August 15, 2013
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Health Watcher  


Georgia Watch will be an official healthcare navigator!


Today, the Department of Health and Human Services announced grant awards totaling $67 million to fund navigator programs in states taking part in the Federal Health Insurance Marketplace.  Navigators are official designees of the federal government helping consumers find and enroll in health insurance in the new Health Insurance Marketplace beginning October 1.  Georgia Watch was part of an application put together by Seedco, a national non-profit, and we are thrilled to announce that Seedco received an award!  The biggest challenge in implementing the ACA's insurance exchanges is the consumer gap in awareness, and Georgia Watch is excited to be part of the solution.


Georgia Watch has been educating consumers about healthcare options for many years, and this designation allows us to help even more Georgians understand their options at a critical time.  We are thrilled have an enhanced role helping healthcare consumers and are grateful to Seedco for partnering with us and other community organizations.  Stay tuned to future editions of the Health Watcher for updates on our navigator efforts.


Will more hospital consolidations equal higher hospital bills?


The enormous increase in hospital mergers, reported on this week in The New York Times, is happening in Georgia.  Some recent examples:  Emory University Hospital purchased St. Joseph's Hospital in 2012, and it was recently announced that more than 20 central and south Georgia hospitals are forming an alliance, to be known as Stratus Healthcare.  In addition, the national merger of Community Health Systems with Health Management Associates will result in the consolidation of five Georgia hospitals under the same owner.


What does this mean for consumers?  Georgia Watch is concerned that less competition among hospitals could mean higher prices, as has already happened with hospital purchases of physician specialty practices.  The Federal Trade Commission is taking a more active role examining proposed mergers to prevent a lack of competition in healthcare markets.


These mergers result in part from the Affordable Care Act's Medicare provisions that emphasize payment for the quality of care rather than the quantity of care.  Georgia Watch supports payment systems that incentivize higher quality care, but is concerned that the ability to charge higher prices is a big motivating factor as well.  Georgia Watch encourages the Federal Trade Commission to robustly review mergers and block those that would drive up prices.


Recent ACA implementation delay may not be as bad as it sounds


Widespread media attention was also paid this week to the fact that as of February of 2013, the Department of Health and Human Services had decided to delay the enforcement of another key provision of the Affordable Care Act (ACA).  Under the ACA, employers who provide insurance to their employees must limit out-of-pocket expenses to $6,350 per year for an individual and $12,700 per year for a family.  Some political commentators have seized upon this announcement to declare the ACA unworkable. 

Before jumping to conclusions, consumers should keep in mind that:  


         The delay only applies to prescription drug, vision, and dental coverage for those currently enrolled in employer based coverage.  The limits will still be in place for other expenses like physician deductibles and co-pays. 

         The delay is only until 2015 in order to give employers more time to improve their delivery systems which often provide separate coverage for these items apart from the main health insurance policy. 

         The delay will not affect policies offered on the health insurance exchanges that start October 1, 2013.  Individuals and small businesses will be able to purchase insurance and receive tax credits to make premiums more affordable, and there will be caps on out-of-pocket costs based on annual income.


Still, those who rely on expensive prescription drug coverage from their employer to manage chronic disease will have to rely on other public and private programs for another year, and that is not news for consumers to celebrate.