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Health Costs

A good omen for Georgia Medicaid waiver plan?

An Ohio program that gave insurance to thousands of low-income patients helped them improve on health measures and also produced unexpectedly low costs, according to a study published Tuesday.

MetroHealth Medical Center in Cleveland

MetroHealth Medical Center

Those findings may have a significant impact in Georgia.

State officials are considering a proposal from Grady Health System in Atlanta to extend coverage to uninsured Georgians through a special Medicaid “waiver.’’ Grady officials say the waiver program would be modeled after the Cleveland MetroHealth Care Plus program.

The study, in the journal Health Affairs, analyzed the impact of the Care Plus program, which gave 28,295 Cuyahoga County residents Medicaid coverage for 11 months in 2013.  full story

Study backs critics of state benefit plan

Since January 2014, many Georgia schoolteachers and state employees have complained about their health insurance plan, saying they bear a heavier burden in costs.

Healthcare CostA recently released study supports their argument.

Last week, the consulting firm Aon Hewitt reported that members of the State Health Benefit Plan pay a greater proportion of health care costs than people covered in six comparable employee plans studied — those of five other Southern states’ plans, plus University System of Georgia workers.

The State Health Benefit Plan (SHBP) covers about 650,000 members, consisting of teachers, other school personnel, state employees, retirees and dependents. full story

Merger mania: Aetna to buy Humana

Insurance giant Aetna said Friday that it has agreed to buy rival Humana for $37 billion in a deal that reflects the rampant consolidation in health care.

aetThe acquisition, if approved by shareholders and regulators, will roughly double Aetna’s membership in Georgia.

Connecticut-based Aetna has roughly 700,000 Georgia members in its health plans, while Louisville, Ky.-based Humana covers 692,000 in Georgia.  full story

Doctors’ suit aims to topple state’s CON rules

Two Cartersville ob/gyns filed suit Tuesday to overturn the state’s health care regulatory process, saying it restricts competition and is unconstitutional.

iStock_000023217379LargeDrs. Hugo Ribot and Malcolm Barfield are challenging the Georgia certificate-of-need program, a complex set of regulations governing the creation and expansion of medical facilities.

The CON process has long been controversial because hospitals often use it to challenge competitors’ proposed projects. It has also pitted doctors against hospitals in battles over building surgery centers.

The physicians’ lawsuit asserts that Georgia’s CON laws “are a restraint on competition, economic liberty, and consumer choice.”

The CON regulations “encourage and facilitate state-granted monopolies and have the effect of restricting competition in the provision of health care services,” the lawsuit says. full story

High court preserves all ACA subsidies

The U.S. Supreme Court, in a 6-3 ruling Thursday, upheld the Affordable Care Act subsidies that have helped millions of Americans, including 412,000 Georgians, obtain insurance coverage.

John Roberts

John Roberts

The ruling was hailed as a huge victory for President Obama and for the ACA, although the constitutionality of the 2010 law was not in dispute in this case.

The justices ruled that federal subsidies can be offered in insurance exchanges run by the federal government, as they are in Georgia and 33 other states.

The plaintiffs in the case argued that the health law did not permit such subsidies in states that have federally operated exchanges. The pointed to the ACA’s language, which says the subsidies are available through an exchange that was “established by the State.”

“Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them,” Chief Justice John Roberts wrote for the court’s majority. “If at all possible, we must interpret the Act in a way that is consistent with the former, and avoids the latter.” full story

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