“It will do monumental things for people who get covered and can go to the doctor and get prescriptions filled and have some peace of mind that they can take…
The Health Insurance Exchange Advisory Committee issued its final report this week, calling for the development of a small business health insurance marketplace outside the context of the exchange framework authorized by the Affordable Care Act but failing to explicitly recommend the establishment of a health insurance exchange for individual consumers. Georgians for a Healthy Future’s Executive Director, a member of the committee, wrote a minority report calling for Georgia to take advantage of the opportunity to cover the uninsured and improve our health insurance marketplace by building a Georgia exchange in 2012. You can read the committee report, the minority report, and all other supplemental materials 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
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 15th 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.
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.
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 KidsTM 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.
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.