Tag: health care
In July 2020, Governor Brian Kemp asked the federal government to approve a plan that would make several changes to private insurance in Georgia. The Governor’s plan is made up of two parts: 1) Reinsurance—which would help to lower premiums for some Georgians; and 2) the Georgia Access model—which would force consumers to enroll in coverage through for-profit insurance companies and web brokers instead of the unbiased and centralized enrollment platform that consumers know and trust (healthcare.gov). Federal health officials are asking Georgians like you to weigh in on the Governor’s plan. The deadline to comment is September 16, 2020. Don’t miss your chance to say how this plan will affect you, your loved ones, and Georgians across the state. After you read this short blog, tell health officials what you think.
What’s in the plan
Reinsurance is a tool that some other states have used to lower premiums for consumers and attract more insurers to their marketplaces. Georgia’s proposed reinsurance program is designed so that it would lower premiums more in regions that have higher insurance premiums. Southwest Georgia consistently has some of the highest premiums in the U.S. Georgia’s plan predicts that premiums may drop by 10% across the state, with rural areas seeing bigger drops than urban areas.
Georgia Access Model
In the second part of his plan, Gov. Kemp proposes to dismantle the Affordable Care Act’s (ACA) health insurance marketplace (healthcare.gov). Georgians would no longer be able to enroll in health coverage through healthcare.gov. Instead individuals would be forced to enroll through a health insurer, web-broker, or a traditional broker.
Healthcare.gov is the most widely used and only unbiased place that consumers can shop for comprehensive health coverage. Consumers know all available plans will cover their health needs and they are offered financial help if they qualify and notified of their eligibility for Medicaid or other public coverage programs.
Under the Governor’s plan, Georgia consumers would be the only people in the U.S. forced to go without healthcare.gov, and instead rely on private entities for shopping and enrollment. For-profit insurance companies, online brokers, and even some insurance agents will display comprehensive, ACA-compliant plans alongside short-term plans or plans that do not cover all health services (like mental health and substance use services).
Impacts on Georgians with mental health & substance use conditions (and those in recovery)
Reinsurance: Could help make treatment & recovery services more affordable
The expected drop in premiums from the proposed reinsurance program will help to lower premiums for comprehensive health coverage (which cover mental health (MH) & substance use (SU) services), especially for rural consumers and consumers with incomes too high to qualify for the ACA’s financial help (>400% FPL). For consumers who need their coverage to access treatment services or to support their recovery, lower premiums will make it easier to afford their premiums and to cover their deductibles and other costs.
Georgia Access: Leaves consumers without access to treatment or recovery services
Under this plan, Georgia consumers will lose access to the most widely used enrollment pathway and its attached consumer assistance but will gain no additional enrollment options. Georgians are already permitted to enroll through insurers, web brokers, and agents.
Under an existing enrollment program run by the federal government, insurers and web-brokers have developed a track record of steering consumers toward substandard plans that expose them to catastrophic costs if they get sick; failing to alert or assist consumers when they are eligible for Medicaid; and making it difficult to compare plans. Because these companies are allowed to show substandard plans alongside comprehensive plans, the Georgia Access model will encourage Georgia consumers to enroll in substandard plans. Substandard plans are dangerous for Georgians with mental health and substance use needs because most do not cover mental health, and many do not offer substance use or prescription drug benefits. On top of that, substandard plans are allowed to exclude coverage for pre-existing conditions and charge more for people with pre-existing conditions like a history of mental illness or substance use.
The Georgia Access model puts Georgians at risk of getting lost in a confusing new enrollment process and becoming uninsured altogether. Georgians with little or no experience buying or using health insurance (e.g. young people), those with limited English proficiency, Georgians with low health literacy skills, and people with intellectual or cognitive disabilities would be at greatest risk of experiencing adverse consequences from the outlined plan.
Governor Kemp’s plan to change private health insurance in Georgia turns back the clock for Georgians with mental health and substance use conditions. Under this plan, Georgians would be at risk of enrolling in plans that do not cover their health needs and leave them to manage their recoveries with no help. As mental health and substance use issues rise as consequences of COVID-19, this plan moves Georgia in the wrong direction.
