Peach Pulse Archives

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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, Navigant@dch.ga.gov 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 16^th 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 16^th from 12pm to 3pm in the 5^th 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 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. 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. MORE >

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Join Our Building a Healthy Georgia Campaign

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Upcoming Events

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AUGUSTA

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Action Alert

Tell Your Member of Congress and Georgia’s Senators:  Medicaid Matters!

As Congress debates deficit reduction proposals, Medicaid is under threat of being cut. The Ryan proposal, passed by the House of Representatives, would make drastic cuts to Medicaid, such that in 10 years Medicaid would be cut by 33%. To put this into context, if a cut of this size were put into effect today, it would translate to $1.9 billion in lost federal funding for Georgia and place $4.4 billion in Georgia business activity and more than 38,000 jobs related to our state’s health care economy at risk.

Medicaid cuts would not only threaten Georgia’s fragile economic recovery, but also threaten access to health care and health outcomes for low-income families, seniors, and people with disabilities. In fact, a landmark study released last week by a team of top-notch researchers led by Harvard and MIT using a randomized control design, the gold standard for health services research, has found that having Medicaid coverage results in improved access to care, improved financial security, and improved reported health status relative to being uninsured. More details about the study are available here and here, and the full report can be downloaded by clicking here.

Please contact your member of Congress and send the message:  Don’t jeopardize Georgia’s fragile economic recovery and the health and economic security of seniors, people living with disabilities and low-income families.  Don’t cut Medicaid. If you don’t know who your member of Congress is, you can find out this information along with contact information here.

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What’s New in Georgia

 

Georgia Health Insurance Exchange Advisory Committee Work Continues

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.

 

Medical Loss Ratio Update: Ensuring Value for Georgia’s Consumers

Health care consumer advocates in Georgia are on standby as the Center for Consumer Information & Oversight (CCIIO) reviews the Georgia Insurance Commissioner’s application for an adjustment to the new medical loss ratio (MLR) rules that require insurance companies to spend at least 80% of the premiums their customers pay on medical services and quality improvement activities, as compared to administrative expenses, or else provide rebates to consumers. Designed to spur insurance companies to operate more transparently and to provide value for the paid premium dollar, the new rules are a step forward for consumers. When Georgia’s application is complete, CCIIO will accept public comment. Georgians for a Healthy Future will be filing comments in collaboration with a range of other groups, and when the comment period opens, we will keep you updated as to sign-on opportunities on this important issue. Kaiser Health News has a video explaining MLR here, and Georgia Public Broadcasting has a story about Georgia’s adjustment request here.

 

Community Health Board Approves Provider Reimbursement Rate Cuts

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.

F as in Fat: Georgia Rankings

According to a new report released by the nonprofit Trust for America’s Health and Robert Wood Johnson Foundation shows that Georgia is the 17^th most obese state, with an adult obesity rate of 28.7% and a children’s obesity rate of 21.3%.  To read that report, click here.  To read a recent AJC article on the report, click here.

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Events

What Health Care Reform Means for Small Businesses in Georgia

This week, Georgians for a Healthy Future and Small Business Majority held the first in a series of presentations focused on small business owners and how health care reform will affect them, their families and their bottom line.  From the tax credits that are already available for businesses who filed 2010 tax returns to the creation of the small business exchange, health care reform will have a positive impact on many of Georgia’s small businesses.

To learn about an upcoming webinar or educational forum, email Amanda Ptashkin.   To view the power point presentation from this week’s webinar, click here.

Building a Healthy Georgia: Augusta

If you live in the Augusta area and have an interest in policies and practices aimed at the obstacles to accessing care for children in the region, join Georgians for a Healthy Future, Voices for Georgia’s Children and Health STAT for our symposium, “Building a Healthy Georgia: Exploring Policies and Practices to Improve Children’s Access to Health Care Services.”

Event Details:

WHEN:             Thursday, August 25^th, 1:00 PM to 3:00 PM

WHERE:           The Salvation Army Ray and Joan Kroc Corps Community Center of Augusta

CONTACT:       For questions, please contact Amanda Ptashkin or at 404-890-5804.

While we request RSVP, please note that there is no cost

REGISTER HERE

For more information about the event, click here.  Don’t live in Augusta?  Think of at least one person who you know in the area who would be interesting in being involved in this conversation and tell them about it!  Stay tuned for more information about upcoming events in a town near you!

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What’s New in Georgia

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Georgia Health Insurance Exchange Advisory Committee Begins Work

The first meeting of the newly appointed Health Insurance Exchange Advisory Committee was held on June 6^th. The committee, consisting of 25 members, heard presentations from the Governor’s staff and was given its charge to determine whether Georgia should establish an exchange and whether there should be a single exchange for small businesses and individuals or whether there should be separate exchanges. Information about the committee and the committee meetings is housed on the state of Georgia website here.

State-based health insurance exchanges are a central feature of the Affordable Care Act (ACA) and will serve as the mechanism for restructuring the individual and small group health insurance marketplaces. If designed well, the exchange can facilitate apples-to-apples comparisons of health insurance options for consumers, make these choices more affordable by providing access to substantial tax credits authorized by the ACA, and navigate consumers who are eligible for the Medicaid or PeachCare for Kids programs to those options. Georgians for a Healthy Future’s Executive Director was appointed to the committee to represent the consumer voice. To see our priorities for the exchange, read our recent op-ed on this issue here.

