia to close its coverage gap!


 

Infographic of the Week

MCD_Georgia-Medicaid-gap-and-employment_infographic

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Peach Pulse, February 12, 2015


Legislative Update

georgia-capital-buildingToday marked the fifteenth day of the 2015 Legislative Session—we’re more than one-third of the way through already! Crossover Day, the 30th legislative day and the deadline for a bill to pass its chamber of origin to remain viable for 2015, is set for March 13th. Sine Die, the 40th and final legislative day for the year, will be April 2nd.

Georgians for a Healthy Future is monitoring and advocating on bills of importance to health care consumers in Georgia. As part of this week’s legislative update, we spoke with Senate Insurance Committee Chairman Charlie Bethel about the legislation moving through his committee and about his priorities with respect to health care policy in Georgia. This conversation also includes a discussion of Senate Bill 1, which would provide for certain insurance coverage for autism spectrum disorders.

Other issues we’re watching include:

The State Budget

Our friends over at the Georgia Budget & Policy Institute have put together an analysis of the health care spending within the proposed 2016 state budget. Click here to read GBPI’s health care budget overview. 

Medicaid Payment Parity

Last week, Sen. Unterman talked to us about her request for $60 million to restore Medicaid payment parity.  Sen. Unterman and advocates continue to work with the health appropriations chairmen in both chambers, but no decisions have been made to date.

Closing the Coverage Gap

Closing Georgia’s coverage gap by expanding Medicaid would open a pathway to health insurance for approximately 300,000 uninsured Georgians. Two bills have been introduced to address Georgia’s coverage gap (HR 226 and SB 38), although neither is expected to receive a hearing. Please thank the cosponsors of these bills for their support and show your support by filling out a postcard that we’ll mail to your legislators!

Tobacco Tax

Georgians for a Healthy Future and our coalition partners continue to support a $1.23/pack increase in Georgia’s tobacco tax to bring us in line with the national average, decrease smoking rates, and bring in needed revenue for health care investments in our state. Click here for our new fact sheet on why Georgia should increase the tobacco tax. While no legislation has been introduced this session to increase the tobacco tax, we expect it may enter the mix as legislators discuss transportation funding.

We will continue to monitor this issue and will let you know when advocacy opportunities arise.


Time is running out – get covered today!

Open enrollment is quickly coming to a close, ending this Sunday, February  15th.  If you haven’t gotten covered yet or you know someone who doesn’t have coverage, don’t wait!  Act now before Sunday’s deadline.  Click here to find a Navigator near you or visit healthcare.gov to sign up.  These Georgians got covered and you can too!

Got Covered - CorneliaCornelia, a recent college graduate, had coverage on her parents’ plan…until she turned 26 and became ineligible.  She really wanted to stay with the same insurer, but also needed an affordable plan.  She applied and found that she qualified for a plan with the same carrier with even better coverage for less money. After her subsidy, Cornelia’s plan cost her only $83 per month.

Got Covered - ScottScott Quimby found an enrollment event near his home by visiting getcoveredamerica.org. He and his wife were able to enroll in a plan, which is a big deal because his wife had a pre-existing condition.  She had suffered brain trauma previously and expressed how grateful she was that she could get covered at an affordable price because of the Affordable Care Act: “I know I made the best decision because I came and got help.”

Got Covered - Mechul2Mechul had gone uninsured previously—for six years—going to the ER when he was seriously ill. He lost coverage when he turned 18, having been enrolled in Medicaid until then as a foster child under his grandmother’s care. He was told when he was younger he was pre-diabetic and felt anxious not have a way of getting regular care.  In March, he went to healthcare.gov to try to enroll but then decided to a navigator to get more information, and finally completed enrollment himself at home. He found a no cost silver-level plan, which was great because cost was the most important factor for him.  Now Mechul is employed and will get coverage through his employer, but he said it was a relief and gave him peace of mind to have health insurance there when he needed it.

If you or someone you know has an enrollment success story they’d like to share, let us know!  With your help, others can get covered and stay covered.


King v. Burwell — What’s at stake for Georgia?

King Burwell Potential Result

On March 4th, the United States Supreme Court will hear oral arguments in King v. Burwell, a lawsuit challenging the tax credits that consumers utilizing the federal Health Insurance Marketplace receive to help make health insurance affordable. Consumers in thirty-four states, including Georgia, use the federal Marketplace to find and enroll in coverage. Nearly nine out of 10 people who enrolled in coverage through healthcare.gov received financial help and paid 75 percent less than the full monthly premium. This has helped bring the nation’s uninsured rate to an historic low.

A study by the Robert Wood Johnson Foundation and the Urban Institute found that the majority of health care consumers who would be impacted and who would likely become uninsured if the tax credits were struck down live in the South. Here in Georgia, hundreds of thousands of people are at risk for becoming uninsured.

