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Risky Medicaid Proposal Hurtles through State Legislature

Risky Health Proposal Hurtles through Gold Dome

Updated Mar. 25, 2019. Flawed legislation to expand access to health insurance is hurtling through the state legislature, and hundreds of thousands of uninsured Georgians are being left behind. Senate Bill 106, the Patients First Act, passed the Georgia Senate on Feb. 26 and advanced to the House. The proposal could expand health insurance coverage to more Georgians, though an arbitrary restriction in the bill is setting Georgia up for lengthy delays or outright failure. As currently written, the proposal could cost Georgia twice as much as alternate plans while covering only half as many Georgians with health insurance.

Earlier this year, Georgia leaders announced a plan with a risky restriction to seek federal waivers that could extend health care access across the state. Senate Bill (SB) 106, the Patients First Act, aims to partially expand Medicaid in Georgia. This change could impact individuals earning up to 100 percent of the federal poverty level (FPL): about $12,100 a year for an individual or $25,100 for a family of four. About 240,000 Georgians may eventually qualify for Medicaid coverage under the proposal.

However, restricting Medicaid eligibility to those only under the poverty line could strand hundreds of thousands of Georgians without affordable health insurance options while also forfeiting an enhanced funding deal from the federal government. That means SB 106 could cost Georgia twice as much as traditional Medicaid expansion while covering only half as many Georgians. And although the legislation is quickly advancing through the Gold Dome, the state has yet to release any estimates of how many Georgians will gain coverage or how much the plan will cost taxpayers.

How could the Patients First Act cover half as many Georgians while costing twice as much as Medicaid expansion? As part of the Affordable Care Act, the federal government agrees to pay 90 percent of the costs if states expand health care access to people earning less than 138 percent FPL—about $35,000 for a family of four. States can leverage this 9-to-1 funding match through Medicaid expansion or a state plan, called an 1115 waiver, to accomplish similar goals with more tailored approaches. Without the enhanced 90 percent match, states receive a lower funding commitment instead (about 67 percent for Georgia).

By arbitrarily limiting the state’s ability to negotiate coverage, SB 106 represents a risky gamble while Georgia’s worsening health care crisis hangs in the balance. Other states have previously submitted waivers asking for the enhanced funding match while offering to cover people up to 100 percent FPL, similar to SB 106. None were approved. Every 1115 Medicaid waiver approved under the Affordable Care Act for the enhanced match—including the most conservative examples in Arkansas, Indiana and Kentucky—expanded eligibility up to 138 percent of the poverty line. Georgia should too.

State lawmakers can fix SB 106 by allowing Medicaid eligibility up to 138 percent of the federal poverty level.


Key Points

Bottom Line

Senate Bill (SB) 106 is an unnecessarily risky proposal that threatens to leave hundreds of thousands of Georgians out of expanded health coverage and restricts Georgia from negotiating the best possible health plan.

An arbitrary restriction in SB 106 will lock Georgia to a failed approach that deprives state leaders of the flexibility needed to negotiate a strong health plan.

SB 106 may cost Georgia twice as much money while covering half as many people compared to other plans, including traditional Medicaid expansion.

A simple change to SB 106 would give Georgia a clearer, more certain path to success. State lawmakers can amend the bill to allow Medicaid eligibility up to 138 percent of the federal poverty level.

The Legislation

The Patients First Act, Georgia Senate Bill (SB) 106, would authorize the Department of Community Health to negotiate two waivers with the federal government that could improve health care in Georgia.

Senate Bill 106 would allow the Department of Community Health to request waivers to increase Medicaid coverage up to 100 percent of the federal poverty level (FPL)—about $12,000 for an individual or $25,000 for a family of four. This could potentially expand health coverage to about 240,000 Georgians.

SB 106 Leaves Hundreds of Thousands of Georgians Behind

The proposal falls far short of covering all eligible Georgians with incomes up to 138 percent of the federal poverty level (FPL). Many of the Georgians who are left out will remain uninsured and continue to struggle to get the health care they need.

About 230,000 uninsured Georgians earn between 100 to 138 percent FPL and would not receive expanded coverage through Medicaid. Georgians earning more than 100 percent FPL currently qualify for financial support to buy health insurance, but many still struggle to afford coverage.

Georgia has the 4th highest number of uninsured kids in the nation, many of whom are eligible for Medicaid but remain uninsured. When more parents and caregivers are covered, more kids are more likely to be insured too.

Other plans would put health insurance cards in the pockets of almost half a million Georgians while likely still costing less than the plan authorized by SB 106.

The Critical Difference Between 100 and 138 Percent

As part of the Affordable Care Act, the federal government agrees to pay 90 percent of the costs if states expand health care access to people earning less than 138 percent of the federal poverty level (FPL)—about $35,000 for a family of four.

