Health Reform in Georgia

Summer 2016 Update on Georgia's Approach to Expanding Medicaid 

In November 2015 the Georgia Chamber of Commerce – Health and Wellness Policy Committee’s Healthcare Access Task Force began a nine month study to develop policy options to increase quality healthcare access for Georgians.

In August 2016, the proposed alternatives to Medicaid Expansion were released in the Quality Healthcare Access Study: Proposed Policy Alternatives report. This report proposes three possible experimental, pilot, or demonstration projects (called 1115 Medicaid waivers) for state officials to consider to expand Medicaid to low-income Georgians.  

As a member of the Cover Georgia Coalition, ARxC is glad to see movement towards implementing an approach for all Georgians to have healthcare coverage. 

News organizations have put forward the following responses to this report:

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Go to Expand Medicaid Now to sign the petition in support of the Expand Medicaid NOW Act (HB 823)

Sponsored by House Minority Leader Stacey Abrams and co-sponsored by Rep. Robert Trammell and Rep. Pat Gardner, the Expand Medicaid NOW Act (HB 823) would compel Georgia's Department of Community Health to expand state state Medicaid eligibility to individuals earning up to 138% of hte federal poverty level and provide health insurance coverage for nearly half a million Georgians.

(January 2016 update)

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The Patient Protection and Affordable Care Act (known as the Affordable Care Act or ACA) was signed into law on March 23, 2010 to improve access to quality health care.

Here are some of changes that the ACA has made to improve access to care for Americans and legally-residing residents: 

- Ends pre-existing condition exclusions

Ends lifetime & yearly limits

Improves access to primary care services

- Makes Medicaid available to low-income citizens and immigrants with certain statuses - but this does NOT apply in Georgia (see below) 

- Offers premium tax credits to help qualifying individuals and families afford coverage

- Simplifies the health insurance application process - through HealthCare.gov or state-based health insurance exchanges

- Requires greater transparency of health insurance benefits 

Learn how these and other provisions in the ACA is making a difference for the people of GeorgiaLearn more about how the ACA may impact you

ARxC is working with a variety of partners to ensure Georgians receive the maximum benefit of the ACA by.

Expanding Medicaid in Georgia 
 
There are nearly 500,000 uninsured Georgians who do not have access to affordable health insurance because they are too poor to gain access the premium tax credits made possible through the ACA, but do not qualify for traditional Medicaid. Expanding Medicaid in Georgia would insure this population, allowing them to access health care, many for the first time.

To date our Governor and Legislature has not taken action to accept the federal money set aside for Georgia to expand Medicaid.
 
Nonetheless, ARxC, as part of the Cover Georgia Coalition, is committed to expand Medicaid in Georgia because doing so would:
- Improve access to care, health status, and financial security for almost 500,000 Georgians
- Improve Georgia's economy by creating 56,000 new jobs and bringing in $6.5 billion in economic stimulus
- Free up state dollars that are currently covering programs that help a limited number of poor Georgians access serivces (i.e. Georgia AIDS Drug Assistance Program, the State Hemophilia Program, and indigent care).
- Prevent struggling hospitals from closing - see Impact of Insured Expansion on Hospital Uncompensated Care Costs in 2014
 

More information about Medicaid Expansion in Georgia is available at:

 
Providing outreach and education services

In addition to ensuring individuals have adequate health insurance and access to health care facilities, ARxC works to facilitate access to the services and information they need to be advocates for themselves.

As a CMS Champion of Coverage, ARxC sends out updates about the Health Insurance Marketplace and guidance on how to use health insurance to access quality health care services. Here are a few key resources in this effort:

HHS.gov/Healthcare: This website provides background information about the Health Insurance Marketplace, the Affordable Care Act, Prevention and Wellness Services, and other information related to the programs and services made available to help Americans access the services they need to be well. 

ACA 101 Webinars: The HHS Partnership Center host a series of webinars about the benefots made available by the ACA. These webinars are open to the public and include a question and answer session where participants can ask HHS staff questions.

From Coverage to Care: From Coverage to Care is an initiative to help people with new health care coverage understand their benefits and connect to primary care and the preventive services that are right for them, so they can live a long and healthy life. 

Georgia-specific resources

- Connecting Georgians to Coverage: Seedco and local community partners launched this resource to provide Georgians with valuable information so they can make informed choices about their new health insurance options and learn about the benefits of being insured.