Still, we want your input! Please share your priorities for the exchange with us. If you have questions about the exchange or would like to learn more, please also be in touch and we can brief you about the details.   To view other states’ progress on setting up exchanges, click here to view a Commonwealth Fund map.

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Cuts to Medicaid Will Harm Georgia’s Economy

Congressional proposals to reduce federal Medicaid support to states and turn the program into a block grant would stunt the economic recovery in Georgia by placing business activity and thousands of jobs at risk while shifting new costs to Georgia at a time when the state can least afford it. According to a new report released this week from the national consumer health advocacy organization Families USA, here in Georgia the proposed cuts could translate to as much as $1.9 billion in lost federal funding and place $4.4 billion in business activity and 38,420 jobs at risk.

Please contact your member of Congress and send the message: 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. If you don’t know who your member of Congress is, you can find out this information here.

For more specifics on the Georgia data, you can download a new fact sheet from Georgians for a Healthy Future and the Georgia Budget and Policy Institute here.  You can also download the full report from Families USA here.

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Pathways to Coverage
Figuring out how to purchase insurance for yourself or your family is a confusing process, particularly if you have a pre-existing condition or are unable to afford coverage.  To help consumers navigate the system, Georgians for a Healthy Future has a new fact sheet called Pathways to Coverage. It’s a basic one-page overview of where and how you can access health insurance in Georgia today, and provides you contact information for relevant resources. If you interact with patients and consumers, please share with them, or any other individuals or organizations who you think would find it useful. Click here to access the fact sheet.

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Starting July 1^st, Insurance Companies Can Offer Stripped-Down Policies in Georgia
Throughout the 2011 Legislative Session, Georgians for a Healthy Future worked in coalition with a range of patient, consumer, and primary care advocacy groups to raise concerns about House Bill 47, which would allow Georgia insurance companies 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. Unfortunately, the legislation passed and was signed into the law by the Governor. It takes effect tomorrow. For a recent article on House Bill 47, click here.

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New Changes to Take Effect July 1 for the Pre-Existing Condition Insurance Plan (PCIP)
The Pre-Existing Condition Insurance Plan, a new option for uninsured consumers who are locked out of the insurance market due to a pre-existing health condition, has had lower than anticipated enrollment since it became available in late 2010. To make the program more accessible, starting July 1^st premiums will be reduced by 15% in Georgia and applicants no longer have to produce a letter of denial from an insurance company but can instead supply documentation from their physician that they do have a pre-existing condition. The requirement to have been uninsured for six months has not been changed. To date, 608 people in Georgia have enrolled in the plan. To download our updated fact sheet on the PCIP, click here. To apply for the PCIP, click here. For a recent report from the Commonwealth Fund on how the program is working around the country, click here.

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Forums and Events

Building a Healthy Georgia: Exploring Policies and Practices to Improve Children’s Access to Health Care Services

Georgians for a Healthy Future, along with partnering groups HealthSTAT and Voices for Georgia’s Children, invites you to participate in a community conversation centered around the barriers that children face when accessing vital health care services in Augusta.  With your active engagement, the goal of this symposium is to catalyze a statewide effort to advocate for policy and practice changes to remove existing access barriers and strengthen the overall health care delivery system in Georgia.  Please share this information with your contacts and partners in the Augusta area and encourage them to attend.

EVENT DETAILS:
WHEN:        Thursday, August 25^th, 1:00 PM to 3:00 PM
WHERE:      The Salvation Army Ray and Joan Kroc Corps Community Center of Augusta
CONTACT:  For questions, please contact Amanda Ptashkin.  To RSVP, click here.  While we request RSVP, please note that there is no cost to attend this event.

SPEAKERS:
Sandra Mobley,PhD, RN, Assistant Professor, Dept. of Obstetrics and Gynecology, Georgia Health Sciences University
Joann Yoon,JD, Assoc. Policy Director for Child Health, Voices for Georgia’s Children
Denise Kornegay,MSW, Program Director,AHEC Network
Michelle Putnam,MPH, Executive Director, HealthSTAT
Amanda Ptashkin,JD,Outreach and Advocacy Director, Georgians for a Healthy Future

To learn more about this event, click here.

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Campaign for Better Care Advocates for Quality Reforms
The Campaign for Better Care is a new effort that aims to ensure that our health care system provides the comprehensive, coordinated, patient- and family-centered care that individuals want and need. Here in Atlanta, Georgians for a Healthy Future joined with coalition partners Georgia Watch, Piedmont Healthcare, Georgia Coalition for the People’s Agenda, The Center for Pan Asian Community Services, and the Urban League of Greater Atlanta in a town hall conversation about safely and effectively navigating healthcare today earlier this week to kick off the effort. To learn more about the campaign or to learn what you can do to support this effort, click here.

