And the companies are offering rates that are comparable to or even below current employer premiums, according to Bill Custer, a health insurance expert at Georgia State University, who was asked to evaluate the filings for GHN.

Aetna, Alliant, Blue Cross and Blue Shield of Georgia, Coventry, Humana, Kaiser Foundation Health Plan, and Peach State will offer a range of plans for individuals in Georgia as part of the Affordable Care Act’s exchange, or “marketplace,” which will debut in 2014.

Missing from the list of insurers is the heavyweight UnitedHealthcare, as well as Cigna. United holds a large share of members in the State Health Benefit Plan.

“On average, these plans are coming in slightly less than premiums of employer plans,’’ said Custer.

He said he based that assessment on premiums for a single person in employer plans in the 2012 Kaiser Family Foundation/HRET benefits survey, where an HMO plan for an individual in the South averaged $456 per month.

“A lot of the fears about premium shock are unfounded, at least in these preliminary filings,’’ Custer said.

Media  reports of competitive rates also have followed insurer filings for exchanges in Oregon, Washington state and California.

The online marketplaces are one of the key ways the health law expands coverage to millions of people not offered coverage by their employers.

The other way is expansion of states’ Medicaid programs, which is up to individual state governments. Gov. Nathan Deal and others in Georgia’s Republican leadership say they won’t agree to expansion here.

The federal government will run the health insurance exchange, or marketplace, in Georgia and many other states. The goal is for individual consumers to be able to make informed choices comparing benefits and price.

The plans in the marketplace are rated Platinum, Gold, Silver and Bronze, based on their level of benefits. The Georgia filings’ Silver plans compare very well with the value of employer plans, Custer said.

Rates for individuals differ based on their age, tobacco use, and region of the state; covering dependents adds to the cost of premiums. Four insurers are offering plans in most, if not all, regions of Georgia: Blue Cross, Humana, Alliant, and Coventry.

Plans in the Atlanta area will have lower premiums than those offered in other parts of the state, according to the filings, obtained by GHN through the state Open Records Act.

“Atlanta is the more competitive market,’’ Custer said.

Among the regions with the highest premiums will be the Albany area, where a recent merger of hospitals is being fought by the Federal Trade Commission. The FTC calls the Phoebe Putney merger with Palmyra anti-competitive.

State Insurance Commissioner Ralph Hudgens, an opponent of the Affordable Care Act, told GHN in a statement that he is concerned that the 2010 law “will drastically increase the price Georgians pay for health insurance.’’

Hudgens added, “I am having those rates reviewed by independent actuaries and will carefully scrutinize each rate to make sure that consumers are protected against unnecessary and excessive increases. Insurers cannot expect to hide behind changes in federal law as a pretext for boosting their bottom line. ”

Custer said that young adults, as expected, will generally pay higher premiums than they do now.

He added that his son, 29, who has a pre-existing condition, recently obtained an insurance policy with a high deductible. He said his son’s premium for a similar plan in the exchange would be 10 percent higher, but that he would also be eligible for the new government subsidies, which would lower that rate.

More than 800,000 Georgians will be eligible for the subsidies next year to buy coverage in the health insurance exchange, according to a report from Families USA.

The report also found that most Georgians eligible for credits are in working families and have incomes between two and four times the federal poverty level, or about $47,100 to $94,200 for a family of four.

Graham Thompson of the Georgia Association of Health Plans agreed that the insurer rates filed for the marketplace are competitive.

The market for the Georgia exchange could potentially be in the hundreds of thousands, Thompson said. Insurers, he said, “are getting out and being aggressive [to gain] market share.’’

Rural areas have some higher rates because costs are harder to manage there, said Thompson, citing rural southwest Georgia in particular. “Where there’s robust competition and choice, insurers are offering competitive prices.”

UnitedHealthcare, in a statement Friday to GHN, said it continues to evaluate exchanges and sees 2014 “as just the very start of the exchange markets.”

“As the economics, sustainability and dynamics of the exchange continue to become clearer over time, the exchange has the potential to be a growth market with much to offer UnitedHealthcare, other insurers and consumers,’’ said Tracey Lempner, a spokeswoman.

The surprise marketplace entrant is Peach State, which covers just Medicaid and PeachCare currently in Georgia.

By Andy Miller for Georgia Health News, 2013. | Permalink | Comment | Health Insurance, Health Reform

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An exhibit of such historic medical books and artifacts has opened at Emory University.

“Medical Treasures,” on display through October, features materials from the Woodruff Health Sciences Center Library, including 18th- and 19th-century works on human anatomy, pathology, surgery, midwifery and alternative medical practices.

