Blog (November 2011)
Advocacy may seem overwhelming, but it’s a lot easier–and can have a bigger impact–than you might imagine. You already have the knowledge, passion, and commitment to be a successful and effective health care advocate. All you need are the right tools. Today we are releasing our latest issue brief: Advocacy Demystified: Tools and Strategies for Effective Consumer Health Advocacy, to arm you with the tools you need to advocate for health care change and empower you to start making a difference in your communities. This is a tool meant for sharing so feel free to send to any individuals or organizations who you think would find it useful. Click here to access the issue brief.
The final report of the Governor’s health insurance exchange advisory committee is expected on December 15th. The committee held its last full meeting on October 27th (click here for meeting minutes) and is now drafting the final report, which is expected to be the basis for legislation in 2012 reforming Georgia’s health insurance marketplace through the establishment of an exchange. The work of the committee received attention in the Washington Post and Kaiser Health News this week. Georgians for a Healthy Future is representing the consumer voice on the committee and will continue to provide updates and advocacy opportunities on this process as they arise. To see Georgians for a Healthy Future’s priorities for a consumer-friendly health insurance exchange, download our brief here.
Beginning in 2014, many health insurance plans, including those to be offered through the new state-based health insurance exchanges, must cover a minimum package of preventive, diagnostic, and therapeutic services and products comparable to those offered in a typical employment-based plan. The specifics of the package are being developed right now by the U.S. Department of Health and Human Services (HHS), and HHS has encouraged consumer advocates to provide input. Here is how to weigh in:
Step 1: Learn more about essential health benefits and this process by reading issue summaries here and here or by participating in an upcoming webinar hosted by the National Academy for State Health Policy here.
Step 2: Prepare and e-mail your comments to ExternalAffairs@HHS.gov. HHS has requested that comments address some or all of the following 5 points below:
- In keeping with the title of the Institute of Medicine report “Essential Health Benefits—Balancing Coverage and Cost,” how can the Department best meet the dual goals of balancing the comprehensiveness of coverage included in essential health benefits and affordability?
- How might the Department ensure that essential health benefits reflect an appropriate balance among the categories so that they are not unduly weighted toward any category?
- What policy principles and criteria should be taken into account to prevent discrimination against individuals because of their age, disability status, or expected length of life as the Affordable Care Act requires?
- What models should HHS consider in developing essential health benefits?
- What criteria should be used to update essential health benefits over time and what should the process be for their modification?
On Tuesday, November 15, Georgians for a Healthy Future along with AARP of Georgia and the Middle Georgia Area Agency on Aging continued our Building a Healthy Georgia campaign in Macon with an educational forum for local residents. The focus was on health care obstacles and successes, the already-in-process implementation of the Affordable Care Act (ACA) and how it will affect local communities, all with a particular focus on Georgians aged 50+. The crux of the conversation centered on how the next few years will be particularly critical in determining the future of our health care system and that collectively we need to work together to to identify those opportunities and ensure that communities all across the state have the information they need to make good health care decisions. (more…)
Do you find your health insurance forms full of jargon and fine print? A little known but important provision of the Affordable Care Act requires health insurance companies to utilize a uniform, standardized form that allows consumers to better understand their coverage and compare their options. Extensive consumer testing has found overwhelming support for this type of simplified, usable form, known as the Summary of Benefits and Coverage (SBC). The SBC not only presents information on deductibles and premiums, but also provides examples that explain and illustrate what insurance would cover for a typical medical procedure. You can see how the new form will look here.
This is an exciting development for health care consumers, but now this provision is at risk of being delayed or weakened. Consumers Union, the nonprofit publisher of Consumer Reports, learned through consumer testing of these forms that consumers found them useful and illuminating in deciphering what their health insurance plans do and don’t cover and is now leading the charge to ensure that the Summary of Benefits and Coverage form is implemented promptly and effectively. Georgians for a Healthy Future proudly added our support to this effort by joining with organizations from across the country in a letter of support for full implementation of the form. You can read that letter here.
If you’d like to add your individual voice to this effort, you can click here to send an email to Secretary Kathleen Sebelius and President Barack Obama to urge them to implement the Summary of Benefits and Coverage requirements without delay.
Over the last several weeks, Navigant, the consulting firm hired by the Georgia Department of Community Health to oversee the Medicaid Redesign assessment, has been conducting focus groups across the state as part of the environmental scan stage of the process. They have met with providers, consumers, advocates and vendors. For those throughout the state who were unable to participate in these forums, there has still been an opportunity to share your opinions and suggestions on how to improve our Medicaid and PeachCare system, but time for that feedback is running out. Currently on the DCH website, there is an online survey for consumers, patients, providers and vendors to weigh in on the process. The survey will close this Friday, November 11. Click here to access the survey.
