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Health Insurance

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

Navigators aided consumers in need, report shows

Consumers in Georgia and three other states who were helped by navigators for the 2014 insurance exchanges tended to be people of color who were not financially secure, a recently released report says.

Navigators, who are specially trained in the provisions of the Affordable Care Act, provide face-to-face, in-person help for consumers seeking information about health insurance policies in the state exchanges, also called marketplaces.

The report by the University of Georgia also said many consumers helped by Seedco navigators in the four states had limited knowledge about health insurance concepts.

Sidney Wood meets with navigator Amanda Ptashkin in March.

A consumer meets with Atlanta-based Seedco navigator Amanda Ptashkin in March.

Seedco, a nonprofit group, was the lead organization in Georgia supplying navigators during the last Open Enrollment period for the ACA insurance exchanges. It also provided these counselors in Tennessee, New York and Maryland, and will do so again in the new enrollment period, which starts next month.

A UGA unit was the second Georgia navigator grantee group last year, but it is barred from participating this time by a newly passed state law. Top Georgia officials have been strongly critical of the ACA and have worked to limit official state involvement in its programs.

The UGA report found that among consumers in the four states helped by Seedco navigators, almost two-thirds (64.5%) were people of color. African-Americans were especially prevalent among these Georgia consumers. About 10 percent of consumers preferred to speak a language other than English. full story

Will map of ACA enrollment look different in 2015?

In health insurance, to a great extent, price is king.

The monthly premium that people will have to pay for insurance is a pivotal factor in how they pick a health plan – or whether they choose to buy coverage at all.

The apparent impact of the cost of premiums is noticeable in the enrollment patterns in Georgia’s insurance exchange, as seen in the first year of its existence under the Affordable Care Act.

A map of exchange enrollment in Georgia in 2014 shows generally low participation rates in rural South Georgia, even though these counties have high percentages of uninsured residents.

Map of Georgia exchange enrollment in 2014. Credit: Enroll America

Map of Georgia exchange enrollment in 2014. Credit: Enroll America

For the current plan year, southwest Georgia in particular had high premiums compared with other Georgia regions. In fact, it had among the highest premiums in the nation.

Two southwestern regions had monthly premiums of $345 and $377 for a particular Silver plan for a 21-year-old, Bill Custer, a health insurance expert at Georgia State University, told reporters in Atlanta on Tuesday. full story

Grady appeals to public in battle over contract

Charles Armbrust had severe headaches from what was eventually diagnosed as a brain aneurysm. He received surgery at Grady Memorial Hospital in Atlanta.

“Grady saved my life – that’s the bottom line,’’ said the former patient.

A video of a tearful Armbrust expressing his gratitude for his medical care is posted on a Grady web page describing problems that the health system says it’s experiencing in reaching a new contract with Blue Cross and Blue Shield of Georgia. Armbrust’s insurer is Blue Cross.

Grady Memorial Hospital

Grady Memorial Hospital

The powerful video is part of a campaign by Grady to call attention to low reimbursements from Georgia’s largest health insurer.

Those payments are lower than Blue Cross rates for other comparable hospitals in Atlanta and throughout the state, says Grady CEO John Haupert.

For trauma services, “it’s much lower than other hospitals,’’ Haupert told GHN on Monday. Overall, he said, Grady loses money when it treats most Blue Cross and Blue Shield of Georgia patients.

Haupert said the two sides have been negotiating for a year. While these talks are continuing, he said, Grady has sent Blue Cross a termination notice that would be triggered Nov. 25.

Both Grady and Blue Cross say they hope an agreement is reached before the November deadline. The contract affects Grady’s hospital and other facilities, but not its physicians. full story

Another important change in state benefit plan

Blue Cross and Blue Shield of Georgia is dropping its Medicare Advantage plan for next year for retirees in the State Health Benefit Plan.

That means UnitedHealthcare will be the sole provider of the Advantage plans for 2015. (Blue Cross is the sole provider for 2014.)

The Georgia Department of Community Health is informing retiree health plan members about the Blue Cross move through email and letter this month, letting them know that the decision won’t affect the coverage in effect for the current year.

SHBP_CoverImage

Medicare Advantage is a health plan offered by a private company that contracts with the federally administered Medicare program to provide benefits. The majority of the 54 million people on Medicare are in the traditional Medicare program, with about 30 percent enrolled in an Advantage plan, according to the Kaiser Family Foundation.

More than 102,000 people are in Medicare Advantage plans under Georgia’s State Health Benefit Plan, according to Community Health, which runs the health plan.

Blue Cross said Monday that its decision to discontinue its Advantage plan was made jointly with the SHBP.

Still, in a comparison of next year’s rates, Blue Cross had premiums that were much higher than United’s. full story

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