Network adequacy — we have a model act!

The National Association of Insurance Commissioners approved an updated network adequacy model act at its Fall meeting in November. The model act is a framework that states can adopt to help ensure that consumers have meaningful and timely access to the health services in their benefit package. With more insurance companies offering narrow network plans, these basic standards are an important consumer protection, and GHF encourages state policymakers to consider tailoring and adopting the model act in Georgia. We’ll be announcing our legislative priorities for 2016 soon, and this issue will be on the list!


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GHF heads to Savannah

Photo Nov 06, 10 44 15 AMGeorgians 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.


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A Note from our Executive Director on Georgia Gives Day

GGD2015_logo_home133wDear Friends,

It’s an exciting time in health advocacy. The nation’s uninsured rate has plummeted over the past two years as Americans who were left out of our health system for too long have finally been invited in. Here in Georgia, half a million people gained coverage through the health insurance marketplace last year and we are working hard to raise awareness during this current open enrollment period.

 

But the pathway to coverage remains blocked for our lowest-income citizens here in Georgia because our state policymakers have not yet taken action to expand Medicaid. Approximately 300,000 Georgians are stuck in a coverage gap: they don’t qualify for Medicaid today and can’t access tax credits to buy private health insurance because their income is too low. Many of these Georgians are working in jobs that don’t come with health insurance. They are restaurant workers, child care workers, and even some veterans. They are our friends and neighbors, and we all suffer when they are left out.

 

Georgians for a Healthy Future is committed to making sure the voices of these Georgians are heard as public policy decisions are made that impact their lives. In the coming year, we plan to redouble our efforts to close the coverage gap in Georgia. This means we’ll be criss-crossing the state to talk to people who fall into the gap and to connect with community leaders, launching a digital advocacy campaign to mobilize the voices in support of closing this gap, and continuing to make the case directly to policymakers.

 

We need your help to do this. We need your partnership, your stories, and your voice. And on November 12th, Georgia Gives Day, we hope you will help support our campaign to close the coverage gap by choosing to give to Georgians for a Healthy Future.

 

You can donate here.

 

Your partner in advocacy,

CZeldin Signature

 

 

 

 

 

Cindy Zeldin

Executive Director

Georgians for a Healthy Future


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Legislative study committees underway

 

The pre-game to the 2016 Georgia legislative session kicked off with the convening of House and Senate study committees last week. Study committees meet during the off-session to take a deeper dive into specific policy issues that may arise when the session gets underway. Each committee will produce a report on its findings and recommendations by the end of the year and potentially introduce legislation during the 2016 session. Click here for a complete listing of House and Senate study committees.

GHF is following and participating in health-related study committees that directly impact consumers. Here’s what you need to know.

Senate Study Committee on the Consumer and Provider Protection Act (SR 561)

In light of changing practices and norms in the insurance market Senate Bill 158 the Consumer and Provider Protection Act was introduced in 2015. This bill outlined provisions for consumer and provider protections regarding health insurance and created the Senate Study Committee on the Consumer and Provider Protection Act. The aim of this committee is to understand how the current insurance environment is affecting the stability of providers and consumers’ access to care. The committee consists of legislators and representatives from the provider, insurer, and consumer communities, including GHF’s Executive Director Cindy Zeldin as the consumer representative. The committee plans to examine the operations of rental networks, contractual issues between insurers and providers, and network adequacy.

 

The first meeting of this committee was held on September 14th at the State Capitol and focused on “rental networks,” also known as silent PPOs. The committee heard testimony from physician and insurer groups as well as from the Department of Insurance. Rental networks occur when third-party entities “rent out” physician-insurer negotiated rates to other payers. The second study committee meeting is scheduled for October 26th at Tift Regional Health System in Tifton and will focus on “all-products clauses” and provider stability issues. The committee will then be back at the State Capitol on November 9th for a meeting focusing on network adequacy and provider directories.

 

Georgians for a Healthy Future has identified network adequacy and the need for more accurate and user-friendly provider directories as important, emerging consumer issues. Network adequacy refers to a health plan’s ability to deliver the benefits promised by providing reasonable access to a sufficient number of in-network primary care and specialty physicians, as well as all and other health care services an insurer guarantees to provide.  GHF will present recommendations on meaningful standards to measure and ensure that provider networks are adequate, as well as how to design provider directories effectively for consumer use. If you are interested in providing testimony or input to this committee, please contact Senator Burke, the study committee chair. Please also let GHF know if these issues have emerged for communities or populations you serve so we can provide the strongest and most informed consumer voice we can on the committee.

 

 

 

Senate Study Committee on Youth Mental Health Substance Use Disorders (SR 487)

The first meeting of the Senate Study Committee on Youth Mental Health Substance Use Disorders convened last week at the State Capitol. The committee is charged with examining prevention strategies and identifying promising approaches to address youth Attention Deficit Hyperactivity Disorder (ADHD) and Substance Use Disorders (SUD). The first meeting included overview presentations from representatives of the Department of Education, Department of Behavioral Health and Developmental Disabilities, and Georgia Council on Substance Abuse (GCSA). The next meeting on October 7th will focus on ADHD and the meeting following that, on October 22nd, will delve into substance use disorders. Georgians for a Healthy Future has been working over the past two years with the Georgia Council on Substance Abuse to raise awareness about the promise of taking a public health approach to substance use disorders that focuses on prevention. We are teaming up with GCSA to host a lunch-time policy forum and discussion on this approach on October 22nd at the Loudermilk Center prior to the study committee’s meeting later that afternoon. Please save the date and we’ll send more details soon. If you are interested in testifying at the October 22nd study committee meeting to talk about prevention, please let Senator Unterman’s office know (you can also reach out to GHF and we can try to pass along your request).