Without this enhanced 90 percent federal match, states receive a lower funding commitment instead. That lower match is about 67 percent for Georgia.

SB 106 Represents Unnecessarily Risky Gamble

SB 106 represents an unnecessarily risky gamble with Georgia’s health crisis in the balance. Georgia’s leaders are putting forward ideas that have previously failed in other states.

Other states have submitted waivers asking for the enhanced match while only proposing to cover people up to 100 percent FPL, similar to SB 106. None were approved.

Every 1115 Medicaid waiver approved under the Affordable Care Act for the enhanced match—including the most conservative examples in Arkansas, Indiana and Kentucky—expanded eligibility up to 138 percent of the federal poverty level. Some states simply expanded Medicaid while others have developed state-specific plans called 1115 waivers to accomplish similar goals with more tailored approaches.

By restricting Medicaid eligibility to 100 percent of the poverty line, the best plan possible will likely cover half as many Georgians while costing twice as much as alternative.

The arbitrary coverage restriction in SB 106 is setting Georgia up for failure. Preventing Georgia’s 1115 waiver from helping Georgians earning up to 138 percent of the federal poverty level (about $35,000 for a family of four) means that our state is unlikely to get a good deal any time soon.

Unclear Proposal Could Result in Massive Changes with Limited Oversight

SB 106 gives Gov. Brian Kemp’s administration broad authority to make extensive changes to health care in Georgia without input from the legislature or public during the drafting stage.

The Governor’s plan offers no guiding principles, assurances of good governance or safeguards for fiscal responsibility.

No fiscal note or cost estimate has been provided for the proposed waivers being authorized even though this bill has been called “the most significant issue” being discussed this year

The governor’s proposal will likely result in covering fewer Georgians at a greater cost to taxpayers.

Simple Solution

There’s a simple solution for this unnecessarily risky gamble: change one number. State lawmakers can amend SB 106 to authorize an 1115 waiver up to 138 percent of the federal poverty level, instead of the current 100 percent.

Or lawmakers can include a back-up plan authorizes Medicaid eligibility up to 138 percent if the current approach is rejected.


Key Questions About SB 106

How many Georgians will gain access to health insurance through the waivers authorized by SB 106?

Georgia’s uninsured rate in 2017 was 13.4 percent. How much will the proposed waivers reduce our growing uninsured rate?

About 240,000 Georgians make too little to get financial help to buy health insurance and do not currently qualify for Medicaid. This coverage gap represents people earning below the poverty line. Will the waiver offer Medicaid eligibility to everyone in this gap?

When can Georgians expect to see expanded access to health insurance from this proposal?

When will Georgians finally get a health insurance card in their pocket from this plan?

What guarantee does Georgia have that an 1115 waiver which only covers people up to the federal poverty level will receive approval from the federal government for the enhanced 9-to-1 funding match? All similar plans that were previously submitted by other states have been rejected.

Why should state lawmakers arbitrarily limit Georgia’s flexibility to negotiate the best deal possible, especially when that restriction is likely to cause significant delays or outright rejection?

If Georgia’s 1115 waiver is not approved for the enhanced federal funding match, will state leaders choose to cover half as many Georgians as traditional Medicaid expansion for twice the cost?

Will the waivers from this proposal protect Georgians with pre-existing conditions?

Will the waivers maintain essential health benefits for Georgians?

What opportunities will Georgia’s legislative branch have to review and inform the waiver proposals?

How will locking Georgia into a risky waiver approach that’s destined for long delays or failure help address our state’s pressing health care crisis?

 

 


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Medicaid – January 2019

Governor Kemp submits his first budget recommendations which includes $1 million for the Department of Community Health “to review and analyze Medicaid waiver options” for consideration by the Governor’s office. This waiver could include a pathway to health coverage for low-income Georgians.


Health Insurance Would Help Matt and Other Georgians Recover From Mental Illness

Matt Hiltman lowered his shoulder as his horse galloped down the windswept field, kicking up clods of earth in its wake. His steel armor gleamed in the bright sun, and the audience on the sidelines roared with anticipation. Two horses and two riders fast approached each other on a collision course. The crowd fell silent as wood crumpled into metal with a loud crunch, and Matt’s lance struck true. The opponent careened off his horse and tumbled to the ground. Cheers burst out across the tournament field. Another victory for a professional jouster.

A lifelong Georgian, Matt is a world-class, full-contact jouster who competed in the sport for five years while also pursuing studies at Georgia State University. “If I had to describe myself, I would say that I’m an adrenaline junky,” said Matt. Beyond scuba diving, hang gliding and other high-octane activities, Matt’s thirst for adventure also inspired him to study diverse fields at college, including geology, chemistry, biology and history. He graduated magna cum laude from Georgia State University with a major in philosophy and minor in psychology, looking forward to a career in law or another field where he could serve the greater good.

