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.

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.

(more…)

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.

(more…)

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.

(more…)

Guest Blog By Joann Yoon

In reading through an issue of The Economist earlier this year, I came across an obituary for Sir John Mortimer, an English barrister and well-known writer.  I didn’t know who he was prior to reading the article, but was impressed to learn about his life and his efforts to make social change through the practice of law and through his writing.  One of the quotes attributed to him that stuck out in my mind was the sentiment that offense makes society move. I often think about this notion, and link it to thoughts particularly as the battle wages on regarding whether or not to implement health reform.

(more…)