We believe there is no legal basis for this challenge and that in June, when a decision comes down, we’ll all breathe a sigh of relief. If the court does, however, strike down the tax credits, such a decision would disproportionately impact the South and would put states like Georgia at a competitive disadvantage by exacerbating existing regional health disparities. If this comes to pass, Georgians for a Healthy Future will advocate for a contingency plan to ensure that Georgians have the same access to tax credits that their counterparts in states like New York, California, Colorado, and Kentucky (states that set up their own health insurance exchanges) have.

Our friends at Families USA have put together a resource page for advocates interested in learning more about King v. Burwell. Click here to find out everything you need to know about the case!


Medicaid Minute

This week, we learned that the Tennessee legislature failed to pass the Insure TN plan.  This is a big disappointment for the 300,000 Tennesseans who fall into the coverage gap and who could have had access to health insurance if the Tennessee plan moved forward. This outcome shows how important it is to garner support from elected officials on both sides of the aisle. There are lessons we can learn for our work here in Georgia. Thank you to all of the Georgia advocates who continue to reach out to your legislators across the state to let them know you support closing Georgia’s coverage gap.  If you’d like to get involved and join the Cover Georgia coalition, email Laura Colbert.


Infographic of the Week

deadline-fine

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Peach Pulse, February 5, 2015


Legislative Update

With this week’s legislative update, we bring the Gold Dome to you! Our biggest update this week is that Senator Renee Unterman is making a $60 million appropriations ask in the state budget to maintain Medicaid payment parity. Medicaid payment parity is an effective strategy to increase access to health care services for low-income children and families enrolled in Medicaid (click here to learn more about what payment parity is and why it matters for health care access). Your GHF team was at the Capitol this week to talk with Senator Unterman about her proposal.

Renee_Unterman_Screenshot

Also this week, the Senate Appropriations Subcommittee on Health held a hearing that included discussion about Medicaid payment parity. No decisions were made at the hearing but we expect the topic will come up again. What can advocates do?  Contact one or more of these legislators!

  1. Call or email Senator Unterman and thank her for leading the charge on this important initiative!
  2. Call or send an email to Senator Burke, who chairs the Senate Appropriations Subcommittee on Health, and Representative Butch Parrish, who chairs the House Appropriations Subcommittee on Health, and thank them for their support on Medicaid payment parity.
  3. Contact Senate Appropriations Chair Jack Hill and House Appropriations Chair Terry England and let them know you support Medicaid payment parity.

Other issues we’re watching.

Medicaid Expansion

There has been no action to date on closing the coverage gap by expanding Medicaid. Please contact your legislators and the leaders of the Health and Human Services and Appropriations Committees to ask them to hold hearings on this important issue.

Click here to let your state senator and representative know that you support closing Georgia’s coverage gap.

Tobacco Tax

Georgians for a Healthy Future and our coalition partners continue to support a $1.23/pack increase in Georgia’s tobacco tax to bring us in line with the national average, decrease smoking rates, and bring in needed revenue for health care investments in our state. All eyes in the House and Senate have been on the transportation funding proposal unveiled last week on the House side, which did not include an increase in the tobacco tax. However, the Senate is expected to take a more diversified approach in this area and the possibility of a tobacco tax increase may be on the table. We will continue to monitor this issue and will let you know when advocacy opportunities arise.

Other Health-Related Bills

Senate Bill 1, which would require insurance companies to provide limited autism benefits for Georgians enrolled in certain individual and small group plans passed the Senate and is now on the House side. A hearing has not been scheduled for the bill on the House side.

Senate Bill 74, which would authorize tax credits for donors to health charity organizations, has been introduced in the Senate and referred to the Senate Finance Committee.


Knowledge is power: Terry’s enrollment story

Terry S“This is your health we’re talking about.  How important is it to you?”  Terry Stidom, an Atlanta health care consumer, cares about his health and is glad about his decision to get covered. “It became a no-brainer,” he said about his decision to enroll in a health plan through the Health Insurance Marketplace last year.  This year, with the increase in providers and plans available in Georgia, he was able to find an even more affordable, comprehensive plan.  What does he love about his plan?  “[It] includes medical, dental, vision, no deductible, low doctor visit co-pays, I get $20 a month in cash back just for going to a gym at least 8 times per month — the list goes on.”  While Terry researched his options and signed up on his own, he encourages others to seek help.  “As you sit and look at each plan, don’t be intimidated by the numbers.  If you’re unsure, call someone to help you.  Knowledge is power!”

Open enrollment ends February 15th – don’t miss out on the opportunity to find the plan right for you and your family.  Click here to find a Navigator in your area and get covered today!

If you or someone you know has an enrollment success story they’d like to share, let us know!  With your help, others can get covered and stay covered.