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National News

6^th Circuit Appellate Court Upholds Individual Mandate
In a 2-1 ruling issued this week, the United States Court of Appeals for the 6^th Circuit upheld the constitutionality of the requirement to purchase health insurance in the Affordable Care Act. The 6^th circuit is the first appellate court to rule on the issue; cases are pending before the 4^th circuit and 11^th circuit court of appeals. Full coverage of the ruling is available here.

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Building a Healthy Georgia

For nearly a year, we’ve been bringing the Peach Pulse to your inbox. Our hope is that it is interesting, informative, and equips you with the information and tools you need to be an effective advocate.

During the 2011 Legislative Session, we kept you updated on bills moving through the legislature that would impact health care consumers, developments with the nation’s new health care law, and other national issues affecting Georgia health care consumers.  We will continue to keep you updated on public policy developments happening in Georgia and nationally throughout the summer and fall, but also want to utilize this forum to highlight opportunities to engage on health care issues through Town Halls, Educational Forums and Health Fairs. Don’t worry–we will still have those other important updates in there!

Georgians for a Healthy Future, along with several coalition partners, is embarking on an exciting new project, the “Building a Healthy Georgia” Campaign. The effort will bring together community leaders, health care providers, consumers and small business owners to foster a dialogue on the most pressing health care issues in local communities, and we hope you’ll get involved.

Between now and October, we will hold forums in 9 cities: Alpharetta, Athens, Butler, Macon, Rome, Savannah, Gainesville, Augusta and Tifton.  Each event will have a different focus in order to address most pressing health care issues in these communities.  As these events are scheduled, we will be sure to share the details as well as an opportunity to participate.

Additionally, if you are planning an event of your own and would like to incorporate information from the health care consumer lens, we are always happy to come and speak to your group or to provide materials.  Please contact Amanda Ptashkin if you would like to include Georgians for a Healthy Future in your upcoming event!

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Upcoming Events

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AUGUSTA

Building a Healthy Georgia: Exploring Policies and Practices to Improve Children’s Access to Health Care Services

Georgians for a Healthy Future, along with partnering groups HealthSTAT and Voices for Georgia’s Children, invites you to participate in a community conversation centered around the barriers that children in your area face when accessing vital health care services.  With your active engagement, the goal of this symposium is to catalyze a statewide effort to advocate for policy and practice changes to remove existing access barriers and strengthen the overall health care delivery system in Georgia.

EVENT DETAILS:
WHEN: Thursday, August 25^th, 1:00 PM to 3:00 PM
WHERE: The Salvation Army Ray and Joan Kroc Corps Community Center of Augusta
CONTACT: For questions, please contact Amanda Ptashkin.  To RSVP, click here.  While we request RSVP, please note that there is no cost to attend this event.

SPEAKERS:
Sandra Mobley,PhD, RN, Assistant Professor, Dept. of Obstetrics and Gynecology, Georgia Health Sciences University
Joann Yoon,JD, Assoc. Policy Director for Child Health, Voices for Georgia’s Children
Denise Kornegay,MSW, Program Director, AHEC Network
Michelle Putnam,MPH, Executive Director, HealthSTAT
Amanda Ptashkin,JD,Outreach and Advocacy Director, Georgians for a Healthy Future

To learn more about this event, click here.

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ATLANTA

Town Hall Conversation: Safely and Effectively Navigating Healthcare Today

Community leaders, civic organizations, healthcare providers and hospitals are collaborating to provide you with valuable healthcare information that everyone must have to safely and effectively navigate healthcare today.  The evening will feature discussion around patient safety as well as how healthcare reform might impact you and your family.  The event will include:

• Free health screenings
• Materials in various languages
• Food and beverages, and
• Opportunities to ask questions

EVENT DETAILS:
WHEN: Tuesday, June 28th, 6:00 PM to 8:00 PM
WHERE:  Atlanta Community Food Bank
732 Joseph E. Lowery Boulevard
Atlanta, GA 30318
CONTACT: To make a reservation or for more information, email hap@georgiawatch.org or call 404.525.1085

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What’s New in Georgia

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Building a Healthy Georgia Campaign

Georgians for a Healthy Future, along with many of our coalition partners is embarking on a series of educational forums across the state aimed at bringing together community leaders, health care providers, consumers and small business owners to foster a dialogue on the most pressing health care issues in local communities.  Between now and October, we will hold forums in 9 cities: Alpharetta, Athens, Butler, Macon, Rome, Savannah, Gainesville, Augusta and Tifton.

To learn more about the Building a Healthy Georgia campaign and ways to collaborate on the events, contact Amanda Ptashkin.

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Governor Deal Establishes Advisory Committee on Health Insurance Exchange

Earlier this week, Governor Nathan Deal issued an Executive Order creating the Georgia Health Insurance Exchange Advisory Committee. The charge of the committee is to determine if Georgia should establish a state-based health care exchange as authorized by the Affordable Care Act. Georgians for a Healthy Future Executive Director Cindy Zeldin will serve on the committee, providing a seat at the table for the consumer voice. We will keep you updated throughout this process, and in turn please send us your thoughts and ideas for how to build a consumer-friendly exchange so we can bring the best ideas to the committee. The Executive Order, including the list of committee members, is available here.

