Health exchanges: Will some be left out?

Print Friendly and PDF By: Andy Miller Published: Feb 27, 2013

The state health insurance exchanges coming in January 2014 are expected to offer a good deal for many consumers — better coverage at a better price.

That debut of exchanges, part of the Affordable Care Act, provides the rationale behind a House bill that would eliminate temporary “conversion’’ policies for people who have lost group health insurance coverage.

The legislation would also end the current “assignment” policies that cover an estimated 2,000 Georgians with medical conditions.

States can create their individual exchanges, but Georgia has opted to let the federal government create the one here.

House Bill 389’s supporters say the exchanges — which will prohibit insurance discrimination based on pre-existing conditions — will provide improved benefits at a price that’s lower than conversion and assignment policies.

“It’s a much better offering,’’ said state Rep. Darlene Taylor (R-Thomasville), who owns an employee benefits management company, at a House insurance subcommittee meeting Tuesday.

Consumer advocates, though, worry that some people with these policies now may fall through the cracks, either from a lack of proper notification or from insufficient time for enrollment in exchanges.

Another group of Georgians may be in danger of losing coverage entirely in January.

Roughly 3,500 Georgians participate in the Pre-Existing Condition Insurance Plan (PCIP), also part of the health reform law. Many people with HIV/AIDS or hemophilia get state financial subsidies to afford this insurance, which covers people with health conditions who can’t get a policy in the private market.

But the PCIP goes away in January.

And because Georgia does not plan to expand Medicaid, the PCIP members who are under the federal poverty level probably won’t be able to afford coverage in the exchanges.

The House subcommittee approved the bill eliminating the conversion and assignment policies, and the full House Insurance Committee passed House Bill 389 on Wednesday.

Yet Cindy Zeldin of Georgians for a Healthy Future told GHN that while she expects the exchange will benefit many people, “it seems hasty and not necessarily in the best interest of consumers” to eliminate the assignment plans before the new marketplace is fully up and running.

Zeldin said she’s also concerned that consumers in assignment policies won’t get enough notice and time to move to the exchange.

“We hope to work with insurers to craft a letter for consumers,’’ she added.

An industry official emphasized that the conversion and assignment policies are very expensive.

“I can’t see anyone who would be worse off’’ by going to the exchange, said Graham Thompson, executive director of the Georgia Association of Health Plans.

Insurers will make people fully aware of what’s coming in January, he added.

This month, the federally run PCIP stopped accepting new applications due to budget constraints. PCIP will continue providing coverage to more than 100,000 people currently enrolled nationwide.

The state PCIP enrollment has jumped to 3,500 from 1,476 in the past year.

Members include 36 Georgians with hemophilia, who get state assistance with their premiums. The coverage allows them both access to medications and medical services to take care of their other health needs, said a Hemophilia of Georgia official.

Most of these patients have incomes under the poverty level, and likely would not be able to afford coverage in the exchanges, said Gail Day, social work supervisor for Hemophilia of Georgia.

“We’re very concerned,’’ Day said Wednesday. “These are people who are poor. They’re kind of in a Catch-22.’’

Under Medicaid expansion, people who are below that income level would qualify for Medicaid coverage. But the U.S. Supreme Court last year made expansion essentially optional for states, and Gov. Nathan Deal has said Georgia won’t expand Medicaid because it would ultimately be too costly.

A spokeswoman for the Department of Public Health, which has provided financial assistance to HIV and hemophilia patients to afford PCIP, noted that the latter program in Georgia is managed by the federal government.

“We have not received formal guidance yet about transitioning patients out of PCIP but we expect there will be a federal transition process,’’ said the spokeswoman, Nancy Nydam, in a statement to GHN.

“That process will likely move PCIP patients to a federal insurance exchange managed by the federal government,’’ Nydam said. “If there is no formal transition process, clients will be moved to the ADAP program,” which provides government drug assistance to people with HIV/AIDS.

State officials moved many patients from ADAP to the pre-existing condition plan over the past year, thereby eliminating a long waiting list for prescription assistance for people with HIV/AIDS.

Larry Lehman of AID Gwinnett/Ric Crawford Clinic said his organization has referred 80 people with HIV/AIDS into the pre-existing condition plan.

PCIP has given them expanded coverage for their medical needs, he said.

Lehman said he’s worried about what will happen with patients when the transition comes in January.

“Certainly we don’t want anyone to go without their meds,’’ he said. “Hopefully, the governor will see [Medicaid expansion] as a huge benefit and savings to the state.’’

 

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