Matt, seen here posing on horseback during a show, worked for five years competing and performing as a jouster.

“I’ve spent a lot of my life and a lot of time thinking about how I can best help the world,” Matt said, “And I’ve got some ideas that I’d like to share.”

The future was brimming with opportunity when Matt’s life hit an unexpected obstacle. At age 29, Matt was hospitalized due to mental illness. “He had an episode of psychosis, and it became obvious at that point that he had bipolar I,” said his mother, Dianne. In Matt’s words, “It was a major shake to my foundation … to discover that my brain is a tool that can be corrupted.”

Bipolar disorder is a mental illness that causes intense shifts in a person’s mood, energy and ability to think clearly, according to the National Alliance on Mental Illness. People with bipolar disorder experience debilitating mood swings, known as mania and depression. About 4.4 percent of adults in the United States experience the disorder at some point in their lives, which generally starts showing symptoms when people reach their mid-20s.

Many treatments can help people living with bipolar disorder, including medications, therapy and lifestyle adjustments. People can lead successful lives after finding the right care regimen and combination of treatments, but that usually requires extensive trial and error. Doctors still have a limited understanding of how the brain works and how best to treat mental illness.

Once I’m healthy, I’ll be able to get out there and help people.
-Matt Hiltman

“It’s been difficult, it’s been very difficult over the last few years,” Matt said.

For Matt, health insurance has been a major barrier to finding the effective treatments that would allow him to begin recovery. Bipolar disorder caused him to lose his job and his health insurance. Untreated, the symptoms make it nearly impossible to work a full-time position with benefits. Matt doesn’t earn enough money to receive subsidies for individual health insurance, so he can’t afford coverage from the private marketplace. He also doesn’t qualify for Georgia’s current Medicaid program.

Watch Matt share his story in his own words.

“He can’t work ‘til his treatment is better,” said Dianne.

Matt sees hope in an advanced brain therapy called Transcranial Magnetic Stimulation. Unfortunately, he cannot receive this cutting-edge procedure without health insurance. Matt is stranded in his recovery process without any affordable health care options.

“There are several treatments that I don’t have access to because I don’t have health care insurance,” says Matt. “That’s frustrating knowing that I might feel relief . . . knowing that it’s out there, and I can’t get it, is very frustrating.”

Matt has virtually exhausted his options for treatment without health insurance.

While Matt and his family have struggled to access treatment, Georgia lawmakers have repeatedly rejected a policy that would provide affordable health coverage to Matt and almost half a million Georgians: Medicaid expansion. About 25 percent of uninsured Georgians who would qualify for coverage through Medicaid expansion suffer from mental illness or substance use disorder.

“He’s not afraid to work hard,” says Dianne. “He’s not unwilling. He just can’t right now. And there’s not anything we can do.”

A new wave of state leaders will have a fresh opportunity in 2019 to tackle Georgia’s growing health crisis and draw down federal funds to broaden health coverage. By allowing Georgians like Matt to access and afford needed medical services, lawmakers can help thousands statewide to get healthy and stay healthy. The policy is popular with the public as well, with more than 70 percent of Georgians supportive of Medicaid expansion according to recent polls.

He’s not afraid to work hard. He’s not unwilling. He just can’t right now. And there’s not anything we can do.
-Dianne Hiltman

For Matt, the idea of getting healthy brings him back to his dream of helping others. “Really it just comes down to . . . you know, once I’m healthy, I’ll be able to get out there and help people.”

Before he’s able to help others, Matt will need to find the right combination of tools to treat his mental illness. He and his family continue to pursue every possible lead, including out-of-state research studies and charity care. But without health insurance, Matt’s recovery appears stuck, and a promising future seems just beyond his reach. In the past, Matt’s hard work helped him succeed in the classroom and in the saddle. Now, his future success rests in the hands of the 236 men and women of Georgia’s General Assembly.

“Having affordable health care and health insurance would give me hope. It would give me more access to different treatments. Mostly, it would give me hope.”


If you or loved ones are living with mental illness, please consider visiting the National Alliance on Mental Illness – Georgia or calling their helpline at 770-408-0625 for more information and support.

To show your support for expanding health coverage in Georgia, please consider sending a short e-mail to your state lawmakers through an easy-to-use form.


