Georgians for a Healthy Future hit the road again recently, this time to Savannah! Along with the Georgia Budget & Policy Institute and the Chatham County Safety Net Planning Council, we hosted Coverage and Access to Care: A Local Focus on Savannah. The event provided the opportunity to have a roundtable discussion about the health and health care needs of people in Georgia’s coastal region. We were joined by representatives from local hospitals, insurers, non-profit organizations, enrollment assisters, and interested Savannah residents for the gathering.
Guided by the chart book, the group had a dynamic discussion about how we could make Georgia’s Medicaid program work better for those who are already enrolled, as well as the benefits of expanding it to cover Georgians in the coverage gap. It was clear the attendees were eager to talk about improving coverage and access to care by closing Georgia’s coverage gap.
Our conversation also touched on the open enrollment period and the needs of consumers enrolling through the health insurance Marketplace (aka healthcare.gov). GHF highlighted our new toolkit and Health Insurance User’s Manual as tools to help Savannah-area consumers get enrolled, stay enrolled, and effectively use their coverage.
This roundtable event gave us the opportunity to learn from the Savannah stakeholders, meet new partners, and identify areas where we can work together to improve Georgia’s health care system. We look forward to returning to Savannah soon to build on this visit.
Georgians for a Healthy Future is excited to release our new enrollment toolkit! The toolkit is a comprehensive compilation of fact sheets, neatly organized, that are designed to walk consumers through each step of the enrollment process – from how to get health insurance (enrollment) to how to use health insurance once they have it (post enrollment).
Need more information like this? You’re in luck! GHF has created the GEAR Network for people just like you. GEAR is the new central hub of resources for Georgia’s enrollment assisters and community partners that are working with people to educate them on their health and health coverage options. We’ll send out weekly emails full of local resources and the information you need to know through OE3 and beyond. For more information on GEAR, check out this presentation.
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Who, what, when, where and why
By Pranay Rana
Pranay is GHF’s Consumer Education and Enrollment Specialist. A certified application counselor, he assists consumers with enrollment into health insurance through the Marketplace. Pranay can also help you once you have enrolled with questions about how your coverage works. To set up a meeting with Pranay you can email him or give him a call at 404-567-5016 x4.
Open Enrollment 2016 (OE3) is less than 10 days away! Open enrollment is an annual period when individuals and families can choose from a variety of coverage options in the marketplace, apply for tax credits, and purchase a health plan that best meets their needs. Consumers can get 24/7 over-the-phone enrollment assistance via the Health Insurance Marketplace at 1-800-318-2596 or can find local in-person assistance at localhelp.healthcare.gov. Individuals and families with incomes between 100% and 400% of the 2015 federal poverty level (FPL) may be eligible to receive financial assistance to help pay for their monthly premiums (see the chart below for what FPL means in real dollars). Consumers with lower incomes (between 100% and 250% of the FPL) may be eligible for additional help with out-of-pocket costs if they choose a “silver” plan. In 2015, 9 out of 10 Georgians who enrolled into marketplace plans were able to access tax credits. Consumers who do not qualify for subsidies may still be able to purchase plans through the marketplace at a full price.
So, when does my coverage start?
|Coverage Dates||Enrollment Deadlines|
|January 1, 2016||December 15, 2015|
|February 1, 2016||January 15, 2016|
|March 1, 2016||January 31, 2016|
The marketplace will discontinue subsidies for those consumers who did not fulfill their tax filing requirements for 2014 in order to reconcile their income and subsidies at the end of the year. Consumers are advised to fulfill their tax filing requirements every year and call the marketplace or local assisters for help if subsidies are being dropped without any legitimate reasons. Consumers who do not qualify for subsidies because their income is too low are also advised to obtain an Exemption Certificate Number (ECN) to avoid tax penalties.
What do I need to do to renew my existing plan?
You may simply call the marketplace for 2016 application renewal if you need to change plans for 2016 or update your information. If you are happy with your existing plan and have no updates to make then you do not need to do anything. The marketplace will simply auto-renew your application for 2016.
What if I need help?
- You can call GHF’s enrollment assister at 404-331-9981 or email email@example.com
- You can call the marketplace 24/7 at 1-800-318-2596
- You can also find local help at healthcare.gov.
Federal Poverty Level Table, 2015
Last week, GHF was on the road again traveling to Athens for UGA’s annual State of Public Health conference. The SOPH conference is a chance for public health researchers, practitioners, and students to share and learn about the newest public health initiatives and research happening across Georgia. We were excited to be featured as a presenter among other experts, advocates, and leaders in Georgia’s public health domain.
In a workshop dedicated to the Affordable Care Act, GHF teamed up with Georgia Watch to talk about Marketplace enrollment efforts in Georgia. The presentation was based on GHF’s “Getting Georgia Covered” report, which explored the successes and barriers to outreach and enrollment efforts in Open Enrollment 2. We also previewed the upcoming open enrollment period, which starts on Sunday, Nov. 1, 2015, and advocated for closing Georgia’s coverage gap.
