The Commission on Mandated Health Benefits, created through legislation passed in 2011 to advise the governor and the General Assembly on the social and financial impact of current and proposed mandated benefits and providers, held its first meeting on March 12th. The meeting was largely an organizational one, but members also discussed how the commission’s work might intersect with aspects of the Affordable Care Act such as essential health benefits and the bills before the General Assembly that would require insurance companies to cover autism, child hearing aids, and medical foods. The next meeting date has not yet been announced.  To read the minutes from the March 12th meeting, click here.

For a bill (except for the state budget) to remain viable, it must pass at least one chamber by the end of Day 30, known as Crossover Day. Crossover Day was last Thursday, March 7th.  Below is a summary of bills that have passed at least one chamber and that Georgians for a Healthy Future is monitoring, as they could have an impact on Georgia health care consumers if enacted into law.

Legislation impacting health insurance consumer protections and access to insurance

A trio of health insurance related bills are moving through the General Assembly. Consumer health advocates are concerned about these bills because they could restrict information and choices for consumers. 

SB 236 would require insurance companies to indicate on statements sent to consumers that provide notice of premium increases the portion of any premium increase that is due to the Affordable Care Act. How this is determined would be left to insurance companies to calculate, and they would not have to disclose their methodology. There would also be no requirement to present information about any other factors leading to premium increases or to notify consumers about any cost savings or benefit enhancements they are receiving as a result of the Affordable Care Act. As such, this bill would result in consumers receiving incomplete and potentially misleading information.  SB 236 has passed the Senate and is in the House insurance committee.

 
HB 198 would require licensing, certification, and training for health benefit exchange navigators and would restrict their ability to assist consumers. While ensuring that consumers receive accurate information from navigators about their health insurance options is an important goal, HB 198’s restrictive language and potentially duplicative training requirements could deter community-focused nonprofits, whose participation in the navigator program will be essential in reaching vulnerable populations who have historically faced barriers to enrolling in health insurance, from becoming navigators or from providing appropriate consumer assistance. HB 198 has passed both the House and and the Senate.

HB 389 would allow insurance companies to terminate, cancel, or non-renew conversion policies or any health insurance policies offered through the health insurance assignment system when guaranteed issue becomes available (with a 90-day cancellation period and a 90-day open enrollment period into new health insurance options made available through the Affordable Care Act). HB 389 has passed the House and is in the Senate Insurance committee.

Legislation that could impact Medicaid and PeachCare beneficiaries

HR 107 would create a joint study committee on Medicaid reform that would study current Medicaid policies and procedures, models in other states, and other aspects of the Medicaid program and report to the General Assembly and the Governor by December 31, 2013 with recommendations. HR 107 has passed the House and is in the Senate Rules committee.

SB 62 would create Federal and State Funded Health Care Financing Programs Overview Committee, a joint committee of the General Assembly. SB 62 has passed the Senate.

SB 163 would direct the Department of Community Health to examine and identify options for reforming Medicaid in Georgia, including but not limited to more use of managed care, with the purpose of bringing savings to the state. SB 163 has passed the Senate and is in the House Health and Human Services committee.

From our friends at Voices for Georgia’s Children:

As of Jan. 1, 2013, Georgia parents and legal guardians once again have the option to sign their children up for child-only health insurance policies. However, open enrollment ends two days from now on Jan. 31. Thereafter, “Child-Only” policy enrollment will be limited to special qualifying events.

Previously, child health insurance coverage in Georgia was available only through Medicaid, PeachCare for Kids ®, or as a part of parent or guardian coverage. Now, child-only policies –– for children under age 19 –– are available to parents or legal guardians who are not eligible for Medicaid or PeachCare and are uninsured, have a policy that does not offer dependent coverage, or experience an involuntary loss of coverage. Further, legal guardians who are insured by Medicare (e.g., seniors), can also purchase this type of policy. Insurers are required to offer coverage even if a child has a pre-existing condition.

Health insurance coverage has a positive effect on quality of life. The uninsured use fewer preventive and diagnostic services, are sicker when diagnosed and tend to receive less therapeutic care, like surgical interventions and medication, once diagnosed. Further, health insurance reduces mortality rates.

“Children who have health insurance have better health outcomes,” said Danté McKay, Associate Policy Director for child health at Voices for Georgia’s Children. “We are delighted that child only policies are returning to Georgia which currently ranks fourth with more than 236,000 uninsured children. Child-only policies will provide a key coverage option for reducing this number.”