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Matt Hiltman: Health Insurance Would Help Matt and Other Georgians Recover From Mental Illness

Matt Hiltman lowered his shoulder as his horse galloped down the windswept field, kicking up clods of earth in its wake. His steel armor gleamed in the bright sun, and the audience on the sidelines roared with anticipation. Two horses and two riders fast approached each other on a collision course. The crowd fell silent as wood crumpled into metal with a loud crunch, and Matt’s lance struck true. The opponent careened off his horse and tumbled to the ground. Cheers burst out across the tournament field. Another victory for a professional jouster.

A lifelong Georgian, Matt is a world-class, full-contact jouster who competed in the sport for five years while also pursuing studies at Georgia State University. “If I had to describe myself, I would say that I’m an adrenaline junky,” said Matt. Beyond scuba diving, hang gliding and other high-octane activities, Matt’s thirst for adventure also inspired him to study diverse fields at college, including geology, chemistry, biology and history. He graduated magna cum laude from Georgia State University with a major in philosophy and minor in psychology, looking forward to a career in law or another field where he could serve the greater good.

Matt, seen here posing on horseback during a show, worked for five years competing and performing as a jouster.

“I’ve spent a lot of my life and a lot of time thinking about how I can best help the world,” Matt said, “And I’ve got some ideas that I’d like to share.”

The future was brimming with opportunity when Matt’s life hit an unexpected obstacle. At age 29, Matt was hospitalized due to mental illness. “He had an episode of psychosis, and it became obvious at that point that he had bipolar I,” said his mother, Dianne. In Matt’s words, “It was a major shake to my foundation … to discover that my brain is a tool that can be corrupted.”

Bipolar disorder is a mental illness that causes intense shifts in a person’s mood, energy and ability to think clearly, according to the National Alliance on Mental Illness. People with bipolar disorder experience debilitating mood swings, known as mania and depression. About 4.4 percent of adults in the United States experience the disorder at some point in their lives, which generally starts showing symptoms when people reach their mid-20s.

Many treatments can help people living with bipolar disorder, including medications, therapy and lifestyle adjustments. People can lead successful lives after finding the right care regimen and combination of treatments, but that usually requires extensive trial and error. Doctors still have a limited understanding of how the brain works and how best to treat mental illness.

Once I’m healthy, I’ll be able to get out there and help people.
-Matt Hiltman

“It’s been difficult, it’s been very difficult over the last few years,” Matt said.

For Matt, health insurance has been a major barrier to finding the effective treatments that would allow him to begin recovery. Bipolar disorder caused him to lose his job and his health insurance. Untreated, the symptoms make it nearly impossible to work a full-time position with benefits. Matt doesn’t earn enough money to receive subsidies for individual health insurance, so he can’t afford coverage from the private marketplace. He also doesn’t qualify for Georgia’s current Medicaid program.

Watch Matt share his story in his own words.

“He can’t work ‘til his treatment is better,” said Dianne.

Matt sees hope in an advanced brain therapy called Transcranial Magnetic Stimulation. Unfortunately, he cannot receive this cutting-edge procedure without health insurance. Matt is stranded in his recovery process without any affordable health care options.

“There are several treatments that I don’t have access to because I don’t have health care insurance,” says Matt. “That’s frustrating knowing that I might feel relief . . . knowing that it’s out there, and I can’t get it, is very frustrating.”

Matt has virtually exhausted his options for treatment without health insurance.

While Matt and his family have struggled to access treatment, Georgia lawmakers have repeatedly rejected a policy that would provide affordable health coverage to Matt and almost half a million Georgians: Medicaid expansion. About 25 percent of uninsured Georgians who would qualify for coverage through Medicaid expansion suffer from mental illness or substance use disorder.

“He’s not afraid to work hard,” says Dianne. “He’s not unwilling. He just can’t right now. And there’s not anything we can do.”

A new wave of state leaders will have a fresh opportunity in 2019 to tackle Georgia’s growing health crisis and draw down federal funds to broaden health coverage. By allowing Georgians like Matt to access and afford needed medical services, lawmakers can help thousands statewide to get healthy and stay healthy. The policy is popular with the public as well, with more than 70 percent of Georgians supportive of Medicaid expansion according to recent polls.

He’s not afraid to work hard. He’s not unwilling. He just can’t right now. And there’s not anything we can do.
-Dianne Hiltman

For Matt, the idea of getting healthy brings him back to his dream of helping others. “Really it just comes down to . . . you know, once I’m healthy, I’ll be able to get out there and help people.”

Before he’s able to help others, Matt will need to find the right combination of tools to treat his mental illness. He and his family continue to pursue every possible lead, including out-of-state research studies and charity care. But without health insurance, Matt’s recovery appears stuck, and a promising future seems just beyond his reach. In the past, Matt’s hard work helped him succeed in the classroom and in the saddle. Now, his future success rests in the hands of the 236 men and women of Georgia’s General Assembly.

