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Health Costs

Arthritis: An all too common and costly disease

Outwardly, Kerry Tucker of Atlanta looks perfectly healthy.

But for the past 25 years, Tucker has battled constant stiffness and pain from psoriatic arthritis.

Kerry Tucker

Kerry Tucker

“Mornings are the toughest,’’ Tucker said at an Atlanta arthritis conference last week. Then there are the flare-ups that leave her in bed for days.

She’s among patients taking a breakthrough “biologic” drug – medications that have made a major difference in their ability to handle arthritis symptoms.

Yet these specially engineered drugs have a hefty price tag for insurers, employers and patients. That cost has consumer advocates alarmed about the potential financial impact on families.

Roughly one in four Georgians are estimated to have a form of doctor-diagnosed arthritis, according to the Atlanta-based Arthritis Foundation. More than 800,000 of them are “limited’’ by the condition, the CDC says.

Thousands of Georgia children have a form of juvenile arthritis. full story

What to expect in Year 2 of ACA enrollment

The Affordable Care Act exchange, which begins its second open enrollment period this Saturday, will offer many Georgians lower prices this time around.

Bill Custer, a health insurance expert at Georgia State University, said Thursday that the average premium statewide for a 40-year-old nonsmoker for the second-lowest “silver” plan will rise by 2 percent from the 2014 figure.

healthcaregovBut in some Georgia regions, the premium for that plan will drop by double-digit rates, he said.

Still, people looking for a second year of coverage in the exchange – or to get a policy for the first time – need to pay attention to many factors besides premiums. Deductibles, co-insurance, prescription drug coverage, and whether specific hospitals and physicians are in a network are among the major considerations.

One thing is almost certain: Healthcare.gov, the federal enrollment website, will work more smoothly during this enrollment period. Last year, the site was plagued with massive technical problems – so much so the federal government extended the open enrollment window. full story

Personal health: Sticker shock at pharmacy

My recent sinus infection came on suddenly and painfully. After diagnosing it, my physician e-prescribed me an antibiotic.

cohdra_100_9279This is tricky territory for me. I’m sensitive to some antibiotics. Years ago, I took a couple of varieties to treat similar infections, and wound up with oral thrush in one case and C. difficile in another. Both were 100 times worse than the original ailment.

My physician knew this history. He prescribed a two-week supply of doxycyline hyclate, a dependable antibiotic that he felt I could tolerate well, partly because I had handled it well in the past.

So I headed to my pharmacy to pick up the “doxy.”

“It’s one seventeen,’’ said the clerk, in an oddly sheepish way.

I pulled a dollar from my wallet and extracted some change from my pants pocket.

She looked at the money and said, “No. It’s a hundred and seventeen dollars.’’

“Whoa,’’ I said. “$117?” full story

Is Georgia’s medical access law too weak?

The state insurance department is looking at possible ways to strengthen a Georgia law that requires health insurers’ networks to give consumers adequate access to doctors and hospitals.

“Georgia is not alone: The feds and all the states are looking at the issue,’’ Trey Sivley, director of the Division of Insurance and Financial Oversight for the Georgia agency, told GHN recently.

Healthcare CostThe National Association of Insurance Commissioners is working on a redraft of its model for a network adequacy law. Georgia is studying the NAIC proposals, Sivley said. But he added that the state’s interest in the details “doesn’t mean that we’re going to adopt” the national group’s plan.

Such regulatory changes, if enacted, would coincide with an accelerating trend of health insurers offering consumers more limited choices of medical providers. The resulting health plans have become known generally as “narrow networks.” full story

Poll: Georgians like expansion, but not ACA overall

A new poll finds 60 percent of Georgians disagree with the state’s decision not to expand the state’s Medicaid program, a key provision of the Affordable Care Act.

The health reform law overall, though, fares less well in popularity. According to the survey, conducted by the Schapiro Group in August and sponsored by Healthcare Georgia Foundation, 42 percent of Georgians approve of the ACA and 46 percent disapprove.

Healthcare CostThe survey also found that the cost of care continues to be an important factor in whether consumers receive health care. Forty-two percent of Georgians said they wanted to seek care at some point, but chose not to do so, up from 33 percent the year before. Cost was the most cited reason for that decision.

And 40 percent of the 400 respondents said they think they have paid more for care over the past year.

“As the troubling trend of increased health care costs continues, Georgians who cannot afford health insurance are simply unable to seek or choosing not to seek the medical care they need,” said Gary Nelson, president of Healthcare Georgia Foundation. full story

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