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How court rules on ACA will affect many Georgians

Georgia would have the fourth-highest number of people affected if the U.S. Supreme Court rules against the current implementation of the Affordable Care Act, a study has found.

The case, King v. Burwell, involves a legal challenge to the tax credits in states with federally run exchanges.

iStock_000023217379LargeUnder the ACA, every state has an insurance exchange, with some being operated by the individual states but most by the federal government. Currently, eligible consumers with coverage purchased on an exchange can get federal tax credits, or subsidies, regardless of how their particular exchange is run.

The plaintiffs in the case say the language of the ACA allows the tax subsidies only where there is a state-run exchange. The Obama administration challenges that interpretation.

If the plaintiffs win, the subsidies would end in most states. And these tax credits make ACA health plans more affordable for low- and moderate-income Americans, so the impact would be great.

A Kaiser Family Foundation study notes that 37 states have federally operated exchanges, and finds that of these states, only Florida, Texas and North Carolina would have more people losing subsidies than the Georgia estimate of 784,000. full story

Grady says figures prove Blue Cross is unfair

Grady Health System has released financial data that it says buttresses its argument that it has been paid unfairly by Blue Cross and Blue Shield of Georgia.

It’s the latest salvo in the contract battle between the major Atlanta safety-net provider and the state’s biggest health insurer.

Grady Memorial Hospital

Grady Memorial Hospital

Since late November, Grady Memorial Hospital has been “out of network’’ for Blue Cross’s health plan members after contract renewal negotiations between the two organizations broke down.

Because those talks failed to produce a deal, patients with Blue Cross insurance face higher out-of-pocket costs at the Atlanta hospital.

Grady has mounted a vigorous media campaign asserting that it has been underpaid by Blue Cross for years. Blue Cross has issued arguments against Grady’s stance in a less publicized way.

The newly presented financial figures, Grady says, were based on a 2012 study facilitated by a national hospital association and compiled by an independent consulting group.

“Because we are still negotiating with Blue Cross, we didn’t want to share details – but the insurer is misinforming the public so it is important we share the facts,’’ Grady says in announcing the study results. full story

Georgia, South still low in health rankings

Georgia retained its ranking of 38th in a newly released 2014 state-by-state health report card.

healthyfoodimageSouthern states generally ranked at the bottom in the annual report by America’s Health Rankings.

The report says Georgia has strengths that include a low prevalence of binge drinking; a low rate of drug deaths; and a low occupational fatality rate.

Since 1990, Georgia’s infant mortality has decreased by 48 percent from 12.6 to 6.6 deaths per 1,000 live births, the report said. And in the past year, premature deaths in Georgia decreased by 8 percent.

The report said Georgia’s weaknesses include a low rate of high school graduation, a high prevalence of low-birthweight babies, and a limited availability of dentists.

In the past two years, obesity increased from 28 percent of Georgia adults to 30.3 percent. And in the past year, diabetes increased from 9.9 percent to 10.8 percent of adults.

Georgia also has a high level of uninsured residents, where it’s ranked 46th. full story

Most in state health plan pick Blue Cross

Blue Cross and Blue Shield of Georgia will remain the dominant insurer for the state’s high-profile employee health plan.

More than 80 percent of State Health Benefit Plan members selected insurance plans from Blue Cross during its recent open enrollment, a state agency said Thursday.

Clyde Reese

Clyde Reese

Blue Cross was the sole insurer offering plans for the 2014 coverage year.  Through public criticism, rallies and a Facebook campaign, many state employees and teachers in the SHBP sought more choices of health insurers for their 2015 coverage.

The state then added two insurers, Kaiser Permanente and UnitedHealthcare,  to the offerings of health plans for next year.  They will share the remaining state health plan members.

The SHBP covers more than 650,000 state employees, teachers, other school personnel, retirees and dependents.

The Department of Community Health’s commissioner, Clyde Reese, announced the enrollment numbers at the agency’s board meeting Thursday. full story

Grady using tough ads in Blue Cross dispute

The starkly worded ads call it an issue of fairness.

With full-page advertisements in newspapers and through TV commercials, Grady Health System has ramped up its media campaign to bring attention to what it says are unfair payments from Georgia’s largest insurer.

unnamed“Blue Cross Blue Shield pushed Grady out of its network,’’ say the ads in the Wall Street Journal and the AJC, which appeared in editions this week.

Grady Memorial Hospital and its clinics, as of Nov. 24, are “out of network’’ for Blue Cross and Blue Shield of Georgia’s health plan members after contract negotiations between the two organizations broke off late last month.

Though the two sides had appeared far apart on what the safety-net hospital system would be paid for services, the collapse of the contract negotiations came as a surprise. Almost invariably, pay disputes between insurers and hospital systems are resolved before an existing agreement expires, though often in the final hours before the deadline. full story

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