“Having affordable health care and health insurance would give me hope. It would give me more access to different treatments. Mostly, it would give me hope.”


If you or loved ones are living with mental illness, please consider visiting the National Alliance on Mental Illness – Georgia or calling their helpline at 770-408-0625 for more information and support.

To show your support for expanding health coverage in Georgia, please consider sending a short e-mail to your state lawmakers through an easy-to-use form.


The future of Medicaid expansion and health coverage in Georgia

Health care emerged as the priority issue for voters this election season. Historic voter turnout and engagement have highlighted the universal desire for affordable, quality health care. Every Georgian wants to be able to see a doctor when they get sick. Every community wants to safeguard their hospital and emergency room. Yet too many of Georgia’s rural hospitals have closed in recent years, and too many Georgians can’t afford health care.

Georgia’s newly elected leaders will have the opportunity in 2019 to embrace a bold solution that would put health insurance cards in the pockets of almost half a million Georgians: Medicaid expansion. While elections come and go, the health care crisis confronting Georgia remains. Seven rural hospitals have closed in Georgia since 2013, and more than half of our remaining rural hospitals are financially struggling. Georgia’s uninsured rate of 14.5 percent is one of the highest in the country, and the uninsured rate in rural Georgia could to climb to 25 percent within the next few years. Substance use disorder and the opioid crisis are devastating communities statewide, demanding a sustained, concerted response.

A strong majority of Georgians support Medicaid expansion. At least seven in ten Georgians think our state should expand Medicaid eligibility, according to polls from the Atlanta Journal-Constitution and 11Alive. Every day Georgia refuses expansion, our state loses $8 million in federal funding for health care.

Although Election Day has passed, the civic responsibility to educate leaders and engage neighbors continues. Send a quick email to your lawmakers about the importance of Medicaid expansion and why you care about this issue. Then share your support for Medicaid expansion with media outlets in your community through a letter to the editor. Visit the tools page for information to guide your thoughts and continued engagement on this important issue.


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Many farmers struggle to protect most valuable part of their farm: themselves

Originally posted by the Georgia Budget and Policy Institute

Julia Asherman is a first-generation farmer who owns and operates Rag & Frass Farm in Twiggs County. Rag & Frass produces beautiful vegetables, fruits and specialty flowers for customers throughout Middle and North Georgia. “I feel like farming is just very fulfilling,” says Julia, “I’ve always been a plant person.”

As an entrepreneur and small business owner, Julia wears all the hats in her company. She works nearly 365 days a year to make her farm profitable in the face of uncertainty from weather, pests and markets. Julia leverages available tools like farm insurance to help mitigate risk for her business, but she hasn’t been able to protect the most important part of her farm: herself.

For years, Julia had no affordable health insurance options. She wasn’t eligible for Georgia’s restrictive Medicaid program and didn’t earn enough money to qualify for financial help to buy health insurance on the marketplace. Her health premium would’ve been $500 a month, almost twice what she pays for her mortgage.

“I have a farm insurance policy that covers if a tornado takes down a greenhouse, and I have liability that covers if someone gets sick from something I produce,” Julia says, “but I don’t have anything protecting me.”

Farming is a fundamental profession, yet agriculture is also one of the most dangerous industries in the country, according to the Centers for Disease Control and Prevention. Every day, about 100 agricultural workers suffer an injury that forces them to miss work. Farmers are nearly twice as likely to die on the job as police officers and five times as likely as firefighters. From tractors rolling over to snake bites, farmers face frequent threats to their health.

I have a farm insurance policy that covers if a tornado takes down a greenhouse, and I have liability that covers if someone gets sick from something I produce, but I don’t have anything protecting me.

Julia Asherman, Rag & Frass Farm

“I’m on a tractor, I’m using heavy equipment, I’m on ladders,” Julia says. “I get on my own roof when I have to patch the roof. There are just a lot of risks.”

Up to 4,200 Georgia agriculture workers could gain affordable health insurance if state lawmakers expand eligibility for the state Medicaid program, according to a 2013 analysis by the Center on Budget and Policy Priorities. All told, Julia and 470,000 other Georgians could be covered through Medicaid expansion. For every one dollar invested by state leaders, Georgia would receive nine federal dollars back for health care. That’s a return on investment that any small business owner would love to have, according to Julia.

Georgia’s Medicaid program currently provides health coverage to almost 2 million residents, including about 1.3 million children and half a million Georgians who are blind, disabled or elderly. About 8 percent of Georgians who qualify for Medicaid are pregnant women or parents with dependent children and very low income (e.g., a family of three would have to bring in less than $6,612 a year to qualify).

