Do you find your health insurance forms full of jargon and fine print? A little known but important provision of the Affordable Care Act requires health insurance companies to utilize a uniform, standardized form that allows consumers to better understand their coverage and compare their options. Extensive consumer testing has found overwhelming support for this type of simplified, usable form, known as the Summary of Benefits and Coverage (SBC). The SBC not only presents information on deductibles and premiums, but also provides examples that explain and illustrate what insurance would cover for a typical medical procedure. You can see how the new form will look here.

This is an exciting development for health care consumers, but now this provision is at risk of being delayed or weakened. Consumers Union, the nonprofit publisher of Consumer Reports, learned through consumer testing of these forms that consumers found them useful and illuminating in deciphering what their health insurance plans do and don’t cover and is now leading the charge to ensure that the Summary of Benefits and Coverage form is implemented promptly and effectively. Georgians for a Healthy Future proudly added our support to this effort by joining with organizations from across the country in a letter of support for full implementation of the form. You can read that letter here.

If you’d like to add your individual voice to this effort, you can click here to send an email to Secretary Kathleen Sebelius and President Barack Obama to urge them to implement the Summary of Benefits and Coverage requirements without delay.

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.

Last week, we sent an alert asking you to add your voice to our effort to ensure that exciting new health insurance standards that provide increased transparency and value for health care consumers, known as medical loss ratio rules, remain strong in Georgia. Your response was overwhelming!

Thanks to your strong support, Georgians for a Healthy Future and Georgia Watch are proud to announce that we jointly submitted public comments on behalf of 17 Georgia organizations to the U.S. Department of Health and Human Services (HHS) requesting that these new standards go through as planned. You can read our public comments here.

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

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

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

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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.

Guest Blog by Joann Yoon, Voices for Georgia’s Children

Thursday, July 1, was the start of Georgia’s 2011 State Fiscal Year, and we began already $375 million behind. The state legislative session which ended on April 29 saw dramatic budget cuts impacting education and other services for children and families. To add insult to injury, Georgia suffered yet another blow resulting from failure of the U.S. Senate to move forward the Federal Jobs Bill, which in part included a provision that would extend an enhanced FMAP to states for an additional 6 months. FMAP, which stands for Federal Medical Assistance Percentages, is a break down of how many Federal dollars Georgia receives to help pay for our state Medicaid program. Given the high unemployment rate and dire financial situations that families in the U.S. were facing, in last year’s Federal Stimulus Bill, Congress instituted an increase in Federal match dollars to all states to help keep their respective Medicaid programs afloat, which are necessary for people that receive injuries or wound for accidents, and for people not in one of these programs can also use services as Expert Woundcare and similar others.

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We are now in the 28th day of the legislative session and as cross-over day approaches, things are heating under the gold dome.  By midnight on Thursday, bills must clear their chamber of origin if they are to pass this term unless they are attached to another eligible measure.  Georgians for a Healthy Future will continue to monitor legislation that will impact the health and welfare of all Georgians and work towards providing access to affordable and quality health care.

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Guest Blog By Holly Lang

Each day, the crisis of affordable care grows for uninsured and underinsured Georgians.

An estimated one-third of all insured Georgians went without adequate health care coverage in 2007, a number that continues to grow each year. Increasingly so, many plans do not pay for preventative care, such as physicals and Pap smears, which are so important when it comes to health.

And for uninsured, the numbers are even worse.

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