A road to health coverage for Georgians

More than a half-million Georgians signed up for health coverage during the Affordable Care Act open enrollment period that ended in February. Many were previously uninsured. These robust enrollment figures show Georgia consumers strongly value health insurance and the access to care and financial security it can bring. An unmet demand is finally being met.

To gain a better understanding of this enrollment success story and what’s next for Georgia’s newly covered consumers, Georgians for a Healthy Future reached out to the enrollment assistance community — health insurance navigators and certified application counselors — and reviewed available data on plan offerings, premiums and enrollment. Three key themes emerged.

First, consumers know and trust local organizations. When enrollment assisters partnered with local groups such as libraries, churches and community health centers, they reached more consumers. Enrollment events promoted locally also helped raise awareness among consumers and prompted them to seek coverage. Once people learned there were health insurance options they could afford and unbiased assistance to help them make sense of the application process, they signed up.

These partnerships proved indispensable. There is more that Georgia leaders can do to encourage them.

In 2014, Georgia policymakers passed legislation that prohibits state and local governments from operating health insurance navigator programs and places other limitations on governmental entities. This legislation has been counterproductive, creating confusion around what educational and consumer assistance local entities could conduct. It has hindered potentially powerful public-private partnerships. Local health departments, for example, cannot refer patients to navigators who could help them get coverage.

Opportunities for this sort of collaboration should not be missed. To ensure they are not, Georgia policymakers should lift the restrictions enacted by House Bill 943.

Second, post-enrollment education is needed to help consumers stay enrolled and take charge of their health. This is an opportunity for the nonprofit sector, particularly local groups. Many consumers they helped enroll haven’t had insurance consistently — if at all — in the past. Insurance concepts such as deductibles and co-payments are new to them. Providing plain-language information about how insurance works and how to access preventive care can go a long way toward providing consumers with the information and confidence they need to use their new coverage appropriately.

As consumers do their part by signing up for coverage, paying premiums, and learning new terms and concepts, they should be able to rest assured their coverage will translate to meaningful access to care when they need it. As insurance companies assemble provider networks for the health plans they offer, it is critical these networks provide reasonable and timely access to all covered benefits.

Consumers do not always have the information they need when selecting a plan to determine if an insurer’s provider network is ultra narrow, narrow or broad; provider directories are routinely inaccurate. In addition, some provider networks limit patients’ access to specialists. To ensure consumers have accurate information about providers and sufficient access to care, more transparency and oversight is needed. We encourage Georgia policymakers to put in place and enforce network adequacy standards for health plans.

Third, many Georgians seeking health insurance remain uninsured because they fall into the coverage gap created when Georgia policymakers declined to expand Medicaid. Approximately 300,000 Georgians do not qualify for Medicaid under existing income eligibility guidelines, yet their incomes are too low to qualify for tax credits to purchase health insurance on the Marketplace.

These low-income Georgians — moms, dads, veterans and young adults among them — are stuck in the gap and left without any affordable options unless our state policymakers act. Thirty states have taken action to close their coverage gaps, thus far with promising results. We encourage Georgia to look at innovative solutions to close the gap in our state, too.

Georgia’s historic surge in health insurance enrollment shows the new health insurance opportunities available under the Affordable Care Act are meeting an important consumer need. We can build on this success by deploying strategies at both the community and policy levels to ensure all Georgians have a pathway to coverage, access to the information they need to choose the plan that’s best for themselves and their families, and access to the preventive and treatment services they need to stay healthy.

Cindy Zeldin is executive director of the nonprofit Georgians for a Healthy Future.

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