Hear Julia’s story in her own words with this short video.

Julia saw these limits firsthand when she went to her local DFCS office to ask about Medicaid coverage for herself given her low income. “They actually told me that I would need to be blind or pregnant to get [Medicaid].”

Beyond the risks of injuries on the job that could cripple her farm, Julia hasn’t been able to afford basic preventative care like mammograms or physicals in recent years. She sees public investments in other local services and can’t figure out why health care solutions are ignored by state leaders. “I don’t understand why there’s a public library but nobody cares if I can get a mammogram.”

I see my health as vital to my farm’s existence and success. If I’m not healthy or able to work because I’m injured, that’s the thing that makes me worry about losing the farm.

While Julia has struggled for years to stay healthy and grow her business, state lawmakers have repeatedly rejected billions of federal dollars meant to pay for health coverage. Every year state lawmakers block Medicaid expansion, Georgia forfeits $3 billion to the federal government. Those dollars could be used to put an insurance card in the pockets of farmers and entrepreneurs like Julia. The majority of people who would be covered by Medicaid expansion are working.

Julia has persevered through all challenges that have confronted Rag & Frass farm thus far and cultivated a growing small business with customers across the state. Yet the biggest risk outside of her control gives her pause.

“I see my health as vital to my farm’s existence and success,” says Julia. “If I’m not healthy or able to work because I’m injured, that’s the thing that makes me worry about losing the farm.”

You can make a difference for Julia and 470,000 other Georgians by showing your support for Medicaid expansion. Contact your lawmakers today. And visit Rag & Frass to buy incredible produce and flowers!


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Julia Asherman: Many farmers struggle to protect most valuable part of their farm—themselves

Originally posted by the Georgia Budget and Policy Institute

Julia Asherman is a first-generation farmer who owns and operates Rag & Frass Farm in Twiggs County. Rag & Frass produces beautiful vegetables, fruits and specialty flowers for customers throughout Middle and North Georgia. “I feel like farming is just very fulfilling,” says Julia, “I’ve always been a plant person.”

As an entrepreneur and small business owner, Julia wears all the hats in her company. She works nearly 365 days a year to make her farm profitable in the face of uncertainty from weather, pests and markets. Julia leverages available tools like farm insurance to help mitigate risk for her business, but she hasn’t been able to protect the most important part of her farm: herself.

For years, Julia had no affordable health insurance options. She wasn’t eligible for Georgia’s restrictive Medicaid program and didn’t earn enough money to qualify for financial help to buy health insurance on the marketplace. Her health premium would’ve been $500 a month, almost twice what she pays for her mortgage.

“I have a farm insurance policy that covers if a tornado takes down a greenhouse, and I have liability that covers if someone gets sick from something I produce,” Julia says, “but I don’t have anything protecting me.”

Farming is a fundamental profession, yet agriculture is also one of the most dangerous industries in the country, according to the Centers for Disease Control and Prevention. Every day, about 100 agricultural workers suffer an injury that forces them to miss work. Farmers are nearly twice as likely to die on the job as police officers and five times as likely as firefighters. From tractors rolling over to snake bites, farmers face frequent threats to their health.

I have a farm insurance policy that covers if a tornado takes down a greenhouse, and I have liability that covers if someone gets sick from something I produce, but I don’t have anything protecting me.Julia Asherman, Rag & Frass Farm

“I’m on a tractor, I’m using heavy equipment, I’m on ladders,” Julia says. “I get on my own roof when I have to patch the roof. There are just a lot of risks.”

Up to 4,200 Georgia agriculture workers could gain affordable health insurance if state lawmakers expand eligibility for the state Medicaid program, according to a 2013 analysis by the Center on Budget and Policy Priorities. All told, Julia and 470,000 other Georgians could be covered through Medicaid expansion. For every one dollar invested by state leaders, Georgia would receive nine federal dollars back for health care. That’s a return on investment that any small business owner would love to have, according to Julia.

Georgia’s Medicaid program currently provides health coverage to almost 2 million residents, including about 1.3 million children and half a million Georgians who are blind, disabled or elderly. About 8 percent of Georgians who qualify for Medicaid are pregnant women or parents with dependent children and very low income (e.g., a family of three would have to bring in less than $6,612 a year to qualify).

Hear Julia’s story in her own words with this short video.

Julia saw these limits firsthand when she went to her local DFCS office to ask about Medicaid coverage for herself given her low income. “They actually told me that I would need to be blind or pregnant to get [Medicaid].”

Beyond the risks of injuries on the job that could cripple her farm, Julia hasn’t been able to afford basic preventative care like mammograms or physicals in recent years. She sees public investments in other local services and can’t figure out why health care solutions are ignored by state leaders. “I don’t understand why there’s a public library but nobody cares if I can get a mammogram.”

