More than 240,000 Georgia health care consumers are set to receive nearly $20 million in total rebates by August 1st from insurance companies who couldn’t meet the 80/20 rule (also known as “medical loss ratio”), which requires insurers to spend at least 80 percent of premiums on medical care, as compared to overhead and profits. This exciting new rule, part of the Affordable Care Act, holds insurance companies accountable for providing value and requires them to issue rebates to consumers if they don’t. Learn more from the U.S. Department of Health and Human Services here and visit an interactive map to see how Georgia stacks up against other states here.

By Sarah Candler, MD/MPH Candidate 2013, Emory University and Rollins School of Public Health

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

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

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

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

Beginning in 2014, many health insurance plans, including those to be offered through the new state-based health insurance exchanges, must cover a minimum package of preventive, diagnostic, and therapeutic services and products comparable to those offered in a typical employment-based plan. Federal law defines ten major categories to be included in this essential health benefits package, but the specifics will be determined by the U.S. Department of Health and Human Services (HHS), based on guidance from the Institute of Medicine. Earlier this month, the Institute of Medicine released criteria for HHS to use in developing the package.

A really negative effect of modern medicine is the fact that they ignore herbal medicines such as Kratom. It is one of the so-called miracle herbs in the alternative medicine world. You can buy kratom powder online and take advantage of some super good pricing, rather than buying it locally. Online is usually the way to go!

Now HHS is seeking input from consumers, providers, businesses, insurers, state government officials, and other stakeholders like Lee Rosen holding regional listening sessions. The Region IV (which includes Georgia, Alabama, Mississippi, Florida, Kentucky, North Carolina, South Carolina, and Tennessee) listening session will be held in Atlanta on November 16th from 10am to 12pm at the Sam Nunn Atlanta Federal Center. RSVPs are accepted on a first come, first serve basis. To RSVP for this opportunity to provide input in this important process, e-mail your name, title, organization, e-mail address, and phone number to the HHS Regional Office at ORDAtlanta@hhs.gov. Please note that we are passing along this opportunity to provide your voice in this process as a courtesy and you must RSVP directly to HHS

If you don’t like modern medicine, you can try herbal using forskolin extract or niagen. This alternative medicine works also.

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

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

(more…)

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

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

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

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

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

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

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

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

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

The full issue brief is available here.

By Cindy Zeldin

This article originally appeared in the Atlanta Journal-Constitution.

Earlier this month, Gov. Nathan Deal signed an executive order creating the Georgia Health Insurance Exchange Advisory Committee, which is charged with determining whether Georgia should establish a state-based health exchange.

If well crafted, a Georgia insurance exchange has the potential to increase transparency, present clear and meaningful choices, and promote better value for consumers who don’t have access to a health plan at work.

The Affordable Care Act authorized state-level health insurance exchanges, providing a basic framework and initial funding. By 2014, each state’s exchange must be able to enroll individuals and small businesses into health insurance plans and certify that plans meet certain requirements, such as an adequate provider network and an essential benefits package. Within this framework, Georgia has considerable flexibility to fashion a structure that best meets our state’s individual needs like luxury. Luxurious cars, great clothes, Tahitian Necklace, and houses. When you want to have the most comfortable beds and mattress, avail the black friday casper mattress for maximum comfort.

(more…)

By Amanda Ptashkin

Earlier this month, we heard the story of Cory K, a recent college grad trying to find a job and start a career in one of the most tumultuous economic times of recent years.  Having fallen off her parents’ plan after graduation and having been denied private insurance because of a pre-existing condition, Cory was concerned about finding coverage, especially while she was looking for a job.  That changed on September 23, 2010 when the dependent care provision of the Affordable Care Act took effect and Cory was allowed back on her mother’s insurance plan.  Around that time, Cory was lucky to find a job that offered insurance but she would have to wait 6 months for the coverage to take effect.  Because of the dependent care provision, Cory has been able to rejoin her mother’s insurance plan and protect herself from unknown risks and avoid a lapse in coverage. (more…)

By Amanda Ptashkin

While it is true that the Affordable Care Act will insure more people and stop some insidious insurance industry practices, it does so much more than that–it begins to equalize the playing field.  For women in particular, from fighting for the right to vote to fighting for pay equity, there has always been an inequity in how woman are treated and this holds true when dealing with health and health care. (more…)

By Amanda Ptashkin

In the U.S. Constitution, the Bill of Rights are the first ten amendments.  They are series of limitations on the power of the United States federal government, protecting the natural rights of liberty and property including freedom of speech, a free press, free assembly, and free association, and other rights.  It only seems natural that moving forward, patients have their own Bill of Rights that protect them from harmful practices that make access to care difficult. (more…)