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House Bill 47 Signed Into Law

During the Legislative Session, Georgians for a Healthy Future worked in coalition with a range of patient and consumer advocacy groups to raise concerns about House Bill 47, which would allow Georgia insurance companies to sell individual health plans 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. Last month, Governor Deal signed House Bill 47 into law. We will monitor its implementation and keep you updated on advocacy opportunities.

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Georgia Department of Community Health Looks at Medicaid Options

The Department of Community Health (DCH) recently announced that they would be undergoing a process to assess the most appropriate approach for providing services to Medicaid and PeachCare for Kids members. The Board of Community Health meets monthly, and the Board’s Policy Committee and Care Management Committee meet periodically as well. Information about upcoming DCH Board Meetings is available here. As we learn more information about potential changes to the Medicaid and PeachCare for Kids programs, we will pass along this information.

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Opening Arguments to Start on June 8^th

The United States Court of Appeals for the 11^th Circuit will hear oral arguments in Atlanta on Wednesday, June 8, 2011, in the case State of Florida v. U.S. Department of Health and Human Services, the Florida Attorney General’s challenge to the Patient Protection and Affordable Care Act that has been joined by Attorneys General from a number of other states. Consumers and small businesses are already benefiting from the law through new tax credits, an insurance plan for people with pre-existing conditions, and additional consumer protections. Georgians for a Healthy Future is joining Families USA and several consumers who have been impacted by the law for a briefing prior to the oral arguments. The briefing will start at 8am on Wednesday morning at the corner of Forsyth St, NW and Walton St, NW outside the Elbert P. Tuttle United States Court of Appeals Building in Atlanta. Please join us to show your support!

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National News

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Premiums to Drop 15% for the Pre-Existing Condition Insurance Plan

Last week, the Department of Health and Humans Services announced that premium rates for the Pre-Existing Condition Insurance Plan (PCIP) would be lowered to encourage more people to enroll.  In Georgia, consumers will see a 15% reduction in premium costs and will no longer need to submit a formal denial letter from an insurer, but rather just send in a doctor’s note confirming the existence of a pre-existing condition.  Consumers hoping to join the PCIP will still need to show that they have been uninsured for six months.  This is a welcome change that should allow more of our state’s 1.9 million uninsured to find and enroll in health insurance.  To read a recent Georgia Health News article on the PCIP, click here.

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Health Transformation Grants Now Available:

Through the Affordable Care Act, $100 million dollars is now available for up to 75 Community Transformation Grants across the country.  These grants are aimed at helping communities implement projects proven to reduce chronic diseases such as diabetes and heart disease. By promoting healthy lifestyles and communities, especially among population groups experiencing the greatest burden of chronic disease, these grants will help improve health, reduce health disparities, and lower health care costs.  State and local government agencies as well as state and local non-profit organizations are eligible to apply for the grants. Letters of interest are due on June 6 and applications are due to the CDC in July 2011, with awards expected to be announced near the end of summer. To learn more about the grant opportunity, click here.

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600,000 Young Adults Get Coverage

Since September 23^rd, 2010, an estimated 600,000 young adults, up to age 26, have been able to remain on or rejoin a parent’s insurance plan through the dependent care provision of the Affordable Care Act.  The Department of Health and Human Services estimated that 1.2 million young adults would gain coverage through this provision in 2011 alone, but given the numbers to date, that figure should be much higher.  This provision is particularly popular because people in their 20’s have the highest uninsurance rate of any group, 30%.  To read more about the dependent care provision of the ACA, click here and here.

Have you been able to keep your children on your plan due to this provision? If so, let us know by emailing Amanda Ptashkin at aptashkin@healthyfuturega.org.

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Georgians for a Healthy Future in the AJC: “Pro & Con: Is first year of health care reform law living up to promised claims?”

Georgians for a Healthy Future’s Cindy Zeldin and Voices for Georgia’s Children’s Joann Yoon marked the one-year anniversary of the new health care reform law by setting the record straight in the AJC on the benefits of the new law to Georgia consumers. The article is available here.

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Second Annual Cocktail Reception

Thank you to everyone who came out for Georgians for a Healthy Future’s 2^nd Annual Cocktail Reception and Fundraiser!  We were delighted to see so many new and also familiar faces supporting the work of our organization.  Click here to view pictures from the event.  If you were unable to attend and would still like to support the important work of our organization, please click here.

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What’s New in Georgia

Update on the 2011 Legislative Session

Thirty-three of the 40 legislative days are now complete. The Legislature is out of session for the remainder of this week; in session each day next week for legislative days 34 through 38, out of session the week of April 4^th; and in Session for the final two legislative days on April 12^th and April 14^th.  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.

Recent Action Was Taken on the Following Bills:

House Bill 47 would 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 passed by the House and is now in the Senate Insurance Committee. 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 214 would 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. The bill was passed by the House and passed through the Senate HHS Health Care Delivery Subcommittee on Wednesday. It now moves to the full Senate HHS Committee. For more information about the legislation, click here.

House Bill 229 would require 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 would remove DCH’s ability to overturn the ALJ’s decision. The bill did not pass by Crossover Day, which means that it is no longer viable this year unless attached to another piece of legislation. To learn more about the benefits of HB 229, click here. For more information on the legislation, click here.

