Laura Colbert, executive director of Georgians for a Healthy Future, agreed the issues of drug prices and transparency, coupled with the role PBMs play in the equation, will come up…
By Jena Jolissaint
Unless you’ve been trapped under something heavy, you probably know the Patient Protection and Affordable Care Act (ACA) was signed into law on March 23rd. You probably also know that Georgia joined Florida and several other states in challenging key provisions of the law, including Medicaid expansion and the individual coverage mandate. But these challenges aren’t going to see the light of day before the states have to start implementing early aspects of the bill. Whether you think health care is a long-overdue step towards addressing the needs of 1.6 million Georgians who are currently uninsured or not, changes to the way the health care industry does business are coming to Georgia. The question that remains is what Georgia plans to do about it.
Several states have already begun implementing some of the insurance reforms required by ACA as providers, including the extension of coverage for adult children up to age 26, the elimination of pre-existing condition bans, and preventative services coverage without a co-payment. States are also examining the extent of their authority as insurance regulators and determining if additional state legislation will be needed to implement the insurance exchanges and expand Medicaid. Even states who have voiced concerns about the cost of implementation are exploring federal funding options and the possibility of long-term savings, including state funds previously spent on uncompensated care. Overall, the key issue is how to identify and maximize the savings while minimizing the strain.
States as diverse as Mississippi, North Carolina, Virginia, Colorado all formed groups to guide implementation, and Georgia should too. At the bare minimum, Georgia needs a Commission to oversee the health insurance exchanges and make recommendations for implementation at the state level (like the Mississippi committee); ideally, the Commission would either include people who have experience with all aspects of health care such as grant writers, medical professionals, consumer groups, community and public health organizations, and representatives from the state Medicaid and insurance offices (like in North Carolina) or be authorized to create advisory committees comprised of such people (like in Colorado). Creating a group to do such things isn’t unheard of in Georgia; after all, Georgia created the Commission on the Georgia Health Insurance Risk Pool back in 2005. Creating a Commission wouldn’t only help the state maximize the financial benefits of the ACA (including those lovely federal funds for research and implementation, some of which have already found their way to the peach state). The Commission could also make sure that the reforms are tailored to fit Georgia’s unique health care needs and enable community input into a process that has up to this point been a rather opaque. The state has already made a few smart choices regarding the ACA, such as applying for grant money to study the exchanges. Formalizing implementation by creating a Commission would be another step in the right direction.
Jena G. Jolissaint, Ph.D. is a J.D. Candidate (2012) at Georgia State University