Georgians for a Healthy Future is spearheading Cover Georgia, a new coalition in support of expanding Medicaid in our state to cover the uninsured.  As part of this on-going effort, we will explore what is at stake for Georgia families and consumers as policymakers weigh this option in the coming months.

In 2014, Georgia consumers with incomes between 100% and 400% of the federal poverty level (FPL), or roughly between $11,170 and $44,680 for an individual, will be eligible for tax credits to purchase health insurance through the new federally facilitated health insurance exchange. Adults with incomes below 100% FPL, however, will not be eligible for these tax credits. This is because the Affordable Care Act envisions individuals with incomes this low becoming eligible for Medicaid through an expansion of that program.

If Georgia fails to adopt this expansion, this would create a “coverage gap,” leaving many Georgians with no options for affordable health coverage. This infographic helps explain how this would play out for two Georgians: Jan would make too much money to be eligible for Medicaid but would not make enough to access tax credits to purchase affordable private health insurance (a typical health insurance policy would consume nearly her entire income).  Meanwhile, John would be able to purchase insurance in the exchange with a tax credit, making health insurance reasonable for his budget.  This is simply not fair. All Georgians should have a pathway to affordable health care coverage. To learn more about Cover Georgia and to join our efforts, click here.

Health exchanges are a central feature of the Affordable Care Act and are intended to provide meaningful and affordable health insurance options for individuals and families who don’t have access to health insurance at work. The exchange, or marketplace, will be a place where consumers can shop for private health insurance plans utilizing decision tools and accessing tax credits to make the plans affordable. By 2014, these marketplaces will be up and running in every state, with some states operating their own exchange marketplaces, some states partnering with the U.S. Department of Health and Human Services on a “state partnership exchange,” and some states deferring to a federally facilitated exchange.

States planning to move forward with their own state-based exchanges must submit a blueprint by November 16^th of this year.  Georgia is not expected to be ready for a state-based exchange, as reported in the Atlanta Journal Constitution last week, and thus a default to a federally facilitated exchange is likely in Georgia.

Ensuring that a health insurance exchange works for Georgia consumers is a key priority for Georgians for a Healthy Future, whether it is a state-based exchange, partnership exchange, or federally facilitated exchange. Regardless of who is administering the exchange on the back end, we must make sure it works for consumers on the front end. To that end, Georgians for a Healthy Future remains engaged in this important issue on behalf of health care consumers. Our Executive Director served on the Governor’s Health Insurance Advisory Committee in 2011, which studied options for Georgia, and submitted a minority report advocating for Georgia to move forward with planning for a state-based exchange despite the full committee’s recommendations against doing so; Georgians for a Healthy Future released a well-received policy brief in August 2011 making policy recommendations for a Georgia exchange; and our staff and coalition partners have been active in discussions with federal officials, along with consumer health advocates from around the country, about how to make sure federally facilitated exchanges are responsive to the needs of consumers within the states.

More information about the exchange blueprint submission process is available here; a summary of Georgia’s status on exchange planning is available here; and all archived materials from Governor Deal’s health insurance exchange advisory committee are available here.

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.

The final report of the Governor’s health insurance exchange advisory committee is expected on December 15^th. The committee held its last full meeting on October 27^th (click here for meeting minutes) and is now drafting the final report, which is expected to be the basis for legislation in 2012 reforming Georgia’s health insurance marketplace through the establishment of an exchange. The work of the committee received attention in the Washington Post and Kaiser Health News this week. Georgians for a Healthy Future is representing the consumer voice on the committee and will continue to provide updates and advocacy opportunities on this process as they arise. To see Georgians for a Healthy Future’s priorities for a consumer-friendly health insurance exchange, download our brief here.

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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In recent years, Georgia consumers have seen their health insurance premiums increase more quickly than their earnings, placing a strain on household budgets. Further, consumers haven’t had access to adequate information to know if these rate hikes are justified. 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 to comply with the law. We hope that Georgia will utilize this program on behalf of consumer to the fullest extent possible to spur insurers to operate more transparently and more fairly in the market. Georgia’s intention to operate rate review was first reported by Georgia Health News. Link is available here.

Georgians for a Healthy Future has a new fact sheet out today about how to access health insurance in Georgia. Please share with patients, consumers, providers, community organizations, or anyone for whom it can serve as a resource. The fact sheet can be downloaded by clicking here.

Guest Blog by Holly Lang, Georgia Watch

In a March ruling that could hold implications for all nonprofit hospitals, the Illinois Supreme Court stripped not-for-profit Provena Covenant Medical Center of its exemption from property tax, stating that the hospital did not provide enough charity care to justify that exemption.

A hospital earns its tax-exempt status through the benefits it provides to the community, the most of which being the free or reduced-cost care for those eligible for such assistance. Such care is deemed indigent or charity 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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Guest Blog By Holly Lang

In January 2009, Georgia Watch was awarded a two-year grant to help expand access to affordable health care to uninsured and underinsured consumers in the metro area. Called the Metropolitan Atlanta Hospital Accountability Project, or HAP, we’ll examine the challenges low-income, uninsured and underinsured patients face in the metro Atlanta area by surveying consumers, by analyzing the financial aid policies at area for profit and nonprofit hospitals, and by looking at current public policies that force hospitals to give free or low-cost care to the state’s uninsured and underinsured consumers. We’ll come up with ways to make those policies better.

Georgia has the sixth-highest number of residents without health insurance in the US and ranks 11th in its percentage of the population lacking coverage, according to a 2008 report from the Georgia State University’s Health Policy Center and the Center for Health Services Research. According to the report, only one in five individuals living below poverty have private insurance and nearly 38 percent are uninsured.

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