Last Thursday, Georgians for a Healthy Future, the Georgia Budget & Policy Institute, Partner Up for Public Health and the Georgia Rural Health Association returned to Butler, Taylor County for our second symposium in our Building a Healthy Georgia campaign.  The event focused on workforce and economic development, the value of access to care and the importance of public health.  Local community leaders, elected officials, key stakeholders, health care professionals and members of the general public  brought their expertise and passion to the conversation and helped highlight local challenges in having a readied workforce and a healthy community. We also discussed how the health of our communities means more than just access to care–it also means fiscal health. We were energized by the level of engagement and interest in working collaboratively to address our most pressing issues in the state and we look forward to continuing the dialogue!

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Beginning in 2012, Georgia consumers who purchase individual health insurance policies will have access to more information about how their premium dollars are being spent AND will be eligible for rebates if their insurance company fails to provide sufficient value for the premium dollar.

These new standards, known as medical loss ratio (MLR) rules, are part of the Affordable Care Act and are designed to spur insurance companies to operate more transparently and to ensure that consumers get the most value for their premium dollars. Consumers will receive rebates if their insurance company fails to spend at least 80 percent of collected premiums on medical care or quality improvement activities, as compared to profits, administration, and marketing. It is estimated that Georgia consumers will receive approximately $42 million in rebates over the next three years.

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At the end of July, the Department of Community Health (DCH) awarded the Medicaid redesign assessment contract to Navigant Consulting.  The purpose of the redesign process is to analyze options to manage Medicaid and PeachCare financing, as well as explore improvements in the delivery of affordable, quality, health care for the programs and their recipients.  As part of the contract, Navigant will hold up to 30 stakeholder focus groups across the state, in cities yet to be announced.   Part of the state environmental scan, the intent of these focus groups is to provide a forum for Georgia-specific input from providers, other agencies, advocates, and others affected by Medicaid and PeachCare to provide useful information to both Navigant and DCH as this process unfolds.  If you or your organization would like to participate in these focus groups, you can submit an application online here. The deadline for submissions is Tuesday, September 13th.

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Georgia’s Department of Community Health (DCH) recently received two federal grants from the Department of Health and Human Services to improve outreach and enrollment for Medicaid and PeachCare as well as improve the public health infrastructure in Georgia.  The first grant, worth $2.5 million, will allow DCH to use technology solutions to better coordinate enrollment and renewal in Medicaid and PeachCare programs.  The second grant, worth $499,738, will go to strengthening public health infrastructure for improved health outcomes and to help train and educate public health workers. To learn more about these grants, click here and here.

By Dr. Harry J. Heiman and Cindy Zeldin

This column was originally published in the Athens Banner-Herald on August 26, 2011.

The recent debt-ceiling debate and prime-time display of our elected leaders’ inability to work together epitomized the challenges of advancing thoughtful and impactful public policies. Following the deal in Congress, news coverage quickly moved to speculation about the “super committee,” tasked with slashing an additional $1.2 trillion in federal spending over the next decade. Lost in the coverage, and seemingly in the discussion, has been the potential impact of the committee’s decisions on vital services for the most vulnerable in our communities. At a time when the number of people without health insurance continues to rise, Medicaid and other programs that support health care access for low-income children, families, and the disabled remain at risk.

Reduced federal and state funding for Medicaid and the health safety net would be particularly traumatic for Georgia, which has been hit hard by the economic downturn and suffers from high poverty, high unemployment, and high rates of uninsured people. Nearly two million Georgians — one in five — are uninsured, and more than one in six live in poverty. These numbers are even worse in many of Georgia’s rural and inner-city communities. At 37 percent, Athens-Clarke County has one of the highest rates of uninsured people in the state. The consequence of these worsening economic indicators is increased distress experienced by Georgia’s most vulnerable citizens. This distress is reflected in Georgia’s dismal health indicators: high obesity rates, high infant mortality rates and overall poor health outcomes.

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Georgia is currently weighing options to determine whether it should establish a health insurance exchange.  Authorized by the Affordable Care Act, the goal behind these competitive health insurance marketplaces is to better facilitate competition and choice for health care consumers. Today, Georgians for a Healthy Future is releasing an issue brief entitled Building Georgia’s Health Insurance Exchange that outlines how a health insurance exchange can benefit Georgia consumers and makes recommendations for our policymakers as they weigh design options for an exchange.