 

 

Senate Study Committee on Women’s Adequate Healthcare (SR 560)

The Senate Study Committee on Women’s Adequate Healthcare met to discuss the current condition of women’s healthcare in Georgia, areas with existing deficits, and the growing number of women who are at risk of unhealthy outcomes. The Department of Public Health, Department of Human Services and Georgia Obstetrical and Gynecology Society presented data and information on areas in which women’s health is in high risk, and policy options to move the needle in the right direction on major health indicators. The next meeting will be health on October 6, 2015, from 9am- 2pm, at Georgia Regents University in Augusta.

 

House Study Committee on School Based Health Centers (HR 640)

Committee members for the House Study Committee on School Based Health Centers met to explore the associations between health and education and ways in which school based health centers can be leveraged to increase access, provide affordable care, and produce cost savings. The committee heard from Voices for Georgia’s Children, the Partnership for Equity and Child Mental Health, and the Global Partnership for Telehealth on the details of the relationship between health and education outcomes. The committee tentatively scheduled the next meeting for September 29th and two additional meetings to follow.


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Network adequacy takes the stage

panelDuring the 2015 Legislative Session, the State Senate established the Consumer and Provider Protection Act Study Committee. This committee will review and make recommendations around several health insurance practices, including network adequacy. GHF has identified network adequacy, or the sufficiency of the health care providers patients can access when they enroll in a health insurance plan, as an important emerging consumer health issue. Our Executive Director, Cindy Zeldin, is a member of the study committee and looks forward to bringing the consumer perspective to the committee’s work. Cindy also recently appeared on WABE and Top Docs Radio to talk about network adequacy and participated in a panel discussion along with several state legislators at the Medical Association of Georgia’s Summer Legislative Education Seminar to discuss this important issue. Stay tuned for study committee agendas, updates, and opportunities to weigh in!

 

Study Committee Schedule:

 

September 14, 9:00 – 12:00

State Capitol, Room 450

 

October 26, 2:00 – 5:00

Tift Regional Healthy System, Tifton

 

November 9, 9:00 – 12:00

State Capitol

 

 


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#donttakemycare

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.


#Donttakemycare

Got Covered - CorneliaCornelia 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

Read more stories like Cornelia’s.


GHF SPEAKS OUT

Georgia leaders, experts weigh in on Obamacare AJC 

CindyZeldin_Headshot - Copy“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.”

Read the full article.


King-Oral-Arguements-Quotes4

 


Local News Highlight

In Republican Stronghold, Worries About End of Obamacare
Bloomberg Politics | Margaret Newkirk
In Georgia’s Gwinnett County where Republicans rule, few really love Obamacare. Few want to lose it either…As the U.S. Supreme Court prepares to rule on a case that could make Obamacare’s private insurance unaffordable in Georgia and at least 33 other states, Gwinnett, where all five of the county commissioners belong to the Republican Party that has been leading the fight against the health care law, illustrates how for many the program has become a fact of life. Obamacare is both groused about and accepted, like taxes and the weather.
Obamacare ruling could kill coverage for 413,000 in Georgia
AJC | Misty Williams

“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.

Read full story.


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2015 legislative session review: webinar

gold dome

 

 

 

 

 

 

 

 

 

 

 

 

 

How much of the state budget went to health, and where was that money allocated?

Which health care-related bills passed, and what do they mean for my family and my community?

For the bills that didn’t pass, are they dead?

What study committees should I be paying attention to throughout the summer and fall?

 

For a complete understanding of what happened this legislative session, don’t miss our webinar.  Lobbyist Andy Lord and Community Outreach Manager Laura Colbert will walk you through what you need to know and answer any questions you may have.

 

Don’t worry – you can still sign up!

 

Date:Thursday, April 9

Time:12:00 – 1:00 EDT


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Join us for health advocates day at the capitol!

 

informationPlease join us on Wednesday, March 25, from 8:45 am to mid-day for a morning of advocacy!  GHF will provide individuals and organizations with the opportunity to advocate for the important health issues that matter to you in the closing days of this legislative session.  You may want to advocate for closing the coverage gap, Medicaid payment parity, raising the tobacco tax, the Family Care Act, rural health care access, or another health policy issue.  You’re all invited to participate!  We’ll provide breakfast, an advocacy training, and an opportunity to share and network with other health advocates.

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

 


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Weekly legislative update

georgia-capital-building

Yesterday 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 onpreventing 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.

 

HB 195  (Rep. Cooper) and SB 51 (Burke) provide 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 was subject to when they were allowed into Georgia as a destination hospital.

 

HB 416 (Rep.Rogers), routinely referred to as the badge bill, 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 passed out of committee on Tuesday March 3.

 

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. The bill passed out of the House HHS committee.

 

HB 429 (Rep. Stephens) seeks to ban coverage denials for medically necessary treatment based solely on life expectancy or the diagnosis of a terminal condition.  The bill is in the House Insurance Committee.

 

HB 76 The House appropriations bill, provides $200,000 to continue the Prescription Drug Monitoring Program in the state, which would otherwise run out of funds and expire on June 30, 2015.  The appropriations bill is currently in the Senate.

 

HB 504 (Rep. Cooper) would extend the flu vaccine protocol that is in place between physicians and pharmacists and nurses for adults to pneumococcal, shingles, and meningitis.

 

HB 436 (Rep. V. Clark) would require physicians and health care providers to offer to test pregnant women who are in their third trimester for HIV and syphilis.

 

HB 463 (Rep. Harbin) would permanently extend a $1,000 tax credit for “medical core clerkship” preceptors for “community based” nurse practitioners and physician assistants.


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GHF interviews Sen. Hufstetler on tobacco tax

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.

 

 

 

 

 


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