2015 Advocate’s Guides are Here!

Advocates_Guide_2015Each year Georgians for a Healthy Future develops our signature A Consumer Health Advocate’s Guide to the Legislative Session, and the 2015 editions are in! Whether you are an individual interested in contacting your legislators to let them know you care about health care issues or if you work for an advocacy group and want to get multiple copies for your volunteers, we’re happy to get the guides into your hands. We create them each year to help you be a better advocate.

In this year’s guide, you will find:

  • Detailed legislative process overview
  • Listing of all representatives and senators, their offices and numbers
  • Key contacts in the governor’s office and relevant agency staff
  • Members of key committees and subcommittees
  • Contact information for other health advocate organizations
  • Media contacts
  • Tips to make you an effective advocate

You can download a PDF version or contact Laura Colbert and arrange to pick up hard copies from GHF’s office.


Medicaid Minute

Welcome-to-Indiana-3x2-555x370CMS has approved Indiana’s plan to expand health care coverage for low-income Hoosiers through a waiver program known as Healthy Indiana.  This is great news for the 350,000 Indianans who will now have access to health care coverage. The Healthy Indiana plan, however, includes some features that raise concerns, such as a 6-month lock out policy for people with low incomes who can’t afford to make payments on premiums. Some of these features could create barriers to access. For a breakdown of the pros and cons of the Healthy Indiana plan and what advocates should be watching, see this analysis from our friends at the Georgetown Center on Children and Families.


Infographic of the Week

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Your voice is needed!

Coverage Gap _ Georgia_EDITTEDWe all know how crucial closing the coverage gap is – it would improve access to health care services for low-income Georgians, bolster our state’s health care delivery system, and strengthen local economies throughout Georgia. We are asking our legislators to schedule hearings on this issue, and we need your help!  Last year, the legislature sent the message with HB 990 that they wanted to be part of the conversation around finding a Georgia solution to cover the uninsured.  We have yet to see them take steps towards opening up that debate.  Tell your legislators that it is time to close the coverage gap.  Send them an e-postcard telling them why you think covering the uninsured should be a priority for the 2015 legislative session.

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Peach Pulse: January 30, 2015


Legislative Update

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The Legislature has completed eight days of the 40-day session and will convene Monday through Wednesday next week. There will also be several committee hearings next week, including:

1) Senate Appropriations Community Health subcommittee meeting Tuesday at 3 PM in CLOB 307.  The agenda for this hearing will feature testimony about the importance of maintaining Medicaid parity for primary care providers in Georgia.

2) Senate Health and Human Services committee meeting on Tuesday at 1 PM in CAP 450 (Agenda to be announced).

3) House Health and Human Services committee meeting on Monday at 3 PM in CLOB 606 to discuss HB 47.

Committee meetings are open to the public and we encourage health-focused advocates to attend. Of course, your Georgians for a Healthy Future team is monitoring legislative developments and advocating for our priority issues throughout the legislative session and we will keep you informed about key opportunities for advocacy as they emerge. Below is a status report on the issues Georgians for a Healthy Future is supporting this year.

Closing Georgia’s Coverage Gap: There has not yet been any legislative activity in this area, as the General Assembly has been focused on addressing the transportation funding issue.  Georgians for a Healthy Future supports holding hearings on the need to close Georgia’s coverage gap as a first step to achieving this legislative priority. Please contact your Representative and Senator and tell them you support holding hearings on Medicaid expansion this year. You can find your legislators here.

Increasing Georgia’s Tobacco Tax: There has been early momentum around increasing Georgia’s tobacco tax, and a bill has been drafted to increase the state excise tax on cigarettes by $1.23 per pack. The bill also includes a comparable increase on other tobacco products. This bill is awaiting a fiscal note from the state, which we expect to be completed by the first week in February.  See our one-pager on how increasing the tobacco tax can help reduce smoking and improve health in Georgia. Georgians for a  Healthy Future is proud to be part of a coalition of health organizations working on this important issue—please stay tuned for updates on this issue once the fiscal note is in!

Medicaid Payment Parity:  Georgians for a Healthy Future supports maintaining payment parity for primary care providers (see this week’s Medicaid Minute for an explanation of how this improves access to care for Georgia patients) by restoring the temporary reimbursement rate hike that expired at the end of 2014.  Senator Renee Unterman has proposed a $60 million appropriation for this, and Medicaid payment parity will be a topic of conversation at next week’s Senate Appropriations subcommittee hearing (on Tuesday at 3pm).  This hearing presents an opportunity to weigh in with your state legislators to let them know you support the payment bump and to ask them to include it in the FY 2016 Budget.