Building Georgia’s Health Insurance Exchange addresses the following questions:

• Who is eligible for the health insurance exchange?
• What types of insurance plans will be available on the exchange?
• How will consumers afford the products offered on the exchange?
• What will Georgia’s exchange look like?
• How will the exchange benefit Georgia consumers?
• What should policymakers focus on to build a successful exchange?
• What is the timeline for implementing an exchange?

Building Georgia’s Health Insurance Exchange recommends the following policy goals for an exchange:

• Create a governance structure that can transparently and effectively oversee the exchange without any conflict of interests; insurance companies or other businesses that have a direct financial stake should not serve on the governing body

• Provide structured choices that supply the information and tools consumers need to make optimal purchasing decisions, including quality and customer satisfaction ratings as well as information about price and benefits

• Create incentives for insurance companies to compete based on value rather than by selecting the healthiest applicants:  consider leveraging volume within the exchange to drive better deals with insurance companies; consider crafting exchange participation rules to allow the highest quality and value plans to participate; and align regulations inside and outside the exchange to eliminate incentives to steer consumers outside the exchange

• Serve as an easy-to-use, one-stop-shop and provide navigation assistance to programs like PeachCare for Kids^TM and Medicaid where appropriate to ensure that all individuals and families eligible for these programs enroll

• Develop a robust outreach and enrollment mechanism to ensure that low-income and minority communities that historically have had the highest rates of uninsurance are engaged and that consumers in rural areas, without internet access, or with limited English proficiency can still enroll in the plan that best meets their needs

The full issue brief is available here.

In recent years, Georgia consumers have seen their health insurance premiums increase more quickly than their earnings, placing a strain on household budgets. Further, consumers haven’t had access to adequate information to know if these rate hikes are justified. Thanks to requirements and resources available through the Affordable Care Act, Georgia’s Insurance Department has expressed its intent to operate a rate review program to scrutinize proposed insurance premium rate increases of ten percent or more to comply with the law. We hope that Georgia will utilize this program on behalf of consumer to the fullest extent possible to spur insurers to operate more transparently and more fairly in the market. Georgia’s intention to operate rate review was first reported by Georgia Health News. Link is available here.

The Health Insurance Exchange Advisory Committee, charged with determining whether Georgia should establish a state-based health insurance exchange, held its second formal meeting on July 12^th. During the morning session, the committee heard from two existing small business exchanges, HealthPass in New York and Florida Health Choices, to help inform the committee’s work. In the afternoon session, the committee discussed potential pros and cons of developing a small business and/or individual health insurance exchange in Georgia. Committee meetings are open to the public, and the next committee meeting will be held on August 16^th (time and location TBD). There are also two upcoming small business listening sessions, one taking place in Albany on July 20^th and one in Dalton on 26^th of July.  For more information on these sessions, email Amanda Ptashkin.  The committee is to make preliminary recommendations to the Governor by September 15^th and final recommendations by December 15^th. Georgia Health News covered this week’s meeting (article here), and all meeting materials are posted on the state’s health reform website here. This week, the federal Department of Health and Human Services released a proposed rule on exchanges, providing additional flexibility for states as they move forward with their exchange planning. Information about the rule is available here, and a summary analysis from the Health Affairs blog is available here.

The Georgia Department of Community Health Board met earlier this week and approved a .5 percent cut in reimbursement rates for providers participating in the Medicaid and PeachCare for Kids programs (final adoption of rules). The board also proposed increasing co-payments for Medicaid patients and adding co-payments for the first time for PeachCare for Kids patients ages 6 and older (initial adoption of rules). Both changes reflect decisions made by the General Assembly during the 2011 Legislative Session. However, there is concern among advocates and health care providers that these changes will diminish access to care. For more information about these changes, see a recent Georgia Health News article here and a recent AJC article here. For materials from the Department of Community Health board meeting and information about upcoming meetings, click here.

Gayathri Suresh Kumar, M.D
Georgia State Director, Doctors for America

The House’s proposed budget plan to reduce federal support for Medicaid by converting it into a block grant program is the most absurd idea.  As a physician at Grady Memorial Hospital in Atlanta, I provide care for many patients who are dependent upon Medicaid for their well-being. Without Medicaid, what would happen to my patients? Would they stop coming to their appointments or picking up their medications knowing they no longer can afford health care? What if their medical conditions spiral out of control and they seek help at a stage where it may be too late for me to provide meaningful care? (more…)