House Bill 476 (pulled from the calendar on Crossover Day) would have established the Georgia Health Exchange Authority, the governance body for Georgia’s health insurance exchange. Under the Affordable Care Act, Georgia recently received a $1 million grant from the Department of Health and Human Services to begin planning for a health insurance exchange. HB 476 also would have created an Advisory Committee to make policy recommendations to the exchange governing board and the Governor by November 15, 2011 for next steps. The bill was pulled under pressure from tea party activists just prior to Crossover Day and is no longer viable this Session. Governor Deal has indicated he will move forward with an Advisory Committee. For the AJC article on HB 476 and the Georgia Exchange, click here.

Senate Bill 17 would 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 bill has passed the Senate and has passed through the House Insurance Committee.  To learn more about SB 17 and benefit mandates, click here for a recent AJC article. For more information about the legislation, click here.

Senate Bill 63 would enact a Georgia Medical Assistance Fraud Prevention Program utilizing smart card technology to verify identification of Medicaid recipients, first directing the Department of Community Health to develop and implement a pilot program. Implementing the bill could present barriers to accessing care, and the methodology proposed has not been proven to be a successful method to target fraud within the Medicaid system. Further, there has been some controversy over a vendor that has been lobbying for the bill. SB 63 has passed the Senate and has not yet had a hearing in the House.  To see the fiscal note on the bill as originally proposed, click here. For a recent AJC article on this issue, click here. For more information on the legislation, click here.

House Bill 461 and Senate Bill 177 would enter Georgia into an interstate “health care compact” to allow member states to opt out of any federal health care law. While interstate compacts are typically used to handle regional and multi-state problems such as transportation issues, water rights or environmental protection, they require approval from the U.S. Congress and the President of the United States. Thus, the compacts have no chance of becoming law. HB 461 passed the House and is in the Senate Insurance Committee. SB 177 passed the Senate and is in the House Insurance Committee. For a recent AJC article on this issue, click here.

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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.

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Bump It Up a Buck Delivers Petitions and Rallies for an Increase in the Cigarette Tax

This week, the Georgia Coalition for Tobacco Prevention ran a 48-hour petition drive to raise awareness and support for the Bump It Up a Buck campaign—an effort to raise the state’s tobacco tax by a dollar.  Doubling expectations, at the end of the drive the coalition had collected over 1,000 names and on Wednesday, held a press conference with local physicians to highlight the momentum behind the movement and hand deliver the petitions to the Governor’s office.  Dr. Harry Heiman, a Professor at Morehouse School of Medicine and Board Member for Georgians for a Healthy Future explained that “tobacco has no redeeming quality.  There is nothing good that comes out of smoking tobacco.  We have the support—the only question is, do we have the political will?” To view coverage of the Press Conference, click here, and here and to read more, click here.

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The Affordable Care Act and You

Insurance Commissioner Hudgens Requests Adjustment to Medical Loss Ratio Rules

Last week, Insurance Commissioner Ralph Hudgens submitted a request to the U.S. Department of Health and Human Services on behalf of the state of Georgia for an adjustment to the recently issued rules pertaining to medical loss ratio (MLR). The MLR rules are designed to ensure that consumers get value for their premium dollar by requiring insurers operating in the individual health insurance market to spend at least 80% of premiums they collect from consumers on medical care and health care quality improvement as compared to administrative expenses such as marketing and profits. The rules were developed by the National Association of Insurance Commissioners (NAIC) after a thorough process. States requesting waivers can propose a phase-in to the MLR requirements for the years 2011, 2012, and 2013 if they can demonstrate immediate implementation of the MLR standard would destabilize the individual health insurance market in their state. They cannot waive them entirely. Georgia thus proposed a phase-in period for the MLR Standard. The application detailing the adjustment request is available here. The data on Georgia insurers that the Insurance Department provided in support of its application is available here. A recent article on this issue from Georgia Health News is available here. The application is under review by the U.S. Department of Health and Human Services. Once deemed complete, public comments will be accepted. More information about how to file public comments is available here.

Focus on Primary Care

By 2014, more than a million uninsured Georgians will gain health insurance as a result of the Affordable Care Act, either through the Medicaid program (when it will be expanded to all Georgians at or below 133 percent of the federal poverty level) or through private insurance purchased through the exchange. Once these Georgians become insured, it is imperative that this coverage translates to access to the health care delivery system. A new state-by-state study of primary care physician supply projects that Georgia will need between 177 and 285 additional primary care physicians to meet the expected increase in primary care utilization resulting from the coverage expansion. In addition to sheer physician supply, an important policy priority will be to ensure that there is an adequate network of primary care physicians participating in the Medicaid program. Beginning in 2013, under the Affordable Care Act, there will be an increase in the Medicaid reimbursement rate for primary care providers such that it is at parity with Medicare reimbursement rates. This increase is funded entirely with federal dollars. Several new reports take an in-depth look at this issue. First, a study in the journal Milbank Quarterly provides state-specific projections of primary care utilization and necessary supply; second, a report by the Center for Studying Health System Change specifically examines primary care participation in the Medicaid program; and third, the Center for Health Care Strategies, Inc, provides a policy roadmap for states to implement the Medicaid primary care rate increase. Finally, a recent media article examines a renewed interest in primary care among medical students due to health reform. For more Georgia-specific information and policy recommendations on our state’s primary care supply, please see this recent presentation to the Georgia General Assembly made by the Georgia Area Health Education Centers.