Coverage Day at the Capitol Recap

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This past Tuesday was Coverage Day at the Capitol! Laura Colbert, GHF’s Community Outreach Manager, spearheaded the day with the help of many Cover Georgia partner organizations.  The opportunity to talk with legislators about the coverage gap drew about 75 advocates and volunteers to the State Capitol. After an advocacy training session, the group met with their legislators throughout the morning by “working the ropes.”  The group reconvened for lunch and a press briefing, covered by both WABE and the Georgia Report! Members of the Cover Georgia coalition displayed their information, materials, and projects in the Capitol Rotunda throughout the afternoon. It was a full day of advocacy in support of closing Georgia’s coverage gap!  We’re hoping that Georgia’s legislators heard our message loud and clear – it’s time to start talking about closing Georgia’s coverage gap!


GHF Receives MLK Community Service Award

IMG_0286GHF celebrated Martin Luther King Jr. Day last week by receiving an award at Emory University’s 23rd annual MLK Community Service Awards.  This year’s award program recognized organizations that work to address injustices in the Atlanta community, often before those injustices become headlines.  Harry Heiman, out-going board chair, and Laura Colbert accepted the award on GHF’s behalf.  In Harry’s acceptance speech, he remembered Dr. King’s quote: “Of all the forms of inequality, injustice in health care is the most shocking and inhumane.”  GHF works hard to ensure equal access to high quality, affordable health care for all Georgians.  We are honored to accept this award and congratulate the other very deserving awardees.


Medicaid Minute

Georgia’s Medicaid patients could face longer wait times for doctor’s appointments without legislative action. That’s because a nation-wide bump in primary care provider reimbursement rates expired at the end of 2014, triggering a need for state action. This temporary rate bump resulted in an average eight percent increase in appointment availability, according to a new study published in the New England Journal of Medicine. The study examined ten states, including Georgia, and concluded that payment rate increases are an effective strategy for enhancing access to primary care services. According to a participating physician in Texas, his practice was able to double the amount of Medicaid patients seen during the two year time the pay bump was in effect.  By restoring the rate bump, known as Medicaid payment parity, Georgia policymakers can help ensure patients get timely access to primary care in an appropriate setting and help keep patients from ending up in the emergency room.


GHF Board Changes

With the New Year, GHF kicks of a new board.  Kathy Floyd has stepped into the position of board chair, taking the reins from Harry Heiman.  A board member of several years, we know she will bring strong leadership and vision to our growing organization.  We are also thankful for Harry’s incredible run and accomplishments as board chair during a period of growth for GHF. We are excited to welcome new board members Danté McKay, Jay Berkelhamer, Natalie Hernandez, and Monica Ponder!  Each brings substantial experience and expertise and we’re excited to have them as part of the GHF team.  As the same time, we are sad to see wonderful partners rolling off the board.  Julie Edelson, Marci Thomas, Jeffery Graham, Sylvia Caley, and Iris Feinberg have all finished their board terms and, while we will miss them, we hope they will enjoy their newfound free time!


Infographic of the Week

Countdown infographic end of open enrollment

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Peach Pulse: January, 23, 2015


Coverage Day at the Capitol 

IMG_0771Please join us this coming Tuesday, January 27, from 9 am to noon for a day of advocacy!  GHF and the Cover Georgia coalition have planned a full day of activities to raise awareness about the important role that coverage plays in the health and financial security of all Georgians and to ask our legislators to close Georgia’s coverage gap.  More than 15 organizations are already participating, and it’s not too late to join us! We’ll provide breakfast and lunch, an advocacy training, and opportunities to share your materials and personal health care stories at our afternoon Capitol Rotunda display.

To sign up, click here.  If you have any questions, please contact Laura Colbert.


The 2015 Legislative Session is Underway!

georgia-capital-buildingThe legislative session opened last week, and health care is already a hot topic. Here is what we have learned in the first week and a half:

It’s budget week! Governor Deal released his budget on Friday, and legislators have been holding budget hearings all week. Here are two aspects of the health care budget that have our attention:

  • The proposed budget eliminates State Health Benefit Plan (SHBP) coverage for non-certificated school employees (bus drivers, custodians, etc) who work less than 30 hours a week.  State officials estimate it will affect more than 11,000 state employees.  We’re still sifting through the details, but we’re very concerned that some of those employees may fall into the coverage gap if they lose coverage through the SHBP.
  • There is no money in the state budget to sustain the primary care reimbursement rate increase that was temporarily funded with federal dollars. This temporary bump  made it easier for patients in Georgia and other states to get medical appointments and access care.
There has also been some early momentum at the Capitol around an increase in the tobacco tax, one of Georgians for a Healthy Future’s legislative priorities! As bills and budget items impacting health care in Georgia are introduced and discussed, we will keep you posted and identify opportunities for advocacy. We’ll be at the Gold Dome throughout the session so look for updates and alerts in each Peach Pulse!

Thank you for making Health Care Unscrambled a huge success!

