Blue Cross Blue Shield (Possibly) Offering Insurance on Exchanges in 2018

Recently, there was some speculation (read: outright panic) over whether or not 96 of our 159 counties would have insurance plans available on the Patient Protection and Affordable Care Act (PPACA) exchanges in 2018. Last week, Blue Cross Blue Shield submitted proposed rates for all areas of the state to the Office of Insurance and Fire Safety Commissioner, according to the Macon Telegraph:

The Georgia insurance department had asked insurers that want to offer exchange coverage to submit their proposed rates by May 16, while the federal deadline is June 21.

The proposed rates will be publicly available after June 21, the agency said.

Submitting rates is only the first step in the process, however, as Commissioner Ralph Hudgens has to sign off of them, and Blue Cross Blue Shield still can opt to withdraw at any time. This latter point is important, given the current state of PPACA and the plans to repeal it.

Blue Cross Blue Shield’s signaled commitment to the Georgia exchanges in 2018 comes at a time when the Trump Administration and House Republicans have filed a motion in federal court to hold a case for 90 days regarding the constitutionality of cost-sharing reductions in PPACA. The purpose of the cost-sharing payments is to reduce the out-of-pocket expenses of low income consumers, but Republicans in Congress have refused to fund the payments in the past, leading to the Obama Administration funding them without a specific allocation. House Republicans sued the Obama Administration in 2014 for illegally authorizing the payments, and a lower court agreed with them. Continue reading “Blue Cross Blue Shield (Possibly) Offering Insurance on Exchanges in 2018”

Isakson Chronic Care Legislation Heads to Senate Vote

The CHRONIC Care Act of 2017, introduced by Sen. Isakson (R-Ga), Sen. Hatch (R-Utah), Sen. Wyden (D-Ore) and Sen. Warner (D-Va), passed unanimously out of the Senate Finance Committee today and heads to a full Senate vote.

The bipartisan legislation could have a major impact on curtailing the cost of Medicare, as the legislation seeks to modernize chronic care treatment, which accounts for approximately 90% of the Medicare spending for senior citizens.

Among many modifications, this legislation seeks to increase flexibility in care by expanding telehealth services, which will increase access to care for seniors in rural areas, and the “independence at home” model, which allows for patients to receive more treatments at home and reduces the number of hospital readmissions.

Additionally, the legislation offers more flexibility to Medicare Advantage Special Needs plans to offer enrollees non-medical services. About one third of Medicare enrollees are in Medicare Advantage plans.

Continue reading “Isakson Chronic Care Legislation Heads to Senate Vote”

Drug Treatment Tourism Isn’t The Type Of Tourism We Had In Mind

Drug treatment centers, colloquially known as methadone clinics, have popped up across northwest Georgia.  The clinics have a purpose: to treat those with a drug dependency of heroin and other opioids by treating with methadone.  Methadone replaces the drug the person is dependent on and is seen as an effective treatment.  It’s also a controversial treatment.  I’m not a doctor, so I won’t speak to the effectiveness or ineffectiveness of the treatment.  If there are any doctors in the house, feel free to opine in the comments.

That’s not really the issue.  The issue is the number of, as an AP article that discusses this matter, “tourists” that these clinics bring to north Georgia.  According to the Department of Behavioral Health and Developmental Disabilities, one in five people treated at a Georgia methadone clinic last year was out of state.  In the same time frame, every two out of three people who visited these clinics in northwest Georgia were from out of state.

Continue reading “Drug Treatment Tourism Isn’t The Type Of Tourism We Had In Mind”

The Two Georgias Are Now Five Georgias

This week’s Courier Herald column:

This is the second in a series. The introductory column can be found here.

During the 1980’s, the Director of Georgia’s Cooperative Extension Service Tal DuVall published a study on “Two Georgias”, highlighting the growing disparity between a prosperous and growing metro Atlanta, and a mostly rural “other Georgia”. It was not well received by then Governor Joe Frank Harris. Enough so that Mr. DuVall wasn’t around long enough to publicize his ideas. That credit is generally given to Doug Bachtel.

It’s never been politically popular to acknowledge that there is more than one Georgia. Whether standing in downtown Atlanta on Peachtree Street, a farm outside of Dublin Georgia, a beach on Tybee Island, or tying up to a dock in Blue Ridge, we’re all presumed to be politically equal. From the perspective of those that govern us, we are all equal in the eyes of the state.

Economically and politically, the various regions of Georgia can only be considered equal when viewed through the distortion of a political lens. The economic disparity can be proven through statistical data of income and sales tax receipts, and through the distribution of Medicaid and SNAP dollars. The political disparities often change with the topic, depending on how the legislators within each region choose to caucus on an issue.

Georgia politics is not the same as it was thirty years ago when we debated and pretended to ignore that there were two Georgias. We’re now a state of ten million people and growing. We’re the eighth largest state in the country, and in less than a generation we’ll likely be the fifth. The political party in power in statewide offices and with near super-majorities in the legislature is different.

We’re no longer a state of two Georgias. In political and economic reality, there are at least five Georgias. Continue reading “The Two Georgias Are Now Five Georgias”

South Georgia is losing another hospital

Southeast Georgia is losing another hospital.

Optim Medical Center Jenkins in Millen is closing and will merge with Screven Medical Center. The Jenkins location will remain open for 60 days, or until June 24, and all patients Image result for jenkins screven countiescurrently receiving treatment at the Jenkins County hospital will be directed to Screven Medical Center.

The closure will put 55 part-time and full-time employees out of job at the Jenkins location. Optim has reported that some will receive severance and others a chance to move to other locations.

