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Health Insurance

Grady, Blue Cross at impasse as contract expires

Contract standoffs between hospital systems and health insurers typically have a way of being resolved — often right before a deadline.

But high-stakes negotiations between Grady Health System and Georgia’s biggest insurer failed to produce a new contract before the midnight deadline Sunday.

Grady Memorial Hospital

Grady Memorial Hospital

That means Grady Memorial Hospital is now “out of network” for Blue Cross and Blue Shield of Georgia members. Patients with Blue Cross insurance will face higher out-of-pocket costs at the Atlanta hospital and its clinics.

Both Grady and Blue Cross expressed disappointment that a deal was not reached. Contract negotiations had been under way for a year.

Grady recently had launched a publicity campaign to call attention to low reimbursements from Blue Cross, saying those payments were lower than the insurer’s rates for other comparable hospitals in Atlanta and throughout the state. full story

Exchange workers put priority on Latino outreach

Maria Espinoza came to a Doraville middle school Saturday looking to repeat what she called her “good experience’’ in the Affordable Care Act exchange.

Maria Espinoza

Maria Espinoza

Espinoza, 35, a construction worker, said through an interpreter that her ACA coverage for this year had worked out well, and that it was inexpensive.  Enrollment is now under way for next year.

Sequoyah Middle School, where Espinoza came to sign up,  was one of several metro Atlanta sites staffed by navigators, or insurance counselors, and by Enroll America personnel on the first day of open enrollment for the exchange.

With 80 percent of its students being Latino, the school was a logical place to do outreach to that population, which have high numbers of uninsured people.

The Latino community has proved at times difficult to reach, despite members’ need for coverage.

Georgia’s Latino/Hispanic population, which was small for most of the state’s history, has grown strongly and steadily since about 1990. They now constitute about 8 percent of the state’s population, but they account for 17 percent of the uninsured in Georgia. 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

Latest ACA court case reverberates in Georgia

The U.S. Supreme Court’s decision Friday to take up a case challenging the subsidies in the Affordable Care Act’s exchanges could wind up having a huge impact in Georgia.

The federal subsidies help millions of Americans afford health insurance offered in the exchanges, which were created as part of the health reform law.

The U.S. Supreme Court made Medicaid expansion optional for states..

According to the plaintiffs, those subsidies are improperly being given in the more than 30 states, including Georgia, that have decided not to run their own insurance exchanges. The federal government runs the exchanges in those states.

If the Supreme Court strikes down subsidies in federally run exchanges, it almost certainly would cause those marketplaces to collapse unless the states step in to run them.

In Georgia, however, that is not legally possible. This year, the Georgia General Assembly passed legislation that bars the state from running an ACA exchange. That prohibition was among other anti-Obamacare provisions that were signed into law. full story

Premature births show slow decline in state

Georgia’s preterm birth rate remained steady in 2013 at 12.7 percent, earning the state a “C’’ grade on an annual March of Dimes report card released Thursday.

The data, though, show Georgia’s premature birth generally declining since 2006, when the percentage hit 14.1 percent.

The national preterm birth rate, meanwhile, fell to 11.7 percent in 2013, the lowest in 17 years, the March of Dimes said.

Women in some rural counties are having to drive long distances to deliver their babies.Preterm births — those before 37 completed weeks of pregnancy — cost the U.S. more than $26 billion annually, according to the Institute of Medicine. And preterm birth is the leading cause of newborn death.

Babies who survive an early birth often face the risk of lifelong medical challenges, such as breathing problems and cerebral palsy. Even babies born just a few weeks early have higher rates of hospitalization and illness than full-term infants.

The report card shows Georgia did well in reducing late preterm births, and the percentage of Georgia women who smoke also has dropped. Smoking by the mother is a risk factor for early births.

Yet one problem area has become worse: Insurance coverage for women in the state. full story

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