Health Care Unscrambled Health Care Unscrambled Health Care Unscrambled Health Care Unscrambled Health Care Unscrambled

Thank you to those of you who joined us for our fifth annual Health Care Unscrambled policy breakfast on January 15! This year’s event featured two powerhouse panels: a bipartisan legislative discussion and a panel that focused on the recent experiences of Kentucky and Arkansas, two Southern states that are moving forward with innovative plans to cover their uninsured and improve population health, and featured the insights of a national expert.

This year’s Health Care Unscrambled also provided an opportunity for Georgia health care advocates, policymakers, stakeholders, and consumers to come together just as the 2015 Legislative Session got underway to focus our attention on the most pressing health policy issues facing our state, including a robust discussion about the coverage gap.  Senator Dean Burke said that while last year he would have said there was a 0 out of 10 chance for Georgia to close the gap, this year he moved it to a 5 out of 10.  We’re excited about these improved chances and will continue to advocate for movement this legislative session!

We wrapped up the event with a reveal of our 2015 legislative priorities, which you can find here. You can read Georgia Health News’s coverage of the event here.


GHF goes to Washington

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This week, Cindy and Anna are representing Georgians for a Healthy Future at Families USA’s Health Action 2015 conference!  We’re getting inspiration from national leaders, learning about best practices from experts and advocates doing great work around the country, and sharing our own experiences advocating for Georgia health care consumers. GHF’s Executive Director Cindy Zeldin spoke on a workshop panel about how to advocate for consumers enrolled in private health insurance. Check out Facebook and Twitter through Saturday for conference updates!


Story collecting with Mercy Care

Mercy Care EventGHF partnered with Mercy Care to kick off the legislative session by collecting the stories of people who fall in the coverage gap.  As the governor was being inaugurated and our legislators were being sworn in, we talked to Mercy Care’s patients how health care coverage would help them.  Everyone we talked to expressed that health care coverage would help them go back to work, take better care of their family, or better manage their health.  We will be sharing these stories on Coverage Day through social media and in person as we talk with policy makers about the importance of closing the coverage gap. HealthSTAT and the National Health Care for the Homeless Council were critical partners for this story collection effort!

 If you are in the coverage gap and would like to share your health care story with us, click here .


Medicaid Minute

Last year, the number of uninsured Americans declined, fewer adults reported difficulties paying for medical bills and medical debt, and fewer adults delayed care because of cost. These encouraging findings, which come from the Commonwealth Fund’s Biennial Health Insurance Survey, are great news for patients and consumers. These coverage and access gains, however, were not experienced evenly across the country. People living in states (like Georgia) that haven’t expanded Medicaid were more likely to be uninsured and to face burdensome medical bills than those living in states that have expanded Medicaid. Let’s not leave Georgia patients and consumers behind-let’s close the coverage gap!


Infographic of the week

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Peach Pulse, December 18, 2014


Time to Act on Tobacco

With the holiday season upon us and the 2015 Legislative Session just around the corner, the health of our state’s children and families is at the top of all of our minds. Georgians for a Healthy Future has focused heavily on promoting policies that ensure a pathway to coverage and meaningful access to care for all Georgians in recent years, but identifying and advocating for policies that improve health outcomes is also close to our hearts. In that spirit, we believe it is time to act on tobacco, which is the leading cause of preventable disease and death. 

Earlier this month, Georgia’s Medicaid program amended its state plan to include a comprehensive smoking cessation program. This is an important victory that will help reduce smoking in our state. If you haven’t already, please take a moment to thank Commissioner Clyde Reese for taking this important step. There is, however, more to do. We need your partnership and your voices to help us take on the biggest hurdle we face in curbing smoking and its harmful effects: increasing the tobacco tax in our state. 

According to the American Lung Association’s annual state report card, Georgia scores an “F” on tobacco taxes. Georgia currently ranks as the 48th lowest tobacco tax in the country at just 37 cents per pack.  Not only does this make tobacco much more accessible to youth (and all Georgians), but it takes much needed revenue off the table for Georgia as the state tries to find funding for transportation infrastructure, education, and health care coverage for Georgians.

In fact, Georgia is so far below the national average for tobacco taxes that we could raise our tax by over a dollar per pack and still just be at the national average.  That is why this year GHF and a coalition of supporters will propose raising Georgia’s cigarette tax by $1.23 per pack.  It’s as easy as 1-2-3! 

One – for the kids who we can prevent from ever starting

Two – for the improved health outcomes that smoking reductions will bring

Three – for the revenue the tobacco tax will bring to our state that can be invested in coverage, access, and prevention.


Network Adequacy: Action Alert

If you’ve been following the Peach Pulse you know that network adequacy is a hot topic in health care right now. (And if you missed it, check here and here to get caught up!) Decision-makers are weighing policy choices that will have implications for health care consumers in Georgia and across the nation. We know that they are hearing from health industry stakeholders; now they need to hear from you!  

