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

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!

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.

“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.”

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.

Originally posted at GBPI.org

Georgia’s Health Coverage Gap

• State lawmakers can put an insurance card in the pockets of 473,000 Georgians by bringing home money from the federal government to pay for coverage.
• About 240,000 Georgians make too little to get financial help to buy health insurance on the Marketplace and don’t currently qualify for Medicaid. These Georgians are stuck in the coverage gap with no affordable health insurance options.
• Rural Georgia is struggling. Six rural hospitals have shuttered since 2013 across the state, and more than half of Georgia’s remaining rural hospitals are financially vulnerable to closure.
• Opioid abuse and unmet mental health needs are decimating communities statewide, exacerbated by high uninsured rates among working Georgians who simply can’t afford access to care.
• The problem is only getting worse. Georgia’s uninsured rate of 12.9 percent is fifth worst in the country. In rural Georgia, the uninsured rate could climb to more than 25 percent by 2026.
• Georgians are already paying taxes toward closing our coverage gap, but state leaders have refused billions in federal health care dollars meant to pay for Georgians’ health coverage and stabilize struggling rural hospitals.

Hardworking Georgians need health coverage to stay healthy

• Working Georgians who could gain coverage earn income below 138 percent of the federal poverty level: about $16,750 for an individual, $22,715 for a family of two and $28,675 for a family of three.
• The majority of people who would be covered by expanding Medicaid are working but often not offered health benefits through their job.
• 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.
• Closing the coverage gap could extend health insurance to nearly half of Georgia’s uninsured veterans, expanding coverage to 32,000 uninsured veterans and military spouses in our state.

Now is the time for state lawmakers to expand health coverage

• Most other states have already put insurance cards in the pockets of hard-working families, helping them afford to see a doctor when they get sick. Georgia is one of only 17 states to not close the coverage gap by expanding Medicaid.
• State leaders have delayed offering serious solutions for Georgia’s worsening health care crisis for years, waiting on Congress to provide a solution that hasn’t come.
• As Georgia leaders refuse to close the coverage gap, the federal government simply keeps our tax dollars. Each year we wait, our state misses out on $3 billion federal dollars meant to pay for Georgians’ health coverage. That’s more than $8 million each day.
• Georgia has already missed out on $12 billion federal health care dollars. Georgia can’t afford to keep waiting.

Closing coverage gap yields big economic benefits for state

• For every dollar the state spends on closing the coverage gap, Georgia receives up to $9 in federal funding.
• Closing the coverage gap could create 56,000 jobs in Georgia each year and boost the state’s economic output by $6.5 billion annually.
• Closing the coverage gap would create at least 12,000 jobs and $1.3 billion in new economic activity in Georgia’s rural communities each year.

Stabilize struggling rural hospitals by closing the coverage gap

• Many Georgia hospitals are struggling because they treat so many patients who lack health insurance and can’t afford high out-of-pocket costs. Closing the coverage gap opens up an important revenue stream to ensure rural communities have access to health care.
• Taxpayers end up paying a share of the cost for uninsured people who show up in emergency rooms. Closing the coverage gap would allow people to go to their doctor instead of the emergency room when they get sick.
• Other states have seen significant reductions in uncompensated care after closing their coverage gaps: Arkansas experienced a 56.4 percent decrease, and Kentucky saw a 59.7 percent decrease.

Strengthen mental health, substance use treatment by expanding health coverage

• Closing the coverage gap can significantly strengthen behavioral health treatment and services in Georgia. About 25 percent of uninsured Georgians who would qualify for Medicaid expansion coverage suffer from mental illness or substance abuse.
• States that closed their coverage gap expanded treatment services to more people with mental illness or substance use disorders. Kentucky saw a 700 percent increase in Medicaid beneficiaries using substance use treatment services after the state expanded eligibility in 2014.

Georgia can afford to close the coverage gap

• Georgia can afford to close the coverage gap, but state leaders have so far chosen to spend tax dollars in other ways, like $309 million for insurance company tax breaks. State leaders could also increase Georgia’s bargain-basement tobacco tax to raise hundreds of millions of dollars a year.
• Closing the coverage gap would extend health coverage almost half a million Georgians, support struggling hospitals, create 56,000 jobs and bring in $3 billion from the federal government. The net cost to Georgia would be $136 million a year on average.