The other presenters in the workshop, including another presentation from our partner Georgia Watch, comprehensively covered the new ACA requirement for hospitals to complete a community health needs assessment (CHNA) of their service area every 2-3 years and how that is being implemented in Georgia. The workshop generated some excellent questions and constructive conversation about these two very different aspects of the ACA.
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At Georgians for a Healthy Future, we pride ourselves on strong partnerships. Over the past few years, we have been collaborating with Georgia Equality and the Health Initiative to ensure that the health care needs of LGBT Georgians are not neglected.
These partnerships brought Whitney Griggs, GHF’s Consumer Education Specialist, to Savannah on September 12th for the annual Savannah Pride Festival. Together with the Health Initiative, Whitney distributed information related to LGBT health care needs and spoke to festival attendees about how to enroll in health insurance. Of particular interest was our joint fact sheet with Georgia Equality on Transgender Health Care. Some of the festival attendees who picked up this fact sheet shared stories of having been denied coverage due to being trans-identified in the past, but who can now get coverage that meets their needs because of the Affordable Care Act. People that stopped by the table were also interested to learn that health care services must be provided regardless of gender identity or expression. This means that health insurance plans must cover transition-related care, as long as that care is covered for cisgendered people under on the same plan. So services such as hormone replacement therapy and gender-specific care (like mammograms and prostate exams) must be covered if they are covered for other people enrolled in the same plan.
Whitney also gave out some tips for trans-identified folks to keep in mind when enrolling in health insurance:
- On all enrollment forms, check the sex box that matches the sex you believe is on file with the Social Security Administration.
- Some important questions to ask include:
- Is hormone replacement therapy covered?
- Is my doctor included in the plan’s network?
- Is there a network of trans-friendly doctors and/or doctors who have training working with or currently serve trans clients?
- Are reconstructive surgeries covered?
All in all, it was great day in Savannah (despite the rain) and people learned a lot from GHF and the Health Initiative.
If you have a specific question about LGBT health care and health insurance, feel free to reach out to Whitney Griggs at firstname.lastname@example.org or the Health Initiative at (404) 688-2524
GHF conducted in-depth interviews with and survey of enrollment assisters across the state to identify best practices and lessons learned from open enrollment 2. Here’s a summary of what worked, what didn’t, and what we can improve on next year.
What worked during OE 2: Successful strategies and best practices
Using a variety of local venues to conduct extensive outreach. Across the board, enrollment assisters identified the importance of conducting a broad range of outreach and enrollment activities at the local level. They identified a variety of venues where they successfully reached consumers including libraries, churches, college campuses, Volunteer Income Tax Assistance (VITA) sites, doctor’s offices, community health centers, cooperative extension offices, small businesses, AIDS service organizations, and local hospitals. For example, one navigator organization worked with a nurse navigator who met with uninsured consumers who presented at the emergency room at the local hospital. The nurse navigator connected these uninsured consumers to a navigator organization, allowing the organization to reach a much larger pool of consumers than if they had not had this partnership. Enroll America also provided significant support to assisters’ outreach and enrollment efforts. Assisters were limited in their ability to retain personal information about consumers, but because Enroll America only provided outreach and education, they could retain contact information and follow up with consumers seeking more information about the Marketplace.
Leveraging the support of existing partnerships for outreach. All of the assisters interviewed acknowledged that one of their best methods for reaching consumers was building upon existing relationships with community organizations. One group wrote letters to community partners letting them know of their navigator services, which created more awareness in their communities. Another enrollment assister organization had deep ties with Family Connection Partnership organizations in their area, which allowed them to have a well-known partner in each of the counties that they covered.
These partnerships allowed the enrollment assister organizations to use existing frameworks of community organizations to educate and provide enrollment assistance to the populations served by these groups. Because of the strong presence and history these partner organizations have in the communities they serve, consumers also viewed them as credible.
Developing trust with consumers. One of the most critical aspects of providing enrollment assistance was for assisters, and their organizations, to be recognized as a trusted resource within their communities. This was especially true for assisters working with immigrant and non-English speaking populations. One Spanish-speaking enrollment assister noted that it put consumers at ease to have a native speaker, rather than someone speaking Spanish as a second language, helping them to enroll. Additionally, due to the strong anti-ACA sentiment in the state, enrollment assisters reported that it was critical to be considered a trusted resource in order to overcome ideological barriers.