1) The US Department of Health and Human Services (HHS) Proposed Rule on the 2016 Notice of Benefit and Payment Parameters is open for comment until December 22, 2014.  To submit a comment, click here.         

2) The National Association of Insurance Commissioners (NAIC) is currently updating its model act on network adequacy. This model provides an example that states can use to enact their own legal protections to guarantee private insurance consumers an adequate provider network once they are enrolled in coverage. Advocates can email jmatthews@naic.org until January 12, 2015 with input.

Consumer advocates are asking these two entities to put in place 1) specific network adequacy standards such as time and distance standards and appointment wait time standards and 2) rules that provide consumers the right to go out-of-network at no extra cost if their plan cannot provide them timely, geographically accessible, and appropriate in-network care. Please take a few moments to submit your comments to HHS and to the NAIC with this important request. If your organization is interested in engaging more deeply on this issue, please contact Laura Colbert at lcobert@healthyfuturega.org to let us know you’re interested in collaborating.


GHF Around Town

It’s been a busy couple weeks for us here at GHF.  The Rural Hospital Stabilization Committee met to hear public comments two weeks ago and we were out in force!  We presented our report to the committee.  In addition, our own Laura Colbert and representatives from the Georgia Budget and Policy Institute, HealthSTAT, Jewish Community Relations Council, Georgia Legal Services, and Voices for Georgia’s Children all pressed how crucial closing the coverage gap is as a the first step to saving our rural hospitals. 

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The following week, the GHF team attended the 29th Biennial, a gathering of legislators and advocates from across the state.  GHF spoke with members on both sides of the aisle and encouraged conversations around closing the coverage gap to give hard working Georgians the access to care they deserve. 

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Start the New Year right with GHF!

January is an exciting month for GHF and Georgia! With the start of the legislative session, advocates across the state will be hard at work educating our legislators and working for the changes we need to improve the health of all Georgians. GHF is no exception!

HCU_dateOur 5th Annual Health Care Unscrambled event is January 15th. For more information on the event, sponsorship opportunities, and ticket prices, click here.

IMG_0778Coverage Day at the Capitol. Please join us on the morning of January 27th to talk with your legislators about why closing the coverage gap is important to you. If you haven’t spoken with your legislators before, we will provide training and talking points to help guide you through the process. If you would like to participate, RSVP to Laura Colbert at lcolbert@healthyfuturega.org.

georgia-capital-buildingWebinar: Health Care Policy and Advocacy for the 2015 Legislative Session, 2015. For those of you who can’t make it to Health Care Unscrambled for the unveiling of GHF’s 2015 policy priorities or want to know how to better advocate for health in Georgia, join us for our first-ever advocacy webinar! To register for the free webinar, click here.


Medicaid Minute

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This week, Tennessee announced its intention to move forward with a plan to close the coverage gap!  In a statement, Governor Bill Haslam said “This plan leverages federal dollars to provide health care coverage to more Tennesseans, to give people a choice in their coverage and to address the cost of health care, better health outcomes and personal responsibility.”  We are thrilled for Tennessee and hope our own elected officials will take note and work to provide a Georgia solution for our hard working, uninsured families.


Infographic of the Week!

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Nykita Navigates

IMG_9114One month down, two to go!  Already, nearly 2.5 million Americans already signed up for health insurance.  Early numbers show that about half of those who have signed up are new enrollees.  If you haven’t enrolled yet or want to shop around before selecting a new plan, there is still time!  Click here to see Nykita’s schedule for upcoming events in your neighborhood.  If you don’t see any close to home, please give her a call to set up a one-on-one appointment. 

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Peach Pulse: December 4, 2014


Health Insurance Hot Topic Update: Network Adequacy

megaWith open enrollment in full swing, Georgia consumers are once again exploring their health insurance options and signing up for coverage. When consumers enroll in a health insurance plan, they gain access to a network of medical providers with whom their insurer has contracted. For health insurance to facilitate meaningful access to care, this network of providers must be adequate to ensure that consumers enrolled in the plan have reasonable access to all covered benefits and services. In a recent issue of the Peach Pulse, we provided a primer on network adequacy, a hot topic in health policy (click here to get caught up on what network adequacy means and why it matters for consumers, advocates, and policymakers). In that overview, we promised to keep you updated on policy developments around network adequacy, in particular the ongoing process at the National Association of Insurance Commissioners (NAIC) to update its model law. This model law can provide a framework for states to establish and enforce standards to ensure that provider networks are adequate. At its fall meeting in November, the subgroup at the NAIC working on network adequacy announced it would take comments on an initial draft of proposed revisions for the model act until January 12, 2015. To learn more about this process and to see the draft, click here.