Child-only policies are available from the following Georgia insurers:

• Aetna

• Blue Cross Blue Shield

• Cigna

• Coventry

• Humana

• Kaiser Permanente

• United HealthCare: 1-877-247-0209

• Child Only Services: 1-877-244-6215

Click here to read more about child-only policies

Each year, Georgians for a Healthy Future develops policy priorities that guide our advocacy work on behalf of health care consumers. Below are the legislative and policy priorities we are supporting in 2013.

Extend health insurance coverage to a substantial portion of Georgia’s uninsured by expanding Medicaid. Approximately 1.9 million Georgians are uninsured, many of whom are low-income working adults without access to an employer-sponsored health plan. An estimated 650,000 of these Georgians could gain health insurance coverage in 2014 at minimal state cost by extending Medicaid to those newly eligible through the Affordable Care Act. The infusion of federal Medicaid dollars into Georgia will both support our state’s health care delivery system and foster economic growth. Georgians for a Healthy Future supports expanding coverage through Medicaid to individuals and families with incomes up to 133 percent of the federal poverty level.

Preserve and strengthen consumer protections for Georgians in private health insurance plans through both federal and state advocacy. The private health insurance marketplace is rapidly evolving, largely as a result of changes spurred by the Affordable Care Act. As these reforms are implemented, it is critical that the consumer perspective is represented in the policy-making process and that rules and regulations incorporate consumer needs. Many of the decisions that would impact health care consumers are currently being made by the U.S. Department of Health and Human Services and the National Association of Insurance Commissioners. To that end, Georgians for a Healthy Future will monitor and advocate on behalf of Georgia consumers on issues including the development of a federal health insurance exchange, essential health benefits, and other private market reforms. At the same time, Georgia policymakers retain authority over many aspects of our state’s health insurance marketplace. Georgians for a Healthy future will continue to support efforts that preserve and strengthen patient and consumer protections and oppose state legislation that places these protections at risk.

Ensure access to quality health care for Medicaid and PeachCare beneficiaries. The Medicaid and PeachCare for Kids programs provide health insurance for our state’s most vulnerable citizens. Georgians for a Healthy Future will monitor legislative and agency level activity and support proposals that facilitate continuous coverage and enrollment, preserve and expand access to care, and improve health outcomes. Because ensuring access to quality care for Medicaid and PeachCare beneficiaries also requires a Medicaid system that is financially sound, Georgians for a Healthy Future will support proposals that ensure the program is adequately funded and will oppose cuts to the program, including cuts to provider reimbursement rates, which jeopardize access to care. We will also continue to monitor the Georgia Department of Community Health’s Medicaid redesign process.

Strengthen Georgia’s public health system. Our state’s public health system plays a critical role by vaccinating children, monitoring and preventing epidemics, ensuring safe food and water, and providing both clinical and community-based preventive services. Despite an increasing need for these services and a growing awareness of the importance of social determinants to community health outcomes, Georgia’s per capita public health spending is among the lowest in the nation. Georgians for a Healthy Future supports a robust, adequately funded public health system to meet the needs of our state.

Increase the tobacco tax. The current funding environment demands evidence-based policy solutions that both advance the health of our state and generate needed revenue. In recent years, even the most basic, vital, and cost-effective programs have been subject to deep budget cuts. Georgians for a Healthy Future opposes further cuts to these vital programs and supports budget solutions such as a substantial increase in the state’s tobacco tax of at least a dollar per pack. Tobacco taxes are a proven strategy with the dual benefit of bringing in additional state revenue and improving the health of Georgians by reducing adult and youth smoking.

Support policies and practices that advance health equity. In addition to overall health outcomes and indicators that consistently place Georgia in the bottom tier nationally, our state has considerable health disparities between communities. Racial and ethnic minority communities, rural and low-income urban communities, and those with disabilities and chronic mental illness, all experience worse health and worse opportunities for health than their peers. Georgians for a Healthy Future will continue to support policies and practices that advance the opportunities for optimal health for all Georgians.

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.

Georgians for a Healthy Future is a proud partner in the Specialty Tiers Coalition of Georgia, a group of consumer and patient advocates committed to ensuring affordable access to medications for patients with rare, chronic conditions. Earlier this month, the coalition hosted an educational forum at Emory University in Atlanta to raise awareness among policymakers and consumers about the growing trend of specialty tiers and the related risks to patients and consumers.