I see my health as vital to my farm’s existence and success. If I’m not healthy or able to work because I’m injured, that’s the thing that makes me worry about losing the farm.

While Julia has struggled for years to stay healthy and grow her business, state lawmakers have repeatedly rejected billions of federal dollars meant to pay for health coverage. Every year state lawmakers block Medicaid expansion, Georgia forfeits $3 billion to the federal government. Those dollars could be used to put an insurance card in the pockets of farmers and entrepreneurs like Julia. The majority of people who would be covered by Medicaid expansion are working.

Julia packs up after a successful day at the farmer’s market 

Julia has persevered through all challenges that have confronted Rag & Frass farm thus far and cultivated a growing small business with customers across the state. Yet the biggest risk outside of her control gives her pause.

“I see my health as vital to my farm’s existence and success,” says Julia. “If I’m not healthy or able to work because I’m injured, that’s the thing that makes me worry about losing the farm.”

You can make a difference for Julia and 470,000 other Georgians by showing your support for Medicaid expansion. Contact your lawmakers today. And visit Rag & Frass to buy incredible produce and flowers!


Retired Clay County Teacher Struggles with Multiple Conditions

 

Teresa began working as a teacher for the Headstart preschool program in 1994 but retired in 2010 because multiple health conditions made it difficult for her to work. Now her family’s only source of income is her husband’s monthly disability check, which is too high to allow him to qualify for Medicaid and too low to allow them to qualify for financial help to purchase private insurance through the Affordable Care Act. (Teresa cannot qualify for Medicaid no matter how low her income is because she does not have a disability or a child under the age of 18.) Both of them fall in Georgia’s coverage gap.

Teresa and her husband are just two of 197 of the Georgians in Clay County that are uninsured because Georgia’s decision makers have not extended health insurance coverage to low-income adults in Georgia (those making less than $16,000 annually for an individual or $20,780 for a family of three.)

Teresa struggles to manage multiple health conditions, the worst of which is a jaw condition that has caused her teeth to rot. Because Teresa has not had health coverage since 2009, she has had to find alternative, insufficient treatments for her jaw condition. She would have to pay $5000—almost four months of income—to receive the necessary medical remedies to alleviate her pain and stop the dental deterioration. If Georgia were to close the coverage gap, Teresa would be able to see her doctor on a regular basis without having to forgo appointments and services that would otherwise be too costly.

Georgia’s Governor and legislature have so far rejected the option to close the state’s coverage gap, leaving people like Teresa and her husband uninsured. Until Georgia’s policymakers extend health insurance to all low-income Georgians, Teresa, her husband, and 240,000 other Georgians will likely continue to skip health care appointments and forgo needed care because they have no pathway to coverage.

Originally posted at HealthyFutureGA.org.


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Eight questions for health care voters to ask Georgia candidates

Originally posted at HealthyFutureGA.org

Georgians across the state are being asked to decide how they will cast their votes in November for positions such as Governor, Insurance Commissioner, state senator and state representative. The decisions made by voters about these elected positions will directly impact critical consumer health issues in Georgia like access to health care, affordability of health insurance, the opioid crisis, and the sustainability of the rural health care system.

As candidates crisscross the state or their districts asking for support, voters will consider their stances on a number of important issues including health care. To help voters make their decisions, we put together this list of questions for voters to ask of candidates about five timely and pressing consumer health care issues.

These questions can be used at town halls and candidate forums or posed to candidates via social media or in one-on-one conversations.