Reaching large numbers of people through events and local media. Enrollment events served as valuable opportunities for assisters to efficiently reach large numbers of people. For example, one of the navigator grantee organizations organized large events in rural communities to provide centralized assistance to a larger pool of consumers. These events were marketed in the local media using radio spots, newspaper ads, and movie theater ads. Additionally, some assister organizations used local media outlets to reach a large number of consumers. One organization in South Georgia held a phone bank with a local television station. The organization reported that following this event, their call volume of consumers looking for enrollment assistance picked up substantially.
What challenges and barriers remain for consumers?
Enrollment assisters identified several challenges in enrolling uninsured consumers and noted some barriers that some uninsured Georgians still face.
Many consumers had limited health insurance literacy. More than two-thirds of our survey respondents identified low health insurance literacy as a barrier to enrollment. Many of the consumers that assisters worked with had never been insured before, so they did not know how to choose a primary care physician or pay their monthly premium. One of the assisters interviewed acknowledged they needed to educate consumers on how to use their health insurance, but that it was a challenge when scheduled with a large number of enrollment appointments. Additionally, some assisters reported that consumers chose the lowest premium plan because they did not understand the concept of a high deductible. Sometimes consumers would return to the assister wanting to change plans once they had tried to use their coverage.
Many consumers fell into the coverage gap. Assisters encountered a large number of individuals and families that fell into the coverage gap, meaning that they did not qualify for Medicaid or subsidies to help them pay for Marketplace coverage and were left without an affordable pathway to coverage. Some assister organizations estimated that over half of the consumers they worked with fell into the gap. Enrollment assisters were able to provide these consumers with a list of resources where they could go to get free or low cost care, but indicated frustration at not being able to do more to help. One navigator described it as emotionally taxing to repeatedly tell consumers that came to them looking for assistance that they were too poor to qualify for health insurance.
Immigrants faced verification and language barriers. Immigrants faced many challenges enrolling in coverage. Assisters reported that, when the consumer did not speak English and the assister did not speak the consumer’s native language, using interpreter services was difficult and often ineffective. Language barriers also created difficulty because key terms and concepts associated with health insurance do not translate well. The biggest barrier for immigrants, though, was identity verification. Enrollment assisters had little or no training on how to properly verify IDs or immigration forms. Additionally, technological problems sometimes prevented them from uploading these documents to healthcare.gov. When they were unable to upload these documents electronically, consumers had to verify their immigration status through the mail, which was a long and cumbersome process. There was also a common concern from families of mixed immigration status that sharing information about their families would lead to legal repercussions. Even though none of the immigration or family information shared with the Health Insurance Marketplace is used to identify immigrants that are not here legally, this is a misconception held by many
Confusion and political opposition to Affordable Care Act hindered partnerships. Stakeholders reported that confusion and political hostility created significant barriers to outreach and enrollment. In addition, the passage of the “Health Care Freedom Act” as part of HB 943 in 2014, which included language prohibiting state and local governmental entities from operating a navigator program, among other provisions, led to confusion among local health departments and other governmental entities regarding their participation in helping consumers enroll in health insurance. An earlier version of this legislation that was not enacted, HB 707, was even more restrictive than the final language that passed and the media coverage over that bill added to the confusion. Most of these entities opted for caution, which meant that potentially powerful partnerships for enrollment were missed. This legislation also ended the University of Georgia’s navigator program (The University of Georgia operated a navigator program through its cooperative extension service during OE1).
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In a 6-3 ruling the Supreme Court upheld tax credits in the Affordable Care Act. This is a big victory for Georgia health care consumers!
As an organization committed to making sure all Georgians have access to the health care they need, Georgians for a Healthy Future is celebrating today’s Supreme Court decision! This ruling is a big win and a big relief for the more than 400,000 newly enrolled Georgians who can keep their coverage and the access to care and financial peace of mind that comes with it.
“Today we celebrate an important victory for health care consumers, and we are relieved that hundreds of thousands of Georgians can keep their coverage,” said Cindy Zeldin, Georgians for a Healthy Future’s Executive Director. “But there is still work to do. Georgia has the second highest rate of uninsured in the country, and three-hundred thousand Georgians fall into a coverage gap that was created by Georgia’s decision not to expand Medicaid.”
Now that the outcome of King v. Burwell is clear, we must not forget these workers, parents, and veterans in our state who still lack access to quality, affordable health insurance. It’s time to close the coverage gap.
King v. Burwell
Sometime this month, the Supreme Court will rule on King v. Burwell, a case that could have major implications for Georgia health care consumers. The Court will rule on whether the ACA allows consumers to receive tax credits to help pay for health insurance in the 34 states including Georgia that use healthcare.gov, the federally facilitated marketplace. Here in Georgia, nearly 9 in 10 Georgians who enrolled in coverage this year accessed tax credits that made that coverage affordable. A ruling for the challenger in King v. Burwell would place coverage at risk for more than 400,000 Georgians. GHF is working to keep you informed and updated with all the latest on this case. Here’s what you need to know.