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Improving the Standard of Care
 
While the ACA is an overhaul of the United States health system, ARxC believes more needs to be done to ensure the health system in Georgia meets the health and wellness needs of its residents. 
 
Our work in this area is guided by the following five principles that we call ARxC’s Standard of Care.
 
1. Transparency and Accountability
 
Transparency ensures patients are fully informed of their health insurance options, financial responsibilities, health care provider options, and health care and wellness opportunities. As stewards of their professions, health care payers and providers must be held accountable to the services provided to patients. Accountability also implies patients uphold their responsibility to be engaged in their own health care decisions.
 
To enforce these principles, ARxC favors development of a third-party "watchdog" committee that assesses and monitors the performance of health care payers and providers. 

Guiding documents for this principle:

- Patient’s Bill of Rights

AMA Code of Medical Ethics for Medical Professionals

2. Health Disparities

Health disparities are inequalities endured by certain groups, commonly defined by race, ethnicity, income, educational level, sexual orientation, and gender identity. These inequalities cause certain groups of people to endure a disproportionate burden of disease, disability and death.

Given the diversity of Georgians, addressing health disparities is the cornerstone of ARxC's best-practice health insurance model for Georgians.

Guiding documents for this principle:

Commission to End Health Care Disparities - Five Year Summary

- Health and Human Services (HHS) Action Plan to Reduce Racial and Ethnic Health Disparities

For more information on health disparities and the ACA read ARxC's publication “The Role of Health Insurance in Addressing Health Inequity” (written by Haley Stolp, MPH).

3. Primary Prevention and Health Promotion     

Today's fee-for-service model of care causes the health care system to thrive on specialty-driven care rather than prevention. ARxC fights to reverse this trend by advocating for a system that provides incentives for preventive medicine and wellness maintenance and reduces disparity in health care.

To optimize prevention initiatives, ARxC works to increase awareness of the preventive services recommended by the United States Prevention Services Task Force (USPSTF) that are available without cost-sharing for newly enrolled health insurance beneficiaries.

Moreover, we are committed to developing new and innovative means of maximizing uptake of evidence-based prevention and disease management practices.

Resources to maximize uptake of preventive services: 

     -     HHS: What are my preventive care benefits?

     -     National Women’s Law Center: Getting the Coverage You Deserve: What to Do If You Are Charged a Co-Payment, Deductible, or Co-Insurance for a Preventive Service

4. Integrity of the Doctor-Patient Relationship 

ARxC fights to preserve the integrity of the doctor-patient relationship and prohibit payers from influencing patients' health care decisions.

To prevent insurance companies from interfering with the care provided to patients by their health care professionals, ARxC has partnered with the Georgia Healthy Living Foundation to support the Fail First Hurts program, an initiative that strives to end the discriminatory fail first practice. For more on this initiative please refer to the GHLF Fail First Hurts factsheet and the GHLF Fail First Hurts survey results.

ARxC's Specialty Tiers initiative and Testimony to Georgia Pharmaceutical Licensing Board are grounded in this commitment to full access to affordable and safe medications for all, especially people with serious chronic diseases.

Guiding documents for this principle:

     -      Richard Jackson: The Crumbling Physician-Patient Relationship

5. Benefit Management and Access to Coverage

Because there is no universal health care system in the United States, Americans are individually responsible for finding a health insurance plan that best meets their health care needs at a cost they can afford.

To facilitate access to the health insurance, ARxC finds it vital that the ACA's Marketplace be consistent with the values of freedom of choice, freedom of practice and universal access for all patients by including the principles of the Health Insurer's Code of Conduct.

ARxC is also invested in assuring that payers cover and maintain coverage for vital services. In February 2014, ARxC expressed our strong opposition to the sudden and drastic changes to Medicare Part D that were proposed by the Centers for Medicare and Medicaid Services (CMS) in our letter to CMS Administrator Tavenner. ARxC then joined 200 organizations and groups demanding that the rule be withdrawn in a shared letter to CMS that was widely publicized.  In response to the opposition, CMS claimed to no longer pursue the changes to Medicare Part D.

Guiding documents for this principle:

      -     AMA Health Insurer Code of Conduct

      -     Center on Budget and Policy Priorities: Rules of the Road: How an Insurance Exchange Can Pool Risk and Protect Enrollees