Closing the coverage gap
  • Over 240,000 Georgians make too little to receive financial help to buy private health insurance but do not qualify for Medicaid, meaning they fall into the Medicaid coverage gap. Many of the families who fall in the gap are hard-working people who work in industries that make up the backbone of our state: trucking, food service, and childcare. Do you support using federal funds to close the Medicaid coverage gap and offer affordable health coverage to these 240,000 Georgians while boosting the Georgia’s economy? Please explain.
  • A 2016 Department of Health and Human Services study showed that marketplace premiums were on average 7 percent lower in states that extended Medicaid to low-income residents. Do you support closing the Medicaid coverage gap as one method to reduce health care costs and lower the uninsurance rate for consumers in Georgia? Please explain.
Georgia’s health insurance marketplace
  • Health insurance premiums for Georgia consumers will rise by as much as 15 percent in 2019 due to the repeal of the individual mandate by Congress and the elimination of cost-sharing reductions, among other things. If elected, what improvements would you make to our health care system to ensure your constituents have access to high quality, comprehensive and affordable health insurance?
  • The federal government has expanded insurance companies’ ability to sell short-term plans that do not cover key services like mental health treatment or prescription drugs. These plans will increase health care costs and roll back consumer protections that many families in our state depend on. How do you think Georgia should regulate these plans?
Opioid/substance use crisis
  • In 2016, about three Georgians died each day from drug overdoses and thousands of Georgians live with substance use disorders regularly. To slow this crisis, a broad spectrum of strategies will be needed from prevention and early intervention to expanded access to treatment. If elected, what would you do to address the state’s substance use crisis?
 Communities left behind
  • Seven rural hospitals in Georgia have closed since 2010. Rural hospitals are often the largest employer in the area and are the economic engines that help to support local small businesses (like the flower shop or pharmacy). If elected, what will you do ensure that rural communities have adequate access to quality, affordable health care?
  • People of color in Georgia have shorter life expectancies, higher rates of chronic disease, and are more likely to be uninsured and live in medically underserved areas. The causes of these outcomes are complex and linked to reduced access to quality education, fewer economic opportunities, discrimination, and other social and economic factors. As (Governor/Insurance Commissioner/other position title), how would you address the health disparities experienced by people of color in Georgia?
Defending health care gains
  • Over the past two years Congress has repeatedly attempted to repeal the AffordableCare Act (ACA) and slash federal Medicaid funding that our state relies on, despite the fact that 74 percent of the public view the Medicaid program favorably. If elected, will you support/continue to support the program in the face of threats? Please explain.

 


Did you ask one of these questions to a candidate? Let us know! We want to know which questions were most helpful and how candidates are responding. Email Michelle Conde at mconde@healthyfuturega.orgwith your feedback.


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Tool Kit for Medicaid Expansion

You can help spread the word about Medicaid expansion on social media and through your networks! Leverage the resources below, tag social media posts with #coverga and link to https://coverga.org to help your network take action.

For example:

Now is the time for Georgia lawmakers to support struggling rural hospitals, address the opioid crisis and provide health care access to 470,000 Georgians by expanding Medicaid. #coverga https://coverga.org

We can’t afford to wait

State lawmakers can help 470,000 Georgians access affordable health care by expanding Medicaid.

Now is the time for Georgia lawmakers to support struggling rural hospitals, address the opioid crisis and provide health care access to 470,000 Georgians by expanding Medicaid eligibility.

Georgia has refused more than $12 billion federal dollars meant to put health insurance cards in the pockets of Georgia families. We can’t afford to keep waiting to expand health coverage.

Georgia is turning down $8 million a day —$3 billion per year—in money we could be using to help hardworking Georgians access health care.

Georgians can’t afford another year of turning down billions of federal dollars that could be coming back to the state to stabilize struggling hospitals, create thousands jobs and provide health coverage to working Georgians.

As taxpayers, Georgians have already invested in boosting access to health care. If we don’t accept this opportunity in Georgia, the federal government simply keeps our tax dollars.

Basic details

About 240,000 Georgians make too little to get financial help to buy health insurance and don’t currently qualify for Medicaid. These Georgians are stuck in the coverage gap with no affordable insurance options. Why? State leaders keep turning down money meant for health coverage.

Many people in the coverage gap work low-wage jobs where they’re not offered health benefits.

The majority of people who would be covered by expanding Medicaid are working. Many of these workers are in some of Georgia’s most important economic sectors: construction, transportation, education and retail.

Strengthen rural communities

Expanding health coverage would support Georgia’s rural hospitals, economic anchor institutions for rural communities across the state.

Closing the coverage gap would create at least 12,000 new jobs and $1.3 billion in new activity in Georgia’s rural communities each year.

Support behavioral Health

About 25% of uninsured Georgians who would qualify for Medicaid expansion coverage suffer from mental illness or substance abuse.

States that expanded Medicaid connected treatment services to more people with mental illness or substance abuse disorder.

Help women access care

Closing Georgia’s coverage gap would extend health insurance to more than 155,000 uninsured women in Georgia.

Georgia ranks among the bottom five states for women’s health insurance coverage.

Financial security

Just one medical bill can send you into bankruptcy when you’re uninsured. Hardworking families in Georgia need health coverage to get care when they need it without facing huge medical bills or going into bankruptcy.

Accountability

Georgia has refused $12 billion federal dollars meant to put health insurance cards in the pockets of Georgia families. Contact your reps and ask them: why? https://coverga.org

Six Georgia rural hospitals have closed since 2013 and many more are struggling. But Speaker David Ralston “isn’t in the mood” to expand health coverage and stabilize rural communities. https://coverga.org

Instead of expanding health coverage, Lt. Gov. Cagle spent a year studying the state’s biggest health care problems. His solution? More research. How long do we have to wait? https://coverga.org


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