Here is your opportunity to share your experiences in dealing with Medicaid–what works? what could be improved? how do we ensure adequate access to providers, particularly in rural communities? The compilation of this information is critical in determining how to redesign our current system to make it work for the most number of Georgians. Navigant will evaluate the survey responses from all across the state and incorporate them into their recommendations for redesigning the system. This is an easy opportunity to have a big impact and we hope that you will continue to promote health care coverage, access, and quality that all Georgians deserve.
Once this stage of the redesign process is complete Georgians for a Healthy Future and our partner organizations will work to ensure that consumer health advocates have the information and tools they need to continue to weigh in on this process. In a few days, Georgians for a Healthy Future will launch a web page where we will house timely and relevant information to help advocates like you exercise your voice in this process and we will be sure to notify you when that site goes live.
For more information, please visit the DCH website pages for the Medicaid & CHIP Redesign.
Thank you for all you do to ensure a healthy future for all Georgians!
Final Ruling on Medical Loss Ratio Standards Heeds Consumer Input and Sets a Reasonable Standard
Thanks to your support and advocacy, Georgia consumers will experience better value in their health insurance plans and will receive rebates if their insurance companies cannot meet these reasonable standards of value.
The U.S. Department of Health and Human Services (HHS) issued a compromise decision this afternoon allowing new health insurance standards, known as medical loss ratio rules, to be phased in between now and 2013 in Georgia. These new standards will provide increased transparency and value for health care consumers.
Back in September, we sent an alert asking you to add your voice to our effort in support of the new standards, which require insurance companies to provide more information to consumers about how their premium dollars are being spent AND to provide rebates to consumers if they don’t spend a reasonable portion of premiums (80 percent) on medical care and quality improvement activities as compared to profits, administration, and marketing. This effort was in response to the Georgia Department of Insurance’s request to lower the standard for Georgia insurance companies.
Today, HHS determined that the Georgia Department of Insurance’s request exceeded the adjustment necessary to prevent a destabilizing effect on the market and would have unnecessarily denied consumers some of the benefits of the new provision. As a result, Georgia insurance companies will be required to meet a 70 percent standard in 2011 and a 75 percent standard in 2012 before fully implementing the 80 percent standard in 2013. The public comments that Georgians for a Healthy Future, Georgia Watch, and 15 additional Georgia organizations submitted were referenced throughout the decision.
Our voices made a difference! While the decision didn’t go as far as health care consumer advocates would have liked, HHS made a balanced decision that carefully considered the needs of health care consumers.
Thank you for your continued advocacy on behalf of Georgia’s health care consumers. To read more about the MLR adjustment process in Georgia, click here.
Beginning in 2014, many health insurance plans, including those to be offered through the new state-based health insurance exchanges, must cover a minimum package of preventive, diagnostic, and therapeutic services and products comparable to those offered in a typical employment-based plan. Federal law defines ten major categories to be included in this essential health benefits package, but the specifics will be determined by the U.S. Department of Health and Human Services (HHS), based on guidance from the Institute of Medicine. Earlier this month, the Institute of Medicine released criteria for HHS to use in developing the package.
Now HHS is seeking input from consumers, providers, businesses, insurers, state government officials, and other stakeholders by holding regional listening sessions. The Region IV (which includes Georgia, Alabama, Mississippi, Florida, Kentucky, North Carolina, South Carolina, and Tennessee) listening session will be held in Atlanta on November 16th from 10am to 12pm at the Sam Nunn Atlanta Federal Center. RSVPs are accepted on a first come, first serve basis. To RSVP for this opportunity to provide input in this important process, e-mail your name, title, organization, e-mail address, and phone number to the HHS Regional Office at ORDAtlanta@hhs.gov. Please note that we are passing along this opportunity to provide your voice in this process as a courtesy and you must RSVP directly to HHS.
AARP has a new state scorecard providing critical information on long term services and supports. This State Long-Term Services and Supports Scorecard is the first of its kind: a multidimensional approach to measure state-level performance of long-term services and supports (LTSS) systems that provide assistance to older people and adults with disabilities. The Scorecard is a tool to help states improve their LTSS systems. The key findings illustrate areas in which there is a large range in state performance and examples of how public policy action can lead to improvement. We must move to become a nation in which older people and those with disabilities are given meaningful choices, have access to affordable, coordinated services, a high quality of life and care, and support for their family caregivers regardless of the state they live in. You can find the scorecard here.