Health Reform in Georgia

 

ACA vs AHCA: Know the Facts and Join ARxC in Taking Action

At ARxC, we agree that the Affordable Care Act, (ACA, also known as ‘Obamacare’), can be improved. We also know that we are dedicated to theprotection of quality, comprehensive, and affordable health care for all Americans. We want to maintain the many important protections patients have gained from the ACA that ensures they can access the care and treatment their providers prescribe. We believe the ACA supports and maintains accessibility, affordability, quality, responsiveness, choices and transparency, and innovative patient-centered care.

While it is not a perfect law, the ACA has provided health coverage and improved access to care for tens of millions of Americans living with chronic and serious health conditions, many of whom were previously uninsured or underinsured. If they lose access and coverage for even one day, their health and well-being can be immediately jeopardized. Therefore, providing them with continuous coverage and consistent care and treatment must be your number one priority. Furthermore, we cannot afford to lose the numerous ACA patient protections, which have improved access to quality health care for all beneficiaries, including those who already had health coverage. For many Georgians, they are feeling unsure and ill from the proposed changes to the ACA.

It is important to understand health care access and affordability would be in jeopardy with The American Health Care Act, (AHCA), and the new Republican congress bill offered to replace the ACA. 

This bill would:

  • - Take health insurance from 30 million people, 82 percent of whom are in working families.
  • - Take coverage from the tens of millions of low and moderate income individuals who gained it through Medicaid expansion.
  • - Cause health care premiums to spike drastically for millions more. (Go to NASHP's State Chart Book: Comparison of Predicted Premium Differences across Counties under the ACA and the AHCA to see how premiums will be affected in Georgia).
  • - Give hundreds of billions of dollars in tax breaks to the wealthy, insurance and drug companies, while eliminating tax credits for working families.
  • - Allows the nation's largest corporations to limit or take away health care coverage for their workers.
  • - Double the number of uninsured children in the country, leaving an additional 4 million children uninsured.
  • - Cut funding of Planned Parenthood health centers that provide an array of preventive and basic health services to millions of women.

 

AHCA changes to the ACA include a number of reforms to the health care system such as:

  • - Repealing the individual and employer mandates created by the ACA.
  • - Doubling the cap on how much individuals can contribute to their personal Health Savings Accounts (HSAs) each year and expanding where these dollars can be used.
  • - Giving power to the states with the biggest entitlement reform in a generation putting Medicaid on a budget.
  • - Fundamentally, the AHCA will affect the lower-income, older Georgians who live in rural areas where health insurance premiums are higher.

 

The Congressional Budget Office (CBO) found the AHCA:

§  Could lead to 24 million Americans losing their health insurance by 2026. But the plan would also reduce the federal deficit by nearly $340 billion over that 10-year period in large part by cutting Medicaid and on eliminating tax credits for people that help them buy individual health insurance.

§  An estimated 750,000 Georgians — many of them poor and older — could lose their health insurance.

§  The data offers a glimpse into how the AHCA could fundamentally change access to health care in the Peach State. Georgia already has the third highest rate of uninsured in the nation.

 

June 13, 2017 Update on status of ACA Reconciliation to proposed AHCA

  • - The House of Representatives continues to hold the AHCA in its chamber until they receive confirmation that the bill conforms to the reconciliation instructions.

 

  • - Senate Republican leadership is in conversation with the Parliamentarian regarding the AHCA’s compliance with reconciliation rules.

 

  • - The House bill is sent to the Senate, leadership would typically put the language through its own committee process but the Senate has decided to skip this step.

 

  • - Instead, several groups of Senators are working to privately negotiate a consensus on how they would alter the AHCA. So far, Senators have not come to any agreement and actual legislative language is far from complete. It is unlikely that any language will be publically available until just before a vote.

 

  • - When Senate Republican leadership has come to agreement on language for their version of the bill; they will need another CBO score before they can vote on the legislation. As a reminder, the Senate version must save at least the $119 billion that CBO estimated would be saved under the House version.

 

  • - With a CBO score released, Senate leadership can offer their version of the legislation as a substitute for the bill passed in the House and move to take a vote.

 

  • - Then the bill goes to the Senate floor. Senate rules require 20 hours of debate before a vote followed by unlimited amendments. Only 51 votes are required to pass budget reconciliation in the Senate.

 

  • - Although Senate Republican leadership has indicated it is working with the goal of having a bill on the floor by July Recess (July 3rd-7th), it may be that we will not see a vote until just before Congress goes on Recess for the month of August.

 

  • - Since the Senate will not pass the same bill as the House, the legislation will either go to a conference committee or directly back to the House for a final vote. If unfortunately, the bill makes it through these steps, the AHCA would then be sent to the President for his signature.

 

CALL to ACTION

It is our job as citizens to tell our legislators that we expect these protective tenets of the ACA be upheld. How can I respond to ensure critical measures of protection under the ACA are upheld?

1.      Please sign onto the “Protect Our Care’ letter and then share with everyone you know and post on your social media outlets. http://act.savemycare.org/page/s/let-us-testify

2.     Call your Senator; write your Senator via Email and Fax. ASK your Senator to oppose any bill that violates the protections and affordable access to patients. Please tell your legislator your concerns about health insurance and your story stating your healthcare needs. Here are some talking points to tell your Senator:

  • - While it is not a perfect law, the ACA has provided health coverage and improved access to care for tens of millions of Americans living with chronic and serious health conditions, many of whom were previously uninsured or underinsured. If they lose access and coverage for even one day, their health and well-being can be immediately jeopardized.
  • - Therefore, we must provide them with continuous coverage and consistent care and treatment as a number one priority.
  • - Furthermore, we cannot afford to lose the numerous patient protections that the ACA provides, including the Essential Health Benefits, which have improved access to quality health care for all beneficiaries, including those who already had health coverage.
  • - Currently, patients are protected from discrimination on the basis of race, color, national origin, sex, disability and age by health programs and activities operated or funded by the U.S. Department of Health and Human Services, including Qualified Health Plans. These landmark protections are critical to fulfilling the requirement of preventing discrimination based on pre-existing health conditions and access to the healthcare that every American deserves.
  • - I urge you not to go back on the promise of affordable and quality care and treatment for everyone, especially those living with chronic and serious illness. 

The numbers do not lie; the ACA actually started working. Twenty million Americans have health insurance who did not have it before. It is doubtful that most Americans will think that a plan that leads to many more people going without insurance is “better” than the ACA. Our legislators have a rare opportunity to make improvements in our health policy, but they must understand that providing secure insurance for everyone in the country needs to be a central feature of what they do. That is not an unreasonable demand, nor is it an impossible task. It will mean listening to the voices of patients, care-givers and providers. It is the job of our legislators to ensure determined and considerate leadership as they are about to become responsible for the health and well-being of all Americans. It is our job to remind them of this.

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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