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Health Reform

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

A tale of two (neighboring) hospitals

Piedmont Fayette Hospital is expanding its emergency room capacity to keep up with Fayette County’s growth and rising patient numbers.

Fayette County

Fayette County

The $40 million project will also add more beds to the hospital, located in Fayetteville, south of Atlanta.

More than 61,000 patients were treated in the hospital ER last fiscal year, but Piedmont Fayette officials expect the number to exceed 67,000 this year.

“We’re at capacity now, and this will help us better serve our patients,” CEO Michael Burnett said last week. And he announced that the hospital wants to add even more capacity in the near future.

Many Georgia hospitals are reeling financially from the high costs of uncompensated care, because they are treating so many uninsured patients. full story

Cold feet: WellStar calls off merger with Emory

In a move that caught the health care industry by surprise, WellStar Health System has broken off talks to create a mega-merger with Emory Healthcare.

The merger discussions had gone on for months and were aimed at producing a giant hospital-based system – the biggest in Georgia and perhaps the Southeast.

Emory University Hospital

Emory University Hospital

Neither WellStar nor Emory gave a reason for the collapse of negotiations.

The potential deal would have married an academic medical center in Emory with a community hospital-based system in WellStar. Industry experts had said it would be a difficult fit because of the stark difference in the two health care cultures.

Marietta-based WellStar announced the end of the corporate courtship Tuesday.

“After a few months of discussion and review with Emory University, the WellStar Board of Trustees has determined a new strategic direction,” Gary Miller, chairman of WellStar Board of Trustees, said in a statement.  full story

Feds make financial pitch for Medicaid expansion

The Obama administration rolled out new statistics this week to buttress the argument that Georgia should expand its Medicaid program.

1088819262-1249The report from the White House Council of Economic Advisers said that if Georgia expanded Medicaid, as outlined by the Affordable Care Act:

** An additional 389,000 Georgians would have insurance coverage in 2016.

** 52,000 additional Georgians would report being in good (or better) health and 36,000 fewer individuals would experience symptoms of depression.

** 55,300 fewer people would have trouble paying other bills due to the burden of medical costs.

The report also estimates that by not expanding Medicaid, Georgia will miss out on $2.85 billion in federal funding in 2016.

The White House report included similar estimates for other states that have not expanded Medicaid. While expansion is called for by the ACA, the U.S. Supreme Court ruled in 2012 that the decision is up to the individual states. full story

Big jump looming in health insurance rates

Many Georgians could face double-digit increases in their health insurance premiums next year, based on initial rates sought by insurers.clipboard

Insurers’ requests in Georgia range as high as a 64.2 percent increase for a Time Insurance Co. plan for individual coverage starting in January. But most of the double-digit increases being requested in the state are in the range of 10 percent to 20 percent.

The federal government this week issued a list of proposed 2016 premium increases of 10 percent or more nationally. Increased scrutiny of high rate increases is called for under the Affordable Care Act.

The report does not list proposed increases of less than 10 percent, and an insurance industry official says many plans in Georgia remain under that threshold.

The rates pertain to health plans offering coverage bought by consumers and small employers both inside and outside the state’s insurance exchange, created under the ACA. The actual premiums will not be finalized until the fall, federal officials noted.

A state insurance regulator said Tuesday that the proposed Georgia premium increases have been sent to outside actuaries for analysis “to make sure they’re thoroughly vetted.” full story

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