According to RheumatoidArthritis.org, specialty drugs are typically breakthrough prescription drugs that are used to treat complex, chronic health conditions such as cancer, multiple sclerosis, rheumatoid arthritis, hemophilia, and HIV/AIDS (remember the odds of contracting hiv). Traditionally, insurance plans cover prescription drugs on a 3-tiered drug formulary (Tier One: generic drugs; a typical co-pay is around $10; Tier Two: preferred brand name drugs; a typical co-pay is around $30; Tier Three: non-preferred brand drugs; a typical co-pay is around $50) These drugs can also have a second effect on you, in this center people get treated when they become addicted to any drugs and substances.
. Specialty tiers, also known as Tier IV, V, or VI, add an additional structure for specialty medications — cost sharing known as “co-insurance” — where the patient pays 20-35% of the cost of the medication, rather than a fixed, predictable co-payment.  Unfortunately, there is no limit on what a beneficiary may be required to pay for therapies relegated to specialty tiers.

The trend towards specialty tiers shifts costs to patients and places needed treatment out of reach for too many patients who are paying health insurance premiums to get the medical care they need, some need this special serums for your eyes and they are not receiving it.  Specialty tiers can result in drug costs well into the thousands of dollars per month for patients, increasing the likelihood that patients will go without needed treatment. In fact, a recent study found that one in four patients with an out-of-pocket prescription cost of $500 or more failed to fill their prescriptions. This indicates patients with insurance are having to choose between needed medications and everyday living expenses.

The Specialty Tiers Coalition will be active in the upcoming 2013 Legislative Session to grow awareness about this issue, and advocate for patient protections. Georgians for a Healthy Future and the coalition are currently serving as a community partner to the Health Legislation & Advocacy course at Georgia State University’s College of Law. Through this partnership, law students are providing research assistance and helping craft potential legislation to ensure adequate patient protections.

To read coverage of the October 10^th forum at Emory University, click here and here. To download a fact sheet on this issue from a coalition leader, Advocates for Responsible Care, click here.

Earlier this year, Governor Deal signed into law House Bill 1166 to restore child-only health insurance plans to the Georgia marketplace. The legislation was sponsored by Representative Atwood and supported by a broad coalition of consumer health advocates, health care industry stakeholders, and legislators, including Georgians for a Healthy Future. The law goes into effect on January 1, 2013, and will make standalone insurance policies for children available through an open enrollment period in January or in the event of a qualifying event throughout the year. The Georgia Department of Insurance is currently preparing the draft regulation, after which there will be a public comment period with the final regulation expected in December.

Several states around the country have taken similar action to make these plans available for children, and earlier this month the Commonwealth Fund issued a report examining legislative and regulatory efforts around the country during 2010 and 2011 and found that, in states that had taken action during those years, child-only coverage is now available in nearly all of those states. Since Georgia’s legislation was passed in 2012 and has not yet gone into effect it was not included in the analysis; however, the authors interviewed officials and advocates in Georgia and noted that legislation had been signed into law in 2012. Kaiser Health News also reported on the story last week. That article is available here. The study is available 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.

A new survey shows that consumers aren’t satisfied with the level of customer service they receive from their health insurance plans. In fact, the industry ranked the lowest of any industry measured in this survey. Additionally, other studies have found that consumers often find health insurance jargon confusing, which makes it challenging for consumers to select a policy that best meets their needs, to know what is covered and what isn’t, and to understand their rights as consumers if disputes arise. While overshadowed by some of the other major reforms included in the law, the Affordable Care Act contains some exciting reforms for consumers in this area, including making available access to clear, plain language information about their insurance plans. The U.S. Department of Health and Human Services issued final regulations on February 9^th requiring an easy-to-understand Summary of Benefits and Coverage and a uniform glossary of terms. These new tools will be available to consumers on September 23, 2012. More information is available here and here.

Georgians for a Healthy Future is monitoring developments at the federal level that will impact benefits and consumer protections for new individual and small group health plans in Georgia beginning in 2014. In December, the Center for Consumer Information and Insurance Oversight (CCIIO), the division of the U.S. Department of Health and Human Services charged with implementing the provisions of the Affordable Care Act (ACA) related to private health insurance, released a bulletin on the essential health benefits (EHB) that all new plans will need to include.

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