Health Costs

In six months, Jimmy Rowalt will no longer have health insurance.

For the past two and a half years, the 25-year-old Athens resident has worked at Highwire Lounge without worrying about the job’s lack of health benefits. Now he’s a manager there, working 45 to 55 hours a week.

A rule allowing young adults to remain on their parents’ health insurance policies until age 26 was one of the first provisions of the Affordable Care Act to go into effect, in September 2010.

Jimmy Rowalt fixes a drink at the Highwire Lounge in Athens

Rowalt was among the many young Americans who took advantage of this provision. Nationwide, the rate of uninsured people between the ages of 19 and 25 dropped 6 percent within a year, according to CDC data.

When the law kicked in, Rowalt was 22. The day he would turn 26 seemed far away to him. Now, however, he hears the clock ticking.

Rowalt’s options will be meager after his October birthday, when he will be dropped by his parents’ insurance company.

A separate feature of the health care law, an online marketplace that is intended to enable uninsured people to obtain reasonably priced health insurance, will go into effect in January. But specifically how that will work is still unclear.

Like many people working for small businesses, Rowalt can’t turn to his employer for relief. full story

Lack of inpatient beds, nursing shortages, slow lab turnarounds and flu season can all contribute to overcrowding and long wait times in hospital emergency departments.

Many factors can lead to ED backups, says Dr. Richard Schwartz, chairman of the department of emergency medicine at Georgia Regents University in Augusta.

He also notes that some patients visit the ED (also known as the emergency room or ER) because they have nowhere else to get routine medical care, while others use it for genuine medical emergencies.

Recent data showed that Georgia patients spend more than two hours on average in an emergency department before they are discharged, according to the government’s Medicare website. The average wait for an ER patient to be admitted as a hospital inpatient is more than four hours.

There can be an increase in risks as well as discomfort when patients have to wait hours before receiving care.

Because emergency departments in different hospitals vary by size and operational setup, it would be hard to find a single strategy for decreasing wait times and overcrowding that could work everywhere, experts say.

But a team of researchers at Kennesaw State University and the University of Buffalo says they may have found an answer. full story

The Federal Trade Commission, in the wake of a favorable U.S. Supreme Court ruling, has taken new legal steps in its battle against the merger of two Albany hospitals.

The agency, which has been fighting the deal for two years, filed motions last week in federal district court seeking a temporary restraining order and preliminary injunction to stop the further integration of Phoebe Putney Memorial Hospital and Palmyra Medical Center.

The FTC said the goal of the legal action is to ensure that Palmyra’s assets are maintained until an administrative trial on the merits of the acquisition, scheduled to begin on August 5.

Last month, the federal agency lifted a stay on the case and directed an administrative law judge to set a new hearing date on the antitrust issues “as soon as is practicable.’’

The agency’s actions followed a February Supreme Court ruling that set aside two previous court decisions upholding the merger. The justices, in a unanimous ruling, said the acquisition by the local hospital authority of Palmyra was not immune from antitrust scrutiny. full story

Health insurers in Georgia are letting smaller firms and individuals move up their policy renewal dates so they can extend their current deals into next year – and avoid possible “rate shock’’ caused by the Affordable Care Act.

State insurance department officials and an industry group say the practice of trying to get around the ACA rules is occurring at least on a limited basis in Georgia

“If consumers think it’s in their best interests to renew before January 1, we certainly are not going to stand in their way,’’ said Jay Florence, assistant insurance commissioner. “There is no state or federal law that prohibits this type of agreement between customer and insurer.”

Anticipated costs of the ACA – which was passed in 2010 and has been taking effect in stages – are leading to these policy changes.

Beginning Jan. 1, the law will require insurers to cover a broad range of benefits, and will restrict their ability to charge more for pre-existing health conditions. To avoid those rules, and potential rate increases that accompany them, insurers are seeking to move up renewal dates for current policies before the year runs out.

“Some customers don’t want a richer set of benefits,’’ Graham Thompson, executive director of the Georgia Association of Health Plans, said Monday. “We’re trying to manage ‘rate shock’ during this time of tremendous transition.’’ full story

Does adding an insurance surcharge for smokers prompt some to kick the habit?

State officials say the number of Georgians in the state employee health plan paying $80 more a month in insurance premiums due to smoking has dropped by 44 percent over the past six years.

The goals of the surcharge in Georgia are to encourage people to quit smoking and to help cover their additional health costs, said Pam Keene, a spokeswoman for the Department of Community, which oversees the State Health Benefit Plan.

From January 2007 to January 2013, the number of state workers paying the $80 fee because of smoking dropped from 46,459 to 25,850.

The plan, which covers schoolteachers, other school personnel, state employees, and dependents and retirees, has more than 650,000 members. They must pay the surcharge if they or a covered dependent smokes.

Twelve states make state employees who smoke pay such a surcharge, reported the Wisconsin State Journal recently. Wisconsin is considering imposing a fee of $50 per month.

June Deen, state director of the American Lung Association in Georgia, said Monday that surcharges generally have not been proved as effective as offering benefits that help employees stop smoking. full story