For what is likely the last time, health officials are asking for comments from Georgians about the Governor’s plan. The deadline to comment is September 16, 2020. Don’t miss your chance to say how this plan will affect you, your loved ones, and Georgians across the state! Tell health officials what you think today!
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.
Thousands of Georgians are stuck without any affordable options for health insurance because state leaders repeatedly reject billions of dollars meant to pay for coverage. About 240,000 workers, students, veterans and other Georgians make too little to get financial help to buy health insurance and do not currently qualify for Medicaid. The majority of these Georgians are working in low-wage jobs where they are not offered health benefits.
Georgia is one of 18 states yet to expand Medicaid eligibility to cover more low-income residents. The map below shows the number of uninsured Georgians who could get coverage if Georgia lawmakers voted to fully expand Medicaid. The federal government covers up to 90 percent of the cost for states to expand income eligibility. This amounts to about $3 billion each year in federal dollars coming back to the state to pay for health care services.
Georgia is home to the fifth-highest rate of uninsured people in the country. Accepting the federal money can help hospitals struggling to stay open and cover the costs of caring for a high number of uninsured patients. Georgia would save an average of $200 million each year from lower costs of providing care to the uninsured.
To find out how a state decision to expand health coverage can benefit your community, browse the map below. Click a county to see detailed data and download specific county resources.
Number of Georgians that Could Gain Health Coverage by Expanding Medicaid
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Georgia (statewide), Appling, Atkinson, Bacon, Baker, Baldwin, Banks, Barrow, Bartow, Ben Hill, Berrien, Bibb, Bleckley, Brantley, Brooks, Bryan, Bulloch, Burke, Butts, Calhoun, Camden, Candler, Carroll, Catoosa, Charlton, Chatham, Chattahoochee, Chattooga, Cherokee, Clarke, Clay, Clayton, Clinch, Cobb, Coffee, Colquitt, Columbia, Cook, Coweta, Crawford, Crisp, Dade, Dawson, Decatur, DeKalb, Dodge, Dooly, Dougherty, Douglas, Early, Echols, Effingham, Elbert, Emanuel, Evans, Fannin, Fayette, Floyd, Forsyth, Franklin, Fulton, Gilmer, Glascock, Glynn, Gordon, Grady, Greene, Gwinnett, Habersham, Hall, Hancock, Haralson, Harris, Hart, Heard, Henry, Houston, Irwin, Jackson, Jasper, Jeff Davis, Jefferson, Jenkins, Johnson, Jones, Lamar, Lanier, Laurens, Lee, Liberty, Lincoln, Long, Lowndes, Lumpkin, Macon, Madison, Marion, McDuffie, McIntosh, Meriwether, Miller, Mitchell, Monroe, Montgomery, Morgan, Murray, Muscogee, Newton, Oconee, Oglethorpe, Paulding, Peach, Pickens, Pierce, Pike, Polk, Pulaski, Putnam, Quitman, Rabun, Randolph, Richmond, Rockdale, Schley, Screven, Seminole, Spalding, Stephens, Stewart, Sumter, Talbot, Taliaferro, Tattnall, Taylor, Telfair, Terrell, Thomas, Tift, Toombs, Towns, Treutlen, Troup, Turner, Twiggs, Union, Upson, Walker, Walton, Ware, Warren, Washington, Wayne, Webster, Wheeler, White, Whitfield, Wilcox, Wilkes, Wilkinson, Worth
Valerie is a mother of three children living in Lamar County. Medicaid covers all three of Valerie’s children, and they rely on the health coverage it provides for their varying health needs. Valerie sometimes has difficulty accessing the care and information the family needs because they live in a rural area, but acknowledges that Medicaid is a lifeline that makes it possible for her to focus on her family’s other needs. Without health insurance through Medicaid, Valerie would have to pay hefty medical bills to ensure her children receive the care they require.
Medicaid provides access to needed health care services for low-income soon-to-be-moms, new mothers, and very low-income parents of minor children. For moms like Valerie, Medicaid makes being a mom a little easier by ensuring that their children have access to the health care services they need to grow and stay healthy. For others, Medicaid would help them get or stay healthy so they can best fulfill the responsibilities of being a mothers or caregivers. Over 150,000 uninsured women would gain health insurance if Georgia’s decision makers extended Medicaid to cover low-income adults (those making less than $16,000 annually for an individual or $20,780 for a family of three).