One Year Later

This week marks the one year anniversary of the passage of the Affordable Care Act and advocates across the state and the country are evaluating the provisions that have already taken effect and seeing how far we have come in just one year.  On Monday, Georgians for a Healthy Future held a press teleconference with Terry Gardiner of the Small Business Majority and Alpharetta small business owner Julie Haley to detail the provisions of the law that help small businesses. These provisions include tax credits that offset the cost of providing insurance coverage for employees.  To read the press release, click here.  Beyond the benefits that small businesses see from the new law, young adults to seniors are also enjoying some new provisions.   The ability for a young adult to remain on a parent’s insurance plan up to age 26 will help get the next generation off on the right foot as they enter the job market in this sensitive economy.  The $250 donut hole checks for Medicare beneficiaries and free preventive services helps lower costs for seniors and allows them to better manage their care.  For more information about the impact of the ACA to date, check out our blog series, “One Year Later,” that explores these topics and more.

New Resources Available

The Consumers Union Guide to the Affordable Care Act was released this week and is a free, easy-to-use guide that walks the reader through parts of the ACA that have already been enacted.  It explores implications for people who currently have insurance, are uninsured, are a Medicare beneficiary, or own or work for a small business.  To access the guide, click here.  Additionally, Young Invincibles released a tool kit this week designed to help young adults figure out the best way to get covered.  To access the tool kit, click here.

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March 15^th: Cocktail Reception and Fundraiser

If you haven’t done so already, please register for Georgians for a Healthy Future’s 2^nd Annual Cocktail Reception and Fundraiser.  Taking place at Ri Ra on Tuesday, March 15^th from 6:00pm to 8:00pm, the evening will include substantive updates on important issues facing the General Assembly as well as an opportunity to network and unwind before Cross-Over Day. We hope to see you there! Click here to purchase your ticket.

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What’s New in Georgia

Update on the 2011 Legislative Session

Twenty-eight of the 40 legislative days are now complete. The Legislature is in session Monday and Wednesday of this week for legislative days 29 and 30. Day 30 is also known as crossover day, the deadline for bills to pass their chamber of origin to remain viable, unless attached to another piece of legislation as an amendment. 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.

Recent Action Was Taken on the Following Bills:

House Bill 476 establishes the Georgia Health Exchange Authority, the governance body for Georgia’s health insurance exchange. Under the Affordable Care Act, Georgia recently received a $1 million grant from the Department of Health and Human Services to begin planning for a health insurance exchange. The exchange will be a structured marketplace where, beginning in 2014, individual consumers and small businesses can purchase health insurance plans from a range of private insurers, in many cases with tax credits to offset the cost of the premiums. HB 476 also creates an Advisory Committee to make policy recommendations to the exchange governing board and the Governor by November 15, 2011 for next steps. This is a constructive first step towards developing a better functioning, value-driven health insurance market for consumers in Georgia. The bill was favorably passed out the House Insurance Committee last week. For more information on HB 476, including several policy reports outlining policy choices for states, click here. For more information about the legislation, click here.

House Bill 47 would 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 passed by the House last week and moves to the Senate Insurance Committee. 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 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. The bill was favorably passed by the House Judiciary Committee last week and will be voted on by the House this week. To learn more about the benefits of HB 229, click here. For more information on the legislation, click here.

Senate Bill 63 would enact a Georgia Medical Assistance Fraud Prevention Program. The bill, as introduced, would have put in place a pilot program that would involve fingerprinting Medicaid patients at the point of service. A committee substitute bill stripped the biometric identification requirement and instead requires a pilot program utilizing smart card technology along with language that the Department may also implement a biometric verification process if it so chooses. Implementing the bill could present barriers to accessing care, and the methodology proposed has not been proven to be successful method to target fraud within the Medicaid system. To see the fiscal note on the bill as originally proposed, click here. For more information on the legislation, click here.

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.

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Budget Update

Last week, the House of Representatives passed the FY 2012 budget.  For the Department of Community Health, the House version of the budget restored proposed funding cuts to dental, vision, and podiatry services for adults on Medicaid; partially restored Medicaid reimbursement cuts to providers; and partially restored funding for the Children 1^st program which provides screening services for newborns and other at-risk children and links children to services to address developmental and other health needs.  To learn more about the health care budget, click here to read Georgia Budget and Policy Institute’s latest report.

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Bump It Up a Buck Campaign Launches

On March 3^rd, the Georgia Alliance for Tobacco Prevention (American Cancer Society, American Lung Association, American Heart Association, ACS CAN, GASCO, Georgians For A Healthy Future, Georgia Public Health Association) launched the “Bump It Up a Buck” campaign, aimed at increasing the state’s tobacco tax by a dollar.  The bump of $1 will generate an estimated $350 million per year in revenue at a time when the state is facing a $2 billion deficit, and will help save critical programs and services, save kids from addiction to tobacco and encourage current smokers to quit.  To learn more about the campaign and to see useful fact sheets on the issue, visit www.bumpitupabuck.org and find them on Facebook and Twitter.

