Peach Pulse: August 11, 2011

What’s New in Georgia

Georgia Department of Community Health Awards Medicaid Redesign Contract to Navigant

The Georgia Department of Community Health has announced that it has hired Navigant Consulting to conduct an assessment and present options for restructuring Georgia’s Medicaid and PeachCare for Kids (CHIP) programs. The assessment will address quality, access, and appropriate utilization of resources within these programs. It will include an environmental scan at both the state and national levels to identify what has worked well and what has not worked well and will be complemented by up to thirty stakeholder forums to gain Georgia-specific input from providers, other agencies, advocates, and members. The assessment phase begins immediately and runs through December. The Department has provided an e-mail address, for anyone who wishes to directly weigh in with the Department about this process. A recent news article about this issue is available here.

Potential Good News for Consumers: Georgia Insurance Department to Review Proposed Health Insurance Premium Increases in Compliance with the Affordable Care Act

In recent years, Georgia consumers have seen their health insurance premiums increase more quickly than their earnings, placing a strain on household budgets. Meanwhile, insurance companies just posted a surge in profits for the second quarter of 2011. Georgia consumers historically haven’t had access to adequate information to know if premium rate hikes are justified based on underlying medical costs or if they are simply going towards profits. 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 in compliance with the law. Insurance companies will have to provide evidence that these proposed premium increases are based on reasonable factors like a change in medical costs, utilization, or benefits. This is an opportunity to spur insurers to operate more transparently and more fairly in the market. Georgians for a Healthy Future will continue to monitor this issue as the Insurance Department implements the new requirements. Georgia’s intention to operate rate review was first reported by Georgia Health News. The link is available here. The Atlanta-Journal Constitution also reported on this issue here.

Next Meeting of the Governor’s Health Insurance Exchange Advisory Committee is August 16th

The Health Insurance Exchange Advisory Committee, charged with determining whether Georgia should establish a state-based health insurance exchange, will hold its third meeting on August 16th from 12pm to 3pm in the 5th floor of the Department of Community Health at 2 Peachtree St. The meetings are open to the public. More information about the work of the committee and upcoming meetings is available here.

New Issue Brief from Georgians for a Healthy Future: Building Georgia’s Health Insurance Exchange

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. Earlier this week, Georgians for a Healthy Future released 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 KidsTM 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.

The Debt Crisis and What it Means for Health Care

The recent raising of the debt ceiling spared both Medicaid and Medicare from cuts, but that may be temporary.  With the formation of the bi-partisan “Super Committee” and both parties gearing up for an uphill battle, drastic decisions will be debated, and we must call, email or fax our Congressional delegation and explain how important it is to protect programs like Medicaid and Medicare that help and serve some of Georgia’s most vulnerable citizens.

To see a brief analysis on how the current budget deal will affect health care programs like Medicaid and Medicare, check out Community Catalyst’s blog on the topic.  For now, here is what you need to know:

  • In the first stage, caps are immediately placed on discretionary spending, saving $917 billion over 10 years.
  • For now, both Medicaid and Medicare have been spared from cuts.
  • That may not be the case moving forward since the bill authorizes a bipartisan joint committee of 12 legislators to come up with an additional $1.2 trillion in cuts to be agreed on by the House and Senate or suffer a “trigger” that would institute across the board cuts.
  • If the trigger is activated, Medicaid is still protected from cuts whereas Medicare would be susceptible to cuts to providers and insurers.
  • As the committee makes its decisions, both Medicaid and Medicare are fair game and thus at risk.
  • It is unclear if the committee will be able to reach a consensus but if they cannot or their efforts do not amount to the total reduction necessary, the trigger will be activated and across the board cuts will result.

Between now and November (the committee’s deadline to have a plan drafted) the health advocacy community must rally behind these important programs and spur outreach to our elected officials to remind them:

Don’t jeopardize Georgia’s fragile economic recovery and the health and economic security of seniors, people living with disabilities and low-income families by simply shifting costs onto individuals, families and the state.  Don’t cut Medicaid or Medicare.

If you don’t know who your member of Congress is, you can find out this information here.

As tough decisions are being made, we must continue to tout Medicaid’s value not only as a means to help low-income children, elderly, and disabled Georgians get health care services; but also one that invests in Georgia’s health care system and its local economies. For more specifics on the effect that cuts in Medicaid would mean for Georgia, you can download a fact sheet from Georgians for a Healthy Future and the Georgia Budget and Policy Institute here.  Families USA also has a Medicaid calculator which allows you to determine the economic impact of proposed cuts to Georgia’s program here.