Governor Deal signed HB 1166 (sponsored by Representative Atwood) into law on May 1^st. The legislation requires insurance companies who sell policies in the individual health insurance market to also sell child-only plans during an open enrollment period. These plans had previously been available in Georgia, but insurance companies stopped writing new policies in response to a change in federal law that prohibited discrimination against children due to pre-existing conditions. HB 1166 drew widespread support and Georgians for a Healthy Future was proud to be a part of the coalition effort that ensured its passage.

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.

Georgia lags other states in progress towards establishing a health insurance exchange as authorized by the Affordable Care Act (ACA), despite the fact that Georgia stands to experience one of the largest drops in the uninsured as a result of the ACA reforms, according to an analysis by the Urban Institute. At our Health Care Unscrambled breakfast in January, a panel of Georgia policymakers discussed prospects for a health insurance exchange and indicated that exchange legislation would not move through the General Assembly in 2012. Nevertheless, Representative Pat Gardner has introduced HB 801 to establish a Georgia health insurance marketplace, or exchange. Please thank Representative Gardner for taking a stand on this important issue! For recent news articles on health insurance exchanges and Georgia, click 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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Georgians for a Healthy Future is a non-profit, non-partisan health policy and advocacy organization that addresses health care issues through a consumer lens. Our 2012 policy priorities were developed with broad input from community stakeholders. We will work collaboratively with our community partners to advance these priorities.

Maximize opportunities and benefits presented by the Affordable Care Act for Georgia health care consumers. Georgians for a Healthy Future will continue to monitor legislation and agency-level activity to implement the ACA and support Georgia laws and regulations that establish structures and systems that maximize benefits for consumers in this process.

Preserve consumer protections for Georgians in private health insurance plans. State laws and regulations provide a basic level of protections and benefits to consumers who buy private health insurance plans. These protections ensure that consumers who purchase these plans obtain meaningful health insurance that covers essential medical services in the event they get sick. Georgians for a Healthy Future will continue to support efforts to preserve and strengthen consumer protections and oppose legislation that would place consumer protections at risk.

Modernize Medicaid and PeachCare by utilizing best practices to improve coverage rates, access to care, and health outcomes. The Medicaid and PeachCare for Kids programs provide health insurance for our state’s most vulnerable citizens. The Georgia Department of Community Health is currently weighing options to redesign these programs. Georgians for a Healthy Future will monitor this process as well as legislative activity and will support policy changes that facilitate continuous coverage and enrollment, preserve and expand access to care, and improve health outcomes. Georgians for a Healthy Future will oppose policy changes that restrict access to vital health care services for Medicaid and PeachCare beneficiaries.

Establish a consumer-friendly health insurance exchange. A well-designed health insurance exchange can add transparency to the health insurance marketplace, spur competition and choice, help make insurance more affordable and available, and give consumers the information they need to make optimal purchasing decisions. Georgians for a Healthy Future will support a health insurance exchange compatible with the American Health Benefit Exchanges (AHBE) authorized by the Affordable Care Act that provides consumers with the appropriate information, tools, and navigation assistance to make optimal purchasing decisions and a governance structure that can effectively and transparently oversee the exchange without conflicts of interest.

Restore child-only health insurance plans to the private health insurance market. Due to a recent change in federal law, insurance carriers in the individual market can no longer deny coverage to a child with a pre-existing condition. Even though insurers may still medically underwrite these policies, insurance carriers in Georgia stopped issuing these policies altogether. Georgians for a Healthy Future will support legislation to restore these plans to Georgia’s health insurance marketplace.

Strengthen Georgia’s public health system. Our 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 services, Georgia’s per capita public health spending is among the lowest in the nation. The establishment in 2011 of the new Department of Public Health presents an opportunity to rebuild our public health infrastructure and to place renewed focus on the critical role of public health. Georgians for a Healthy Future supports a robust, adequately funded public health system to meet the critical 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. Tobacco taxes are a proven strategy with the dual benefit of bringing in additional state revenue and increasing the health of Georgians by reducing adult and youth smoking.

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.

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 niagen preventive, diagnostic, and therapeutic services and products comparable to those offered in a typical employment-based plan, although some people that consume pain relieving drugs always struggle to be able to get hired, if you happen to be one of them there are sites where you’ll be finding the right solution for your employment issues. The specifics of the package are being developed right now by the U.S. Department of Health and Human Services (HHS), and HHS has encouraged consumer advocates to provide input. Here is how to weigh in:

Step 1: Learn more about essential health benefits and this process by reading issue summaries here and here or by participating in an upcoming webinar hosted by the National Academy for State Health Policy here.

Step 2: Prepare and e-mail your comments to ExternalAffairs@HHS.gov. HHS has requested that comments address some or all of the following 5 points below:

• In keeping with the title of the Institute of Medicine report “Essential Health Benefits—Balancing Coverage and Cost,” how can the Department best meet the dual goals of balancing the comprehensiveness of coverage included in essential health benefits and affordability?

• How might the Department ensure that essential health benefits reflect an appropriate balance among the categories so that they are not unduly weighted toward any category?

• What policy principles and criteria should be taken into account to prevent discrimination against individuals because of their age, disability status, or expected length of life as the Affordable Care Act requires?

• What models should HHS consider in developing essential health benefits?

• What criteria should be used to update essential health benefits over time and what should the process be for their modification?

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.