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Health Reform

Big insurance deal raises questions, fears

The biggest health insurance deal ever was announced earlier this month.

And though it is yet to be reviewed by regulators, the proposed transaction has already prompted concerns about its potential impact in Georgia and elsewhere.

Aetna’s $33 billion acquisition of Humana will get close regulatory scrutiny by state and federal officials over its effect on competition and prices.

Mark Bertolini

Mark Bertolini

Central questions about the deal include:

Will it lead to higher health insurance premiums? Will it contribute to the trend toward limited consumer choice of medical providers?

A deal would substantially affect Georgia, if only because of the numbers of insurance consumers affected. The merger would double Aetna’s enrollment in the state to roughly 1.4 million.

State insurance regulators and the U.S. Department of Justice will review the transaction from a competition standpoint.

The Medical Association of Georgia, meanwhile, said Thursday that it has “grave concerns” about the merger and “is evaluating every option to protect physicians and patients in the state.”   full story

A good omen for Georgia Medicaid waiver plan?

An Ohio program that gave insurance to thousands of low-income patients helped them improve on health measures and also produced unexpectedly low costs, according to a study published Tuesday.

MetroHealth Medical Center in Cleveland

MetroHealth Medical Center

Those findings may have a significant impact in Georgia.

State officials are considering a proposal from Grady Health System in Atlanta to extend coverage to uninsured Georgians through a special Medicaid “waiver.’’ Grady officials say the waiver program would be modeled after the Cleveland MetroHealth Care Plus program.

The study, in the journal Health Affairs, analyzed the impact of the Care Plus program, which gave 28,295 Cuyahoga County residents Medicaid coverage for 11 months in 2013.  full story

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

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