To ensure the needs of consumers are considered in this process, the NAIC consumer representatives released a report featuring the results of a survey of state Departments of Insurance and recommendations for state policymakers, regulators, and the NAIC to consider as they work on updating network adequacy standards. These recommendations include:

  • Establish quantitative standards for meaningful, reasonable access to care, such as minimum provider-to-enrollee ratios, reasonable wait times for appointments based on urgency of the condition, and distance standards that require access to network providers within a reasonable distance from the enrollee’s residence.
  • Ensure consumers are provided sufficient information to identify and select between broad, narrow or ultra-narrow networks. In areas without sufficient choice, require health plans to offer at least one plan with a broad network or an out-of-network benefit, with limited exceptions to be determined by the Commissioner.
  • Require health plan provider directories to be updated regularly, publicly available for both enrolled members and individuals shopping for coverage, and include standards for information that must be included to provide consumers with information on network differences and the potential financial impact on consumers depending on which plan they choose.

There are 17 recommendations in all. For advocates interested in learning more about this issue and in speaking up for consumers in this process, see the full report here.

If you would like to weigh in at the state level, please contact Georgia’s Department of Insurance and ask the Commissioner to support the NAIC’s process to revise the model act and specifically to support the consumer recommendations described above.

If you are an individual consumer enrolled in a commercial health plan and the provider directory you were given was incorrect or if you have concerns about your ability to access covered services under your plan, please contact the Georgia Office of Insurance & Fire Safety, Consumer Services Division by calling (800) 656-2298 or use the Consumer Complaint Portal at www.oci.ga.gov/ConsumerService. Please also consider sharing your story with Georgians for a Healthy Future so we can get a better picture of what is happening in our state.


Rural Hospital Stabilization Committee: Your voice is needed!

hospitalWe’re hoping you read our report released two weeks ago to the Rural Hospital Stabilization Committee (RHSC) on how closing the coverage gap can help save our rural hospitals.  (And if you didn’t – here is it!)  This Friday, the RHSC is taking public comment and your voice is needed!  You may register to make comments when you arrive at the meeting. Comments will be presented on a first come, first serve basis. No power points, but handouts (should you be so inclined) are allowed.  If you interested in commenting, but are unsure of how to best shape your argument, feel free to reach out to Laura Colbert, GHF’s Community Outreach Manager.  Even if you aren’t comfortable speaking, please show up and show your support!  Details are below.

Location: Two Peachtree Street.  5th floor.  Located on the corner of Peachtree Street and Marietta Streets.  The Five Points MARTA Station is just south of Two Peachtree.

Time: 10:00 AM to 1:00 PM


Connecting Georgians to Coverage: GHF partners with the Bhutanese Association of Georgia to get people covered

Every Saturday morning, many Bhutanese immigrants gather at their temple in Clarkston for SAT prep, U.S. citizenship, and English classes.  Recently, Laura Colbert, Georgians for a Healthy Future’s Community Outreach Manager, joined them to provide information about health care coverage and the Affordable Care Act’s open enrollment period.  With the help of a translator, Laura spoke with approximately twenty community members about the benefits of health care coverage, how to get covered, and where to find affordable medical care if they were not eligible for coverage. She also answered their questions about health care coverage for their children and Medicaid.  (In return, Laura learned quite a bit about Bhutanese culture.)

This educational event was the product of a partnership with the Bhutanese Association of Georgia (BAG), which works to integrate Bhutanese refugees into life in Georgia. GHF and BAG have been working together over the past year to educate the Atlanta-based Bhutanese community about health care coverage and to increase health coverage enrollment.  In addition to educational events, several fact sheets have been created by GHF and translated into Nepalese to be distributed in the community.

Georgians for a Healthy Future continues to work to increase enrollment among all Georgians, especially in communities that may need extra education or encouragement to enroll.


Medicaid Minute: Who qualifies?

Each state has slightly different eligibility criteria for Medicaid.  When we talk about closing the coverage gap– as 28 other states have either through Medicaid expansion or a state-specific 1115 waiver – it’s important that we all know just who is (and isn’t) eligible for Medicaid today in Georgia and who could gain coverage if we close that gap.