Artifacts in the exhibit include one of the earliest stethoscopes from the 19th century, and a kit of a Civil War surgeon’s instruments, primarily used for amputation.

Materials related to the discovery of anesthesia are also part of the exhibition, including notes of Long, the Georgia physician and anesthesia pioneer for whom Emory University Hospital Midtown was originally named.

The last exhibition case is dedicated to a significant medical book: “de humani corporis fabrica” (On the structure of the human body), first published by Andreas Vesalius in 1543. It is considered the first accurate book on human anatomy.

Here’s a slideshow of some of the artifacts that are on display, courtesy of Emory.

Click here to view the embedded video.

By Andy Miller for Georgia Health News, 2013. | Permalink | Comment | Physicians

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Editor’s Note: This is the third in a series of articles on the Athens uninsured initiative, produced by graduate students in the Health and Medical Journalism Program at the University of Georgia. Visit the previous article by clicking on the red button to the left.)

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Patricia Thiessen was driving in her hometown of Reno, Nev., when she suddenly lost the sight in her right eye. It returned within moments.

Six weeks later, the same thing happened to her left eye. It was obvious something was seriously wrong.

Thiessen, who does not have health insurance, went to her local hospital and took advantage of a free screening offer she had received in the mail. She discovered she was suffering from carotid artery disease, which would ultimately increase her risk of stroke. Plaque buildup in the arteries was blocking the blood flow to her brain and causing the episodes of blindness.

The hospital referred her to a cardiologist, who informed her that she would need two surgeries to unclog the arteries. The bill would be close to $60,000.

Thiessen was working part time as a cosmetologist and caring for her disabled brother and sister. “The cost of health insurance was out of my range,” she said. “It was like a thousand dollars a month.”

The high cost was because she would have to buy an individual policy, and she had a history of skin cancer. The Affordable Care Act had not fully kicked in yet, and insurance companies could still penalize people for pre-existing medical conditions.

“Literally, I would have been paying off medical bills for the rest of my life,” said Thiessen, who at the time of her vision scare was 64, a year away from qualifying for Medicare. Waiting that extra year and gambling on her eyesight wasn’t an appealing option.

Fortunately, a billing coordinator in the specialist’s office told her to call Access to Healthcare Network (AHN), a coalition of health care providers in Nevada and the state’s only nonprofit medical discount plan.

Athens will soon become the first Georgia community – in fact the first community outside Nevada – to implement a plan like the one that helped Thiessen. The Athens Health Network’s health assurance plan will launch next year.

Fast action in urgent cases

The experiences of consumers and physicians in Reno give us some idea of what to expect.

Members of the network pay a monthly fee that gives them access to a large number of specialists, clinics and hospitals where they pay cash – at deep discounts – for the care they receive.

Thiessen called AHN on a Friday afternoon, and a staff member quickly set up the two procedures she needed to restore blood flow to her brain.

The hospital charged her $800 for each procedure, performed earlier this year. Factoring in the payments to the surgeons and anesthesiologist, Thiessen paid about $4,500 total – compared to an estimated $60,000 she would have owed without AHN.

“It would have been $44,000 just for the hospital,” she said.

Thiessen is one of nearly 600,000 Nevadans without conventional health insurance, and one of roughly 8,000 who now have access to affordable care because they have joined AHN. In Georgia, an estimated 2 million people are uninsured, and in Athens about 5,000 of them would be eligible to join a plan like AHN.

As the Affordable Care Act, the 2010 federal health care law, moves forward, many Athens-area residents will still be in need of this nonprofit medical discount network, especially if Georgia does not expand its Medicaid program under the act.

Easing hassles for caregivers

When it comes to specialized care, “we are the funnel for the rest of the northern half of Nevada,” said Trevor Rice, the member services director for AHN.

Before AHN was created, “People couldn’t get specialty care at a price they could afford, so it just didn’t get done,” Rice said.

As a result, there was a “pent-up” need for care before AHN was launched seven years ago, and lots of early members needed attention from surgeons and medical specialists. But AHN’s rate of referrals for specialty care has decreased in the years since, Rice said, probably because that backlog of unaddressed problems has been cleared.

Although AHN is a “shared responsibility” model, meaning that members, while getting reduced rates, still have to pay for care, “most of our providers would probably view us as a charity program,” Rice said.

“Therefore it’s all about the relationship,” said Rice. The organization works hard to ensure that being part of AHN is as little hassle as possible for health care providers.

In Athens, an uninsured person with carotid artery disease needing immediate surgical attention, like Thiessen, would have found it nearly impossible to get surgery at an affordable price.