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The Affordable Care Act and You

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Early Retiree Reinsurance Program Provides Financial Relief to Georgia Health Plan Sponsors, Including State Health Benefit Plan

The Early Retiree Reinsurance Program (ERRP) was established by the Affordable Care Act to assist businesses, state and local governments, non-profit organizations, and other plan sponsors that provide health insurance to early retirees with the cost of that coverage. The ERRP is intended to help stabilize plans that provide insurance to early retirees. Without such coverage, early retirees between the ages of 55 and 64 face difficulties securing an affordable health insurance policy in the individual market because of their age or pre-existing health conditions. As of December 31, 2010, over 5,000 plan sponsors were approved for participation in ERRP, including 74 Georgia-based plans. The Georgia Department of Community Health was among the approved applicants, receiving $34.9 million for the State Health Benefit Plan. More information about the ERRP and the funds directed to Georgia employers is available here. For a full report on the ERRP in 2010, click here.

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New Report Finds Full Implementation of the Affordable Care Act Will Reduce Georgia’s Rate of Uninsured by 12.6 Percentage Points

A new report by the Robert Wood Johnson Foundation estimates the effects of the Affordable Care Act on states, in particular the increases in insurance coverage, subsidies in the exchanges, Medicaid enrollment and federal spending.  Nationally, full implementation will lead to a 10.3 percentage point decrease in uninsurance for the non-elderly—in Georgia that reduction is 12.6 percentage points. In terms of the Medicaid program, upon full implementation, 1.8 million Georgians will be enrolled in Medicaid. Among this group, 29% will be newly eligible and newly enrolled.  For more data on the effects of full implementation and to read the full report, click here.

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Progress Continues on Health Insurance Exchanges

Georgia’s planning work on a state health insurance exchange continued with the introduction of HB 476, and progress continues in states around the country. For primers on how exchanges will work, what points of flexibility states have, and resources for how to ensure the exchanges are consumer friendly, see Families USA’s Health Insurance Exchange Resources. For a recent AJC article on Georgia’s progress, click here.

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National News

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New Flexibility

President Obama outlined a proposal to move up the date from 2017 to 2014 in which states wishing to innovate to achieve the same coverage and affordability goals as will be met under the Affordable Care Act can apply for a waiver to pursue these strategies. As Georgians for a Healthy Future discussed in media interviews (here and here) on this topic, the provision is intended for states that are already at near-universal coverage and it is unlikely that Georgia would be able to shift course and set up a separate system that would meet the coverage and affordability benchmarks without doing it under the framework in the Affordable Care Act.

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Employers and Health Care Reform

A new policy brief issued by the Robert Wood Johnson Foundation examines the issues surrounding the effects of health care reform on employers.  To expand access and strengthen the employment-based health system, the ACA requires midsize and large companies to make payments to the federal government if they do not offer health insurance to their employees and dependents starting in 2014. The brief explores the current state of employer-sponsored coverage and what the likely impact is of implementation.  To read the brief, click here.

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Small Business: A Year Later

A new fact sheet from Small Business Majority details how provisions of the new health law address concerns with rising health care costs and ultimately affect small businesses across the country.   A recent study found that nationally 87% of small businesses are eligible for tax credits to help offset the cost of health care for employees.  Additionally, small businesses benefit from access to the Pre-Existing Condition Insurance Plan and free preventive care now available through health plans.  To learn more about the effects of the law on small business, click here.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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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.

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What’s New in Georgia

Update on the 2011 Legislative Session

With thirteen Legislative days complete, several bills have been introduced that could impact health care consumers in Georgia.

House Bill 47 would allow Georgia insurers to sell individual health insurance products with benefits equivalent to those sold in other states. This could circumvent current Georgia standards for basic consumer protections and essential medical services that all insurers must cover today under Georgia law. The Health and Life Subcommittee of the House Insurance Committee heard testimony on this legislation on Wednesday. Georgians for a Healthy Future expressed our concerns to the subcommittee. The subcommittee plans to vote on the legislation next week.

House Bill 214 would create a separate public health agency, the Department of Public Health. On December 1, 2010, The Public Health Commission issued its final report to the Governor, Speaker, and Lieutenant Governor recommending that the Division of Public Health become an independent, cabinet-level state agency, with the Commissioner reporting directly to the Governor and serving as the state’s chief health officer.
This legislation implements the recommendation of the Public Health Commission. The bill is assigned to the House Health and Human Services Committee.  To read a recent Georgia Health News Article on HB 214, click here.

Senate Bill 17 would create a special advisory commission on mandated health insurance benefits in Georgia. The purpose of the commission would be to assess the impact of mandated health benefits and providers and advise the Department of Insurance on these issues, among other responsibilities. The bill was unanimously passed out of the Insurance and Labor Committee on Thursday.

Senate Resolution 140 seeks to dedicate funds for trauma care from existing vehicle registration fees that are already being paid to the state.  Trauma care is a significant problem in Georgia since there are only 16 trauma centers for the state’s 159 counties and particular lack of access in rural areas.  To read recent articles on trauma funding, click here and here.

We will continue to monitor these and other health-related bills throughout the Legislative Session.

