Peach Pulse: February 25, 2011

What’s New in Georgia

Update on the 2011 Legislative Session

Nineteen of the 40 legislative days are now complete. The Legislature will be in session every day next week for legislative days 20 through 24. Georgians for a Healthy Future is monitoring several bills that would impact health care coverage and access in Georgia. If you’d like to weigh in on these bills, you can find your legislator’s contact information here.

Action was taken on the following bills this week:
House Bill 47would allow Georgia insurers to sell individual health insurance products with benefit designs equivalent to those sold in other states, circumventing current Georgia standards for basic consumer protections and essential medical services that all insurers must cover today under Georgia law. The bill was favorably passed out of the House Insurance Committee this week. For more information about the concerns this legislation raises for patients and consumers, click here. For more information about the legislation, click here.

House Bill 214would move the Division of Public Health out of the Department of Community Health and establish a new, independent agency, the Department of Public Health, implementing the recommendation of the Public Health Commission. The new stand-alone agency would operate on the same budget as the Division of Public Health and provide Georgians a nimbler and more efficient public health agency with a clear focus on prevention and population-level health. On Wednesday, the bill was favorably reported out of the House Health and Human Services Committee. Clickhere to read a release from Partner Up! for Public Health Campaign on this legislation. For more information about the legislation, click here.

House Bill 229 requires that DCH process appeals requests and refer them for hearing before an Administrative Law Judge (ALJ) within 15 days. Currently, after the ALJ hears a case and renders an impartial decision, DCH may appeal the decision to itself.   HB 229 removes DCH’s ability to overturn the ALJ’s decision, providing a fair and efficient administrative appeal process that protects the integrity and impartiality of the hearing before the Administrative Law Judge. This week, the bill was recommitted to subcommittee to incorporate amendments suggested by members after subcommittee approval. It will be heard again next week. To learn more about the benefits of HB 229, click here. For more information on the legislation, click here.

Senate Bill 17would establish a Special Advisory Commission on Mandated Health Insurance Benefits to study the social and financial impact of current and proposed health insurance benefit mandates and providers. The Senate passed the bill this week. However, because the Affordable Care Act will establish an essential benefits package—a federal floor—for all new health plans beginning in 2014, the impact of the proposed Commission is unclear. To learn more about SB 17 and benefit mandates, click here for a recent AJC article. For more information about the legislation, clickhere.

Additional Analyses & Resources on Proposed Health Care Legislation in Georgia
You can also track the status of various health care related bills and download analyses and resources on these bills on our new legislative tracking page on the Georgians for a Healthy Future website. The page is available here.

Health Care & The State Budget

On Thursday, the House Appropriations Health Subcommittee held a public hearing on the FY 2012 Department of Community Health (DCH) budget. The Medicaid and PeachCare for Kids programs, administered by DCH, are a critical source of health insurance for our state’s most vulnerable children and families. Due to stability protections in federal law, eligibility levels for these vital programs are maintained in the proposed budget. Still, three proposed changes to these programs raise concerns about access to care:  the proposed FY 2012 budget places additional co-payments on low-income patients; eliminates adult dental, vision, and podiatry services; and reduces provider reimbursement rates. Each of these provisions would have a negative impact on access to care by creating financial barriers for patients, shifting care to inappropriate settings, or discouraging provider participation in these programs.

If your legislator sits on the Appropriations Committee, please ask them to protect Medicaid and PeachCare for Kids. Members of the appropriations committee can be found here. You can find your legislator’s contact information here. To learn more about the Governor’s Proposed Health Budgets, click here for a recent analysis from the Georgia Budget and Policy Institute.

Primary Care in Georgia

On Monday, the House Appropriations Health Subcommittee heard invited testimony on Georgia’s primary care workforce. Georgia is below the national average on overall physician supply and primary care physician supply, and our primary care trends are getting worse. For more information about this important issue, click here.

A Statewide Screening Program for Children is At Risk

Children 1st is a statewide program that identifies and screens at-risk children ages birth to five and connects them to appropriate health care services.  The proposed FY 2012 budget cuts $2.9 million from this program, making it impossible for the program to continue to operate as a statewide program.  For more information or to raise your concerns about this cut, please contactHealthy Mothers, Healthy Babies Coalition of Georgia, which has been closely monitoring this issue.

Georgia Alliance for Tobacco Prevention

Georgians for a Healthy Future continues to work with the Georgia Alliance for Tobacco Prevention to increase the tobacco tax from $.37 to $1.37.  This dollar increase would bring us closer to the national average of $1.45 and bring in an estimated $400 million in new revenue to help balance the state budget.  If you would like to learn more about the Alliance or ways to get involved, please email Eric Bailey at the American Cancer Society.