Since many specialists in Clarke County don’t accept patients that are uninsured or on Medicaid, many low-income patients who receive primary care at community health centers or free clinics either go without specialty care or travel long distances to get what they need.

Ian Branam is a freelance health and science writer currently pursuing a master’s in health and medical journalism at the University of Georgia. Ian has bachelor’s degrees in history and psychology from the University of Georgia. He is particularly interested in writing about public health, epidemiology, and the environment. Follow on Twitter as @ianbran6

By Ian Branam for Georgia Health News, 2013. | Permalink | Comment | Health Insurance, Health Reform, Safety Net

The state Department of Behavioral Health and Developmental Disabilities told GHN that Southwestern State Hospital currently has a patient census of 116, divided between people with mental illness and development disabilities, and those housed in the facility’s forensic unit.

The closing of the hospital continues the revamping of the state’s services for people with mental illness and developmental disabilities in the wake of Georgia’s landmark 2010 agreement with U.S. Department of Justice, which aims to move people from mental hospitals into community living situations.

Since then, the state DBHDD has closed its mental hospital in Rome and downsized services at its historic Milledgeville facility.

About 600 employees work at the Thomasville hospital. A DBHDD spokesman, Matt Carrothers, said the workers can apply for open state jobs and similar positions newly created by private providers, and can receive services such as GED preparation and testing, workforce training, and employment assistance.

The mental health patients at Southwestern State will be served in various facilities located across the southwestern region of Georgia, and those with more acute needs will be served in an alternate psychiatric hospital, state officials said.

In addition, the state agency said it will increase the mental health services in the region, including Behavioral Health Crisis Centers, Crisis Stabilization Units and Intensive Case Management Teams.

“I’m always supportive [of the closing] of state hospitals because I believe that where people recover and maintain wellness is in the community,’’ Sherry Jenkins Tucker of the Georgia Mental Health Consumer Network told GHN. “It’s an opportunity to free up resources to enhance our continuum of care and create more and better community-based services for people.’’

Carrothers of DBHDD said patients in the Southwestern State forensic unit — those under court jurisdiction — will be transferred to the state forensic facility in Columbus.

Those with developmental disabilities will be moved to community-based services, most of them in group homes.

The state has reduced the hospital population of people with developmental disabilities from roughly 1,000 to 342 currently. But DBHDD Commissioner Frank Berry last week said he is imposing a 45-day delay in moving people with disabilities out of the hospitals. He cited concerns about quality of care.

The DOJ accord — hailed by consumer advocates as a model for other states — aims to increase community services across the state, including housing, crisis teams and stabilization units, so people with disabilities can avoid the need for hospitalization.

At a Carter Center forum last week, Berry spoke of the difficulty of telling parents when disabled people are to be moved into the community, with support services, after living for decades in a hospital. Parents often want their disabled offspring to remain in the institution they’ve known for so long, he said.

He also spoke of the difficulty of telling employees of state-operated hospitals that they may be losing their jobs due to the changes, but that the state needs them to stay on until that happens.

Here’s a link to a GHN article on the mental health forum Friday.

Eric Spencer, executive director of the Georgia chapter of the National Alliance on Mental Illness, told GHN that his organization’s hope is that sufficient services will be in place prior to the Dec. 31 Thomasville closure. Spencer said that with the facility closures in Rome and Milledgeville, many individuals wound up without services or in jails.

Any savings from the closure should go to strengthen community services in southwest Georgia, Spencer added.

By Andy Miller for Georgia Health News, 2013. | Permalink | 4 comments | Disabilities, Mental Health, Safety Net

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Republican governors in Georgia, South Carolina, Alabama, Mississippi and Louisiana, along with their GOP-controlled legislatures, have bucked proposals to open their states’ Medicaid programs to hundreds of thousands of uninsured people, as outlined under the 2010 Affordable Care Act.

But a newly released survey of adults in those five Southern states shows a different sentiment among the public. Across the region, 62.3 percent of respondents view Medicaid expansion favorably, including 61 percent in Georgia, according to the survey results released Tuesday.

When people were asked a more detailed question about expansion — whether the state should keep Medicaid as it is or expand it to cover more uninsured people, with the state eventually paying part of the cost — the percentages dropped a bit but still showed a majority, 53.8 percent, in favor. Georgia’s favorable figure of 51.6 was the lowest of the five states.

A large majority of African-Americans (78.4 percent) in the survey favored Medicaid expansion, compared to a substantial but smaller number of non-Hispanic whites (44.2 percent). A majority of women favored expansion (57.2 percent), while slightly less than half of men did (49.6 percent).