  • Very low income parents. Medicaid is offered to parents who make up to 40% of the Federal Poverty Level (FPL).  For a family of four, parents with income up to $9,036 annually or $753 per month can receive health coverage through the Medicaid program.
  • Pregnant Women. Pregnant women who earn up to 220% FPL.  For a family of four, a pregnant woman with income up to $52,488 would be eligible for Medicaid
  • Most Children. Children are covered at varying income limits based on their age and family size. The Children’s Health Insurance Program (CHIP), known as PeachCare for Kids in Georgia, is layered on top of the Medicaid program. Together, these programs provide coverage to children in families with incomes up to 247% of the FPL.  For a family of four, that’s $58,932 annually.
  • The low-income elderly. In addition to Medicare, many, but not all, low income elderly adults whose income is less than $25,560 per year qualify for Medicaid.
  • Low-income women diagnosed with breast or cervical cancer.
  • Aged, Blind, and Disabled. With varying income limits, those who receive Social Security Income, live in a nursing home, or community care center qualify.
  • Qualified Medicare Beneficiaries. These are the aged, blind or disabled who have hospital insurance and have incomes below 100% FPL.  Medicaid will cover some of their Medicare expenses.
  • Low-income Terminally Ill. Those with an annual income of less than $25,956 and who are expected to live less than six months.

*Numbers are pulled from the GA Department of Community Health and Peach Care for Kids webpages.


Nykita Navigates

IMG_9114Nearly half a million people enrolled in health insurance through the federal marketplace in the first week of open enrollment!  The deadline for January 1st coverage is fast approaching: December 15th.  Don’t miss out!  If you need in person assistance, please see the below events or contact Nykita at 404-567-5016 or nhowell@healthyfuturega.org.


Upcoming events:

January 19:  15th Annual United Ebony Society MLK Day Celebration and Health Fair (Lawrenceville, GA)


Recurring events:

Cobb County Public Health (Marietta, GA) Every Tuesday, Starting November 18, 2014 and ending February 10, 2015 (with the exception of November 25, 2014)

Clarkston Library, DeKalb County (Clarkston, GA) Every Thursday, Starting November 20, 2014 and ending February 12, 2015

Fayette County Library Presentation (Fayetteville, GA) December 8, 2014; January 12, 2015, and February 2, 2015

Events are subject to change, and new events are added all the time – check back here regularly for updates!

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Peach Pulse: November 13, 2014


Open Enrollment Starts Saturday!

megaIf you receive our Peach Pulse, there’s a good chance you already know that open enrollment for health insurance starts this Saturday, November 15 and goes through February 15.  Two important things to remember and share with your friends, family, colleagues, and community members:

  • Even if you enrolled last year, you should go to healthcare.gov and shop around as your plan and premiums may have changed, or you may qualify for more financial assistance.
  • Unless you qualify for an exemption, the penalty fee for not obtaining health insurance has risen to $325 or 2% of your income (whichever is higher).

If you have enrolled successfully through the Health Insurance Marketplace or remain uninsured and think you fall into the coverage gap (Not sure what that is?  Check out this Kaiser Family Foundation resource that explains the coverage gap!), please consider sharing your story.  Highlighting your stories is crucial to showing our lawmakers that the ACA is working and that we need to close the coverage gap so that no Georgian is left uninsured.


Nykita Navigates

IMG_9114With open enrollment starting this Saturday, our Navigator, Nykita, has been very busy!  GHF is excited to highlight some of Nykita’s materials, as well as some great work from our partner organizations.  The following materials are great to print out at home for your own use or if you’re helping others enroll.

  • Affordable Care Act Basics: Guide to the Marketplace – Your basic guide to the ACA and the health insurance market place
  • Marketplace Application Checklist – Your check list of what you should bring to your appointment with a Navigator (it’s longer than you think!).
  • Health Insurance 101 – Not quite sure the difference between an HMO and a PPO?  How about co-insurance and co-pay?  This brochure will answer your questions.
  • Enrollment Brochure – Important dates and numbers to remember throughout open enrollment.
  • Navigator Resource Guide – Georgetown University’s Center on Health Insurance Reforms (CHIR) has launched its web-based Navigator Resource Guide on Private Health Insurance and the Health Insurance Marketplaces.  Targeted at Navigators, this is an amazing resource to help answer the tough questions.

Ready to get enrolled?  Check out Nykita’s schedule to see what events are happening in your neighborhood.  Check back often for updates.


Medicaid Minute

All eyes are on open enrollment, but for more than 400,000 Georgians, there still isn’t a health care option available.  Our elected state officials have the power to solve this problem. The health care law was designed to provide a path to health insurance to all Americans, but our state government has to opt in to make that a reality. Governor Deal and the state legislature have so far declined to use federal tax dollars that have already been set aside to provide coverage to those in the gap, but the opportunity to accept this money is still available.  We can opt in now by expanding Medicaid eligibility to all low-income Georgians who currently do not qualify.  Still need more details?  Click here to learn more.


It’s Not Too Late To Give!

GA Gives DayAs you know, Georgia Gives Day is in full swing!  The day isn’t over and as of sending time we are 30% of the way to achieving our goal of $1,000!  Your participation and support allows us to continue the work we do: educating the public and our lawmakers, providing valuable resources to partner organizations and leading the charge for closing the coverage gap in Georgia.  If you haven’t, please consider a small donation.  To donate, click here.

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