The Health Insurance Exchange Advisory Committee issued its final report this week, calling for the development of a small business health insurance marketplace outside the context of the exchange framework authorized by the Affordable Care Act but failing to explicitly recommend the establishment of a health insurance exchange for individual consumers. Georgians for a Healthy Future’s Executive Director, a member of the committee, wrote a minority report calling for Georgia to take advantage of the opportunity to cover the uninsured and improve our health insurance marketplace by building a Georgia exchange in 2012. You can read the committee report, the minority report, and all other supplemental materials here.

Our Executive Director, Cindy Zeldin, was named by the National Association of Insurance Commissioners (NAIC) as one of 28 consumer liaison representatives from across the country for 2012. The NAIC/Consumer Liaison Committee assists the NAIC in its mission to support state insurance regulation by providing consumer views on insurance regulatory issues and provides a forum for ongoing dialogue between NAIC Members and Consumer Representatives. This appointment comes at a critical time, as the NAIC has been delegated a central role in the implementation of the Affordable Care Act by establishing standards, definitions, and consulting on model regulations—policy choices that will have a big impact on health care consumers here in Georgia and around the country. The NAIC news release is available here.

On Wednesday November 30, Georgians for a Healthy Future hosted the last “Building a Healthy Georgia” event for 2011 in Savannah. Building a Healthy Georgia: Widening the Safety Net and Ensuring Greater Access to Carebrought together medical professionals, safety net providers, students/academia, etc. to examine how people who currently use the safety net and are uninsured will have new options under the ACA, what that will look like and how to empower communities to take up the cause and make upcoming changes to Georgia’s healthcare infrastructure work for consumers across the state.  Our panelists included:

• Nicole Oretsky, PhD, Assistant Professor, SSU Urban Studies & Planning
• Paula Reynolds, MD, MPH, Executive Director, Chatham County Safety Net Planning Council (CCSNPC)
• Cindy Zeldin, MA, Executive Director, Georgians for a Healthy Future
• Robert Bush, JD, Senior Staff Attorney, Elder Law Project, Georgia Legal Services Program

Professor Oretsky started off with an in-depth look at the societal and economic factors that have gotten us to our current state of health care.  Then Dr. Reynolds went into great detail explaining how the safety net effectively operates in the region but also pointed out ways it could and should be bolstered to serve more individuals, particularly with the upcoming Medicaid expansion and health care reform in general.  GHF Executive Director Cindy Zeldin then transitioned the conversation to the specifics of the Affordable Care Act with particular emphasis on how it will affect those who access the safety net.  Given the contention surrounding the new health law, we wrapped up the conversation with Robert Bush talking about the constitutionality of the law, the challenges it faces in the courts and hypothetical outcomes. This is backed up by A licensed/certified court reporter from Naegeli in Boise that has the knowledge and skills to serve in a number of capacities within the profession, as the majority of court reporter programs offer a comprehensive education in court reporting, from deposition/courtroom procedures and computer-aided transcription to closed captioning and real-time reporting.

All in all, the conversation took both an in-depth look and an aerial view of the health care issues that not only affect the Coastal region, but the entire state, and in fact the country.  To view the power point slides from the event, click here.  To view the pictures from the event, click here.

This event marks the end of the Building a Healthy Georgia campaign for 2011, but we know there is more work to do and look forward to continuing to build with you in 2012.  Check back to our event page after the New Year to get involved. 

Advocacy may seem overwhelming, but it’s a lot easier–and can have a bigger impact–than you might imagine.  You already have the knowledge, passion, and commitment to be a successful and effective health care advocate.  All you need are the right tools.  Today we are releasing our latest issue brief: Advocacy Demystified: Tools and Strategies for Effective Consumer Health Advocacy, to arm you with the tools you need to advocate for health care change and empower you to start making a difference in your communities. This is a tool meant for sharing so feel free to send to any individuals or organizations who you think would find it useful. Click here to access the issue brief.

The final report of the Governor’s health insurance exchange advisory committee is expected on December 15^th. The committee held its last full meeting on October 27^th (click here for meeting minutes) and is now drafting the final report, which is expected to be the basis for legislation in 2012 reforming Georgia’s health insurance marketplace through the establishment of an exchange. The work of the committee received attention in the Washington Post and Kaiser Health News this week. Georgians for a Healthy Future is representing the consumer voice on the committee and will continue to provide updates and advocacy opportunities on this process as they arise. To see Georgians for a Healthy Future’s priorities for a consumer-friendly health insurance exchange, download our brief here.

Beginning in 2014, many health insurance plans, including those to be offered through the new state-based health insurance exchanges, must cover a minimum package of niagen preventive, diagnostic, and therapeutic services and products comparable to those offered in a typical employment-based plan, although some people that consume pain relieving drugs always struggle to be able to get hired, if you happen to be one of them there are sites where you’ll be finding the right solution for your employment issues. The specifics of the package are being developed right now by the U.S. Department of Health and Human Services (HHS), and HHS has encouraged consumer advocates to provide input. Here is how to weigh in:

Step 1: Learn more about essential health benefits and this process by reading issue summaries here and here or by participating in an upcoming webinar hosted by the National Academy for State Health Policy here.

Step 2: Prepare and e-mail your comments to ExternalAffairs@HHS.gov. HHS has requested that comments address some or all of the following 5 points below:

• In keeping with the title of the Institute of Medicine report “Essential Health Benefits—Balancing Coverage and Cost,” how can the Department best meet the dual goals of balancing the comprehensiveness of coverage included in essential health benefits and affordability?