The Affordable Care Act and You

The Pre-Existing Condition Insurance Plan:  New Resources & Information

The Pre-Existing Condition Insurance Plan (PCIP), authorized by the Affordable Care Act, is a new health insurance option for uninsured Georgians who are locked out of the insurance market due to a pre-existing condition. The PCIP covers a range of benefits, including the applicant’s pre-existing condition, and does not base eligibility for the program on income or any other factors aside from having been uninsured for 6 months, having been denied coverage for a pre-existing condition, and meeting U.S. citizenship requirements. Premiums for the plan are based on a standard population and vary only by age. As of February 1stof this year, 399 Georgia consumers gained coverage through the PCIP. The premiums are subsidized entirely with federal dollars and no state funds are associated with the program. In fact, the Governor’s FY 2012 budget proposal realizes savings of $680,263 from the movement of previously uninsured hemophilia patients who had been accessing life-saving drugs through a state program into the PCIP, where those drugs are now covered. For more information about the PCIP, click here to download our new fact sheet. If you think you are eligible for the program, you can apply here. If you work with consumers, patients, or volunteers and want additional resources to raise awareness of the program, including a downloadable widget to add to your website, click here.

Progress on the Health Insurance Exchange

This week, the Atlanta Journal-Constitution reported that Insurance Commission Ralph Hudgens said Georgia should move forward with creating and running its own insurance exchange.  The state health insurance exchanges, which must be operational by 2014, will be new marketplaces where most individuals and small businesses will buy insurance.  States are given the option of operating their own exchange or allowing their citizens to access a federal exchange.  Over the past few months, with a $1 million grant from the U.S. Department of Health and Human Services, the Governor’s Office of Planning Budget has been convening stakeholders and advocates to gather input on the feasibility of establishing a health insurance exchange in Georgia.  This week, Georgia PIRG released a new policy brief entitled, “Building a Better Health Care Marketplace” that discusses the key components of creating a strong exchange.  To read that brief, click here.

Medical Loss Ratio Update:  Consumer-Friendly Rules on Insurance Premiums May be at Risk in Georgia

Under a provision of the Affordable Care Act known as medical loss ratio, insurers operating in the individual health insurance market are required to spend at least 80% of premiums on medical services, improving value for consumers by limiting the amount of consumers’ premiums that can go towards administrative costs such as marketing and profits. This standard was developed through a transparent, fair, and methodical process undertaken by the National Association of Insurance Commissioners (NAIC). The rules are good for consumers, they promote value, and they hold insurers accountable for how premium dollars are spent. If states can demonstrate that these rules would have a destabilizing effect on the individual health insurance market, however, a state’s Insurance Commissioner can apply for an adjustment to the rules. Although there may be instances in which insurers genuinely cannot meet the new MLR standard and would be forced to leave a state’s market unless an adjustment is granted, most individual market insurers should be able—and expected—to spend no more than 20 percent of the premium dollars they collect on non-medical costs. Georgia’s Insurance Department is currently collecting information from insurers and will likely file a request for adjustment. Once the request is filed, there will be a 10-day window for public comment. To ensure that the insurance industry voice is not the only perspective heard, we encourage our partner groups to join us in filing public comments from the consumer perspective at the appropriate time. We will continue to provide information and updates on this issue as we learn more. If you or your organization would like to assist with preparing public comments, please contact us.

National News

D.C. Federal Court Ruling in Favor of ACA

On Tuesday, D.C. Federal Court Judge Gladys Kessler upheld the Affordable Care Act.  This is the third time that a court has reviewed the health reform law on its merits and found it constitutional.  Two rulings have struck down all or parts of the law and 12 cases have been dismissed outright. This ruling reinforces that the individual responsibility provision of the law was a reasonable measure for Congress to take and is in line with the Commerce Clause of the Constitution.  While the issue continues to be litigated by district, appellate and most likely the Supreme courts, it is clear that states must continue the work of implementation while these issues are being resolved to ensure that all Americans are able to access the benefits of the new law.

The CLASS Program

Last week, the Department of Health and Human Services released a new implementation brief on the Community Living Assistance Services and Supports (CLASS) Program.  The CLASS Program was created by the Affordable Care act to be a federally administered health insurance program designed to assist eligible individuals in purchasing long-term community living services and support.  Approximately 10 million seniors and people with disabilities need long-term services and supports and current options in place are insufficient to adequately provide for these citizens.  The CLASS Program will offer eligible beneficiaries:  advocacy services, advice and assistance counseling, and cash benefit. To learn more about the Class Program and its implementation timelines, click here.