At the same time, the poll showed that only one-third of adults in the five states view the Affordable Care Act favorably, with 43.8 percent not liking the law. Especially unpopular is the requirement that individuals obtain health insurance or pay a penalty.

But large majorities (75 percent in the region) support ACA provisions for health insurance exchanges, where individuals and small businesses can shop for coverage; and for financial subsidies for people to afford insurance (68.8 percent, and 66.2 percent in Georgia).

“When you talk about the [Affordable Care Act] as a whole, people get into their political mindset,’’ said Cindy Zeldin, executive director of the advocacy group Georgians for a Healthy Future. “But when you take it out of the political context, many of these individual provisions are common sense.’’

Southern states generally need expansion the most because of their large numbers of uninsured, Zeldin said.

The survey shows “strong support for Medicaid expansion,’’ Zeldin added. “Hopefully, our elected officials will see this. It’s clear that this is what Georgians want.’’

The poll was conducted by the Joint Center for Political and Economic Studies, a Washington, D.C.-based think tank that analyzes a broad range of public policy issues of concern to African-Americans and other communities of color. Joint Center officials noted Tuesday that the five Deep South states have a large African-American population, including 30 percent of Georgia residents.

About half the states in the nation plan to expand their Medicaid programs. If Georgia were to expand Medicaid – which the state’s current leadership says it won’t do – more than 650,000 people would be added to the program’s rolls.

Gov. Nathan Deal has remained firm in his opposition to it, citing an estimated $4.5 billion cost to the state over 10 years. And his fellow Republicans in the state’s political establishment are not pushing for it.

Deal, who has voiced skepticism about the law’s federal funding guarantees, says Medicaid expansion would prove too costly to the state in any event, adding to the expense of a financially strapped program.

Deal spokesman Brian Robinson, responding to the survey results in an email Tuesday to GHN, said an expansion would cost the state “vast amounts of money.”

“And it depends on never-ending largesse from a federal government drowning in debt already,’’ Robinson added. “If you asked respondents to write a check for their share of the new costs, I dare say the number of supporters will drop precipitously. It’s the easiest possible thing to be for new entitlements when you’ve come to believe they’re free.”

The survey’s results mirror those in an AJC poll conducted in December, when 65 percent said they believed the state should accept increased federal funding for Medicaid under the Affordable Care Act, often known informally as Obamacare.

The new survey interviewed 500 adults in each of the five states.

Besides racial differences, the survey also found class divisions over the ACA. Respondents who were well educated, earned good incomes, and had health insurance — and whose acquaintances also had health coverage — were cooler to the ACA and its provisions than were those less well-off and those having friends, family, and neighbors who were uninsured.

Separately this week, the Los Angeles Times reported that Republican opposition in many statehouses to expanding Medicaid will likely widen the divide between the nation’s healthiest and sickest states.

Residents of the states that plan to expand — concentrated in the Northeast, upper Midwest and West Coast — currently have better access to doctors and are less likely to die from preventable illnesses.

Colon cancer deaths in states opposing Medicaid expansion, for example, are an average of 16 percent higher than in pro-expansion states, according to a Times analysis of state health data.

Deaths from breast cancer are 8 percent higher on average in anti-expansion states. And adults under 65 are 40 percent more likely on average to have lost six or more teeth from decay, infection or gum disease.

Yet most state leaders fighting the Medicaid expansion have advanced few alternative plans to tackle their states’ health shortfalls, the L.A. Times article said. That means that, at least in the short term, America’s unhealthiest states could fall even further behind as the Affordable Care Act is implemented, the Times article reported.

The Medicaid program’s conservative critics, who contend it could ultimately sap state budgets, say poor Americans would be better helped by alternative strategies, including limits on government medical aid to encourage people to take responsibility for their own health care.

“If history has proven anything, it’s that there is no such thing as a temporary entitlement program,” South Carolina Gov. Nikki Haley said, thanking state legislators there for rejecting Medicaid growth, which she called a “looming public policy nightmare and fiscal disaster,” the  Times article reported.

Yet Ron Pollack of consumer advocacy group Families USA, commenting on the poll results, said Tuesday that a governor who turns down expansion “is committing financial malpractice.’’

Expansion would not only improve many people’s access to health care, but it would also save money for states in covering the cost of the uninsured and would create jobs  and boost economic activity, Pollack said. “It’s a win-win-win proposition.’’

By Andy Miller for Georgia Health News, 2013. | Permalink | 4 comments | Health Insurance, Health Reform, Medicaid, Safety Net

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