• How might the Department ensure that essential health benefits reflect an appropriate balance among the categories so that they are not unduly weighted toward any category?

• What policy principles and criteria should be taken into account to prevent discrimination against individuals because of their age, disability status, or expected length of life as the Affordable Care Act requires?

• What models should HHS consider in developing essential health benefits?

• What criteria should be used to update essential health benefits over time and what should the process be for their modification?

On Tuesday, November 15, Georgians for a Healthy Future along with AARP of Georgia and the Middle Georgia Area Agency on Aging continued our Building a Healthy Georgia campaign in Macon with an educational forum for local residents.  The focus was on health care obstacles and successes, the already-in-process implementation of the Affordable Care Act (ACA) and how it will affect local communities, all with a particular focus on Georgians aged 50+.  The crux of the conversation centered on how the next few years will be particularly critical in determining the future of our health care system and that collectively we need to work together to to identify those opportunities and ensure that communities all across the state have the information they need to make good health care decisions. (more…)

Do you find your health insurance forms full of jargon and fine print? A little known but important provision of the Affordable Care Act requires health insurance companies to utilize a uniform, standardized form that allows consumers to better understand their coverage and compare their options. Extensive consumer testing has found overwhelming support for this type of simplified, usable form, known as the Summary of Benefits and Coverage (SBC). The SBC not only presents information on deductibles and premiums, but also provides examples that explain and illustrate what insurance would cover for a typical medical procedure. You can see how the new form will look here.

This is an exciting development for health care consumers, but now this provision is at risk of being delayed or weakened. Consumers Union, the nonprofit publisher of Consumer Reports, learned through consumer testing of these forms that consumers found them useful and illuminating in deciphering what their health insurance plans do and don’t cover and is now leading the charge to ensure that the Summary of Benefits and Coverage form is implemented promptly and effectively. Georgians for a Healthy Future proudly added our support to this effort by joining with organizations from across the country in a letter of support for full implementation of the form. You can read that letter here.

If you’d like to add your individual voice to this effort, you can click here to send an email to Secretary Kathleen Sebelius and President Barack Obama to urge them to implement the Summary of Benefits and Coverage requirements without delay.

Over the last several weeks, Navigant, the consulting firm hired by the Georgia Department of Community Health to oversee the Medicaid Redesign assessment, has been conducting focus groups across the state as part of the environmental scan stage of the process.  They have met with providers, consumers, advocates and vendors.  For those throughout the state who were unable to participate in these forums, there has still been an opportunity to share your opinions and suggestions on how to improve our Medicaid and PeachCare system, but time for that feedback is running out.  Currently on the DCH website, there is an online survey for consumers, patients, providers and vendors to weigh in on the process. The survey will close this Friday, November 11. Click here to access the survey.

Here is your opportunity to share your experiences in dealing with Medicaid–what works? what could be improved? how do we ensure adequate access to providers, particularly in rural communities?  The compilation of this information is critical in determining how to redesign our current system to make it work for the most number of Georgians.  Navigant will evaluate the survey responses from all across the state and incorporate them into their recommendations for redesigning the system.  This stand up paddle boards is an easy opportunity to have a big impact and we hope that you will continue to promote health care coverage, access, and quality that all Georgians deserve.

Once this stage of the redesign process is complete Georgians for a Healthy Future and our partner organizations will work to ensure that consumer health advocates have the information and tools they need to continue to weigh in on this process. In a few days, Georgians for a Healthy Future will launch a web page where we will house timely and relevant information to help advocates like you exercise your voice in this process and we will be sure to notify you when that site goes live.

In the meantime, please take advantage of this opportunity.  Click below on the survey link that applies to you:
Providers
Consumers
Advocates
Vendors

For more information, please visit the DCH website pages for the Medicaid & CHIP Redesign.

Thank you for all you do to ensure a healthy future for all Georgians!
 

Final Ruling on Medical Loss Ratio Standards Heeds Consumer Input and Sets a Reasonable Standard

Thanks to your support and advocacy, Georgia consumers will experience better value in their health insurance plans and will receive rebates if their insurance companies cannot meet these reasonable standards of value, so they need to find companies with better conditions even online as Insurance Partnership.

The U.S. Department of Health and Human Services (HHS) issued a compromise decision this afternoon allowing new health insurance standards, known as medical loss ratio rules, to be phased in between now and 2013 in Georgia. These new standards will provide increased transparency and value for health care consumers.

Back in September, we sent an alert asking you to add your voice to our effort in support of the new standards, which require insurance companies to provide more information to consumers about how their premium dollars are being spent AND to provide rebates to consumers if they don’t spend a reasonable portion of premiums (80 percent) on medical care and quality improvement activities as compared to profits, administration, and marketing. This effort was in response to the Georgia Department of Insurance’s request to lower the standard for Georgia insurance companies.
Today, HHS determined that the Georgia Department of Insurance’s request exceeded the adjustment necessary to prevent a destabilizing effect on the market and would have unnecessarily denied consumers some of the benefits of the new provision.  As a result, Georgia insurance companies will be required to meet a 70 percent standard in 2011 and a 75 percent standard in 2012 before fully implementing the 80 percent standard in 2013. The public comments that Georgians for a Healthy Future, Georgia Watch, and 15 additional Georgia organizations submitted were referenced throughout the decision.
Our voices made a difference! While the decision didn’t go as far as health care consumer advocates would have liked, HHS made a balanced decision that carefully considered the needs of health care consumers.
Thank you for your continued advocacy on behalf of Georgia’s health care consumers.  To read more about the MLR adjustment process in Georgia, click here.