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Progress Continues on Health Insurance Exchange Feasibility Study

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. As policymakers consider options for how to structure an insurance exchange, Georgians for a Healthy Future will continue to weigh in on behalf of Georgia consumers. Our top priorities for the exchange are that the governing body be transparent and free of conflicts of interest and that the exchange will seamlessly facilitate enrollment into private health plans as well as Medicaid and Peach Care and that it will provide a robust mechanism for consumers to make true apples-to-apples plan comparisons based on value. The U.S. Department of Health and Human Services has announced a new round of exchange establishment grants. We do not yet know if or when Georgia will apply for the grants, but we will keep you updated as we learn more.  To read a recent article on the exchange feasibility study, click here.

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Georgia Alliance for Tobacco Prevention Works for $1 Increase

Georgians for a Healthy Future has joined with a range of health care focused organizations to support a $1 increase in Georgia’s tobacco tax. Our current tobacco tax is only 37 cents per pack, well below the national average of $1.45. Increasing a state’s tobacco tax has demonstrable public health benefits: it reduces smoking and related death and disease; keeps kids from starting to use tobacco products; and reduces the long-term health care costs associated with treating illnesses attributed to tobacco use. A $1 increase will also generate an estimated $400 million in new revenue to mitigate cuts to other vital health care programs in the state budget. As the Special Joint Committee on Georgia Revenue Structure considers the recommendations of the Special Council on Tax Reform and Fairness for Georgians, we will alert you for opportunities to support a $1 increase in the tobacco tax.

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The Affordable Care Act and You

Small Businesses and the Economy

A recent survey of 619 small business owners revealed that 1/3 of employers who do not offer health insurance said they would be more likely to do so because of the small business tax credits—credits which are available to 84% of small businesses here in Georgia because of the Affordable Care Act.  Additionally, the report explained that there is still a gap in education about the new law to small businesses—only 43% are familiar with the new tax credits available to them.  To read the full report, click here.  Small Business Majority has a tax credit calculator to help small business owners to determine what their credits might be.  Additionally, the National Women’s Law Center has a handy tool for non-profits to determine if they too qualify for the small business tax credits.  That can be accessed here.  In addition to the tax credits available through the new law, a recent report by Small Business Majority showed that the Affordable Care Act is helping to stimulate the economy and since its enactment, job growth has consistently grown and will continue to do so in the future.   To learn more about health reform and the economy, click here.

To those of you in the small business community or to those who work with them, Small Business Majority is holding a webinar on Thursday February 17^th at 3pm that will focus on what the new healthcare law means for small business.  It will focus on both federal and state provisions to help local small business owners understand how the law will affect them. Topics being discussed include: Small business tax credits— who’s eligible for them and how to claim them; State insurance exchanges; High-risk pools; Shared responsibility; Cost containment and; Tools and resources available for small businesses interested in learning more about the law. To RSVP for the webinar, click here.

Additionally, as we gear up to celebrate the 1^st Birthday of the Affordable Care Act, we are looking for small businesses that have benefitted from the new law and would love to hear your story.  Please contact Amanda Ptashkin to learn how to get involved.

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New Proposed Rules Benefit Students

This week, the Department of Health and Human Services released proposed rules that would apply the Affordable Care Act’s consumer protections to college health plans starting in 2012, meaning college students will be guaranteed the same consumer protections and benefits as all Americans under the new law.  To read the proposed rules, click here.

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National News

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The Florida Ruling and Its Implications

On January 31^st, U.S. District Judge Roger Vinson of Florida was the first in the nation to strike down the entire health care reform law—a suit to which Georgia was a party. To date, 25 challenges to the law have been filed and 4 have been decided: 2 upholding the law and 2 finding all or part of the law unconstitutional.  Twelve cases were dismissed outright.  This ruling will have little impact on what is happening on the ground where many states are already moving ahead with implementation of the ACA.

This week, Gov. Deal, along with 28 other governors, sent a letter to President Obama urging him to direct the U.S. Department of Justice to expedite the appeals process in the multistate litigation against the new law before states begin implementing portions of it.  To read the letter sent to the President, click here.

Georgia consumers cannot afford to lose the benefits of the Affordable Care Act, including discounts for seniors struggling with the cost of lifesaving prescriptions, protections for children due to pre-existing conditions, and coverage for young adults up to age 26. To read a recent Georgia Health News article on the ruling, click here.

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Medicaid Stability Protections May be at Risk

Stability protections, also known as “maintenance of effort” requirements, ensure that states do not adopt more restrictive eligibility levels or enrollment procedures in their Medicaid and Peach Care programs so that children and families can maintain stable health coverage. Several states have asked Congress to eliminate these federal stability protections so that they have flexibility to roll back eligibility for populations they cover at state option. While we recognize that states, including Georgia, are facing difficult budgetary climates, cutting health care coverage would make it harder for consumers to access primary care and manage conditions, resulting in poorer health outcomes and higher costs down the line. Cutting Medicaid would also have a negative impact on the doctors, pharmacies, and hospitals in Georgia who rely on Medicaid reimbursement funds. Please urge your Member of Congress in Washington to preserve stability protections in Medicaid and CHIP. For more information, click here.

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