As part of the Affordable Care Act, beginning in 2014 all new individual and small group health insurance plans must cover a core set of health care services and items across ten broad categories including hospitalization, prescription drugs, maternity and newborn care, and preventive services, among others. This core set of services and items is known as Essential Health Benefits.

The benefits that health plans are currently required to cover vary by state. To ease the transition to essential health benefits in 2014, the U.S. Department of Health and Human Services (HHS) set out a process for each state to select a benchmark health insurance plan (which would include all benefits currently mandated in that state) that would then be supplemented to fill in any gaps and ensure health benefits across all ten categories are covered.

Last week, HHS issued a proposed rule outlining each state’s benchmark plan.  HHS is accepting public comment on all states’ proposed benchmark plans, including Georgia’s benchmark, until December 26th, 2012 (instructions for how to comment are included within the proposed rule). You can view the proposed benchmark plan for Georgia here. For additional information about the Essential Health Benefits process, see a recent Health Affairs article here. For additional information through a Georgia lens, see a recent Georgia Health News story on Essential Health Benefits 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.

Health Insurance Exchange Advisory Committee Issues Interim Report

The Governor’s Health Insurance Exchange Advisory Committee, charged with determining whether Georgia should establish a state-based health insurance exchange, held its fourth full committee meeting this morning. The committee heard reports from each of the active subcommittees: governance, operations and finance, insurance markets, and contingency plans. The committee also issued an interim report to the Governor, which was released today. According to, knowledgefirstfinancialcompanyhistory.ca/ final recommendations are due to the Governor on December 15^th of this year per the Executive Order issued by the Governor earlier this year. The interim report is available 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.

(more…)

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.

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…)

As we continue to celebrate the 1 year anniversary of the Affordable Care Act, we look to the changes that affect senior citizens and highlight how far we’ve come in just one year.  One of the first provisions to take effect under the new law was the beginning of the closing of the Medicare donut hole.   (more…)