Cornelia Hinton, a recent college graduate at age 26, was no longer eligible to remain on her parents’ health insurance plan. Affordability (enhanced by a tax credit) was Cornelia’s main concern when enrolling in health insurance through the Marketplace. After her subsidy was applied, Cornelia’s plan cost her $83/month.
Cornelia is just one of the 400,000 Georgians whose coverage hangs in the balance. Let’s show our support for her and for the hundreds of thousands of Georgians who finally have access to health care and financial peace of mind. Spread the word. #DontTakeMyCare
GHF SPEAKS OUT
“A door that had been closed to too many Georgians for too long has finally been opened, and consumers have responded. The individuals and families who have walked through this door come from all corners of our state and from all walks of life. But they share a combination of relief and pride at finally enrolling in health insurance that fits within their budget. If the Court rules for the challengers, these newly enrolled Georgians will be looking to our state leaders for answers. Our state’s leadership should commit to use every tool in the toolbox to allow consumers to maintain access to marketplace health insurance and to the tax credits that have helped make it affordable.”
Local News Highlight
“I’m not a big Obama fan, but I don’t know how anybody could be against this,” Wilson said. “Prisoners get all of their health care paid for, so why can’t someone who’s worked all their lives also get some help?” Yet conservatives in Georgia and across the nation are just that – staunchly opposed to the Affordable Care Act, its mandate that most Americans buy insurance and its use of billions of taxpayer dollars to help pay for Obamacare plans.
GHF surveyed and interviewed enrollment assisters across the state to understand not only the “what,” but also the “why” behind the second open enrollment period. The results of that research have led us to several policy recommendations to maximize health insurance enrollment and retention and to ensure that coverage translates to meaningful access to timely and appropriate medical services for Georgia health care consumers.
- Close the coverage gap in Georgia. Approximately 300,000 Georgians fall into the coverage gap, meaning they do not qualify for Medicaid under existing income eligibility guidelines in Georgia but their income is still too low to qualify for financial assistance (tax credits) to purchase health insurance on the Marketplace. Eligibility for tax credits begins at 100 percent of the Federal Poverty Level, or $11,770 for an individual or $20,090 for a family of three in 2015, while Medicaid eligibility for most adults in Georgia cuts off at income much lower. Thirty states including DC have closed their coverage gaps thus far with promising results. We encourage Georgia policymakers to take this important step as well to ensure all Georgians have a pathway to coverage.
- Set and enforce network adequacy and transparency standards. Many of the plans sold through the Health Insurance Marketplace are Health Maintenance Organization (HMO) plans that feature narrow provider networks. While these narrow networks can help keep premiums down, a trade-off many consumers may be willing to make, consumers do not currently have sufficient information to make this choice. There is no information available to consumers at the point of sale about whether a provider network is ultra narrow, narrow, or broad, and provider directories are routinely inaccurate. More transparency and oversight are needed to ensure that consumers have accurate and useful information to make these choices. It is also important that all provider networks allow for meaningful access to all covered benefits. To ensure this, we support putting in place and enforcing network adequacy standards.
- Encourage public-private partnerships and remove unnecessary restrictions on consumer education and assistance. Many of the enrollment assisters we surveyed indicated that reducing barriers to partnering with state government organizations such as public colleges, universities, and health departments would lead to stronger and more effective partnerships. Specifically, many respondents indicated that improved coordination between enrollment assisters, the Marketplace, and the Georgia Department of Community Health (DCH) to better facilitate PeachCare for Kids and Medicaid enrollment would be helpful. The “Health Care Freedom Act,” passed in 2014 as part of HB 943, prohibits state and local governmental entities from operating a health insurance navigator program and places other limitations on governmental entities. This provision has been counterproductive, creating confusion around what educational and consumer assistance activities local entities can engage in as they work to serve their community members. We recommend lifting these restrictions.
From choosing a plan to using your plan, health insurance can be complicated and many Georgians lack the information they need to make informed decisions. In GHF’s recent report [LINK] Getting Georgia Covered: Best Practices Lessons Learned and Policy Recommendations from the Second Enrollment Period, we interviewed enrollment assisters across the state and found that more than two-thirds of our survey respondents identified low health insurance literacy as a barrier to enrollment. Many of the consumers that assisters worked with had never been insured before, so they did not know how to choose a primary care physician or pay their monthly premium. One of the assisters interviewed acknowledged they needed to educate consumers on how to use their health insurance, but that it was a challenge when scheduled with a large number of enrollment appointments. Additionally, some assisters reported that consumers chose the lowest premium plan because they did not understand the concept of a high deductible. Sometimes consumers would return to the assister wanting to change plans once they had tried to use their coverage. As we move forward, Georgians for a Healthy Future will be focusing efforts on improving the health literacy of Georgians and ensuring they have the knowledge, information, and confidence they need to make informed decisions.