Continue reading “South Georgia is losing another hospital”

You Can’t Have a Hospital Because We Don’t Get to Build It

In the continuing saga that is the building of a hospital in Columbia County, The Augusta Chronicle reports today that the Georgia Court of Appeals has voted to send the case Doctors Hospital filed against the Georgia Department of Community Health back to Fulton County Superior Court. Doctors Hospital had asked for a judicial review of the GDCH’s decision to award Augusta University Medical Center a Certificate of Need (CON) through an exemption in 2014, and somehow, all the documentation for the review did not make its way to the Appeals Court. Specifically, Doctors Hospital had asked that some documents be added to the file, and they weren’t for whatever reason. Fulton County was supposed to send those documents within 10 days of the request back on November 8, 2016.

They missed the deadline by 154 days as of this morning.

Now, they have been ordered via ruling to submit the complete review to the Appeals Court, where it will be re-docketed for the next term. Yes, it’s a paperwork error, probably just an oversight from someone who earnestly made a mistake and had no ulterior motives, but Columbia County residents have been held hostage by this drama for almost four years already. Continue reading “You Can’t Have a Hospital Because We Don’t Get to Build It”

Blue Cross Blue Shield Considers Pulling Out of Health Insurance Exchanges; Would Leave Rural Georgians with No Providers in Markeplace

On April 4th, Andy Miller of Georgia Health News alerted readers that Anthem, the parent of Blue Cross Blue Shield of Georgia (BCBS), is considering pulling out of the health care exchange market. This will affect the Atlanta marketplace, but there are other insurers these consumers can select. The real trouble is for the 96 Georgia counties that have no other providers participating in the exchange in their area. What do these people do if there isn’t a provider to choose?

Back in 2o09 and 2010, the Patient Protection and Affordable Care Act (PPACA) — better known as Obamacare — took over my life. I was a health and education legislative assistant on the Hill, so of course it did. I’ve always felt that there was an especially heavy hand from the health insurance agencies when it came to drafting the legislation — and I was not alone in that belief — and that “Insurancecare” might have been a better nickname for it than “Obamacare.” (Side note: The quickest way to ruin my day back then was to tell me an insurance lobbyist had dropped by and wanted to know if I could take a “quick meeting.”) I do commend Democrats (and the one Republican, who everyone forgets) who supported PPACA for tackling a very large problem in American health care. I think they tried to fix the wrong problem, however, and now Republicans are in danger of making the same mistake.

Americans want affordable, accessible health care. They think they want insurance, because with the health care system the way it is in this country (and was prior to 2009), that’s what seems to make health care accessible and affordable, but it’s not. However, now we have a problem because we went with an insurance-for-all plan that requires that there is actually insurance-for-all. I’ll explain, but it’s a dense topic, so buckle up! Continue reading “Blue Cross Blue Shield Considers Pulling Out of Health Insurance Exchanges; Would Leave Rural Georgians with No Providers in Markeplace”

Dear Medical Association Of Georgia: Do Better

Hello MAG. It’s time we had a little chat.

You guys come to the capitol every year, and talk about reducing the burden of regulation on your physicians so they can be free to practice medicine. It’s a worthy goal, one I’m usually sympathetic to. Or at least, I have been.

Do you know where bad regulations come from? They come from upset voters who complain to legislators after having bad experiences. They come from people who feel powerless to stop bad practices and bad management, and want the government’s help to level the playing field.

You guys have some very bad practices. If you’re not careful, you’re going to get more – not less – regulations. Continue reading “Dear Medical Association Of Georgia: Do Better”

Ralston Puts “Other Georgia” In The Spotlight

This week’s Courier Herald column:

There was a time in recent Georgia history when it was impolite to talk about the concept of “Two Georgias”. There was the thriving and growing Atlanta – the economic engine of the state.

Then, there was everything else. The “Other Georgia”. The people that could see the writing on the wall. The people who knew their rural grip on power was slipping. The people who could see that economic and population trends were shifting against them. The people who liked things the way they were, but knew times were changing whether they liked it or not.

With the assistance of UGA professor and Georgia political master Dr. Charles Bullock, we believe the term was popularized during the administration of Governor Joe Frank Harris by the late Doug Bachtel. “Two Georgias” was not a term of endearment. It was, in essence, perceived as a threat to those at the Capitol that they were spending too much time courting the favor of the business interests of Atlanta, and not the greater population that lived outside the area.

The 80’s were several lifetimes ago in Georgia politics. Time did march on, and political and demographic trends did shift. Continue reading “Ralston Puts “Other Georgia” In The Spotlight”

Serve The Patient, Serve The Student, Starve The Bureaucracy

This week’s Courier Herald column:

In my day job, I spend a good bit of time working on policy solutions in the areas of medicine and education, among other topics. They are complex areas, without singular problems nor singular silver-bullet solutions. The fields appear to have very little in common. And yet, many of the barriers to success in each field have a similar root cause.

My mother spent the first ten days of this year in the hospital. It was not a pleasant visit, not that hospital stays usual are. The information we received about her condition and reason for hospitalization was incomplete and contradictory. We had difficulty getting basic questions answered. All communication, we were told, was to come from the doctor. “The”, singular, doctor, who we saw for a couple of minutes per day. She eventually made it clear to us in no uncertain terms that she had already answered our questions and didn’t care to be asked again, nor to have her orders questioned.

After firmly requesting she be replaced by my mom’s doctor from a previous and very recent stay, that doctor said “Had I seen you on your first day here, you wouldn’t be here now”. By that point she had a new infection (that she predicted she would get on day 2 of her stay – a prediction doctor #1 ignored) and she remained in the hospital four more days.

My mother, a registered nurse, made it clear as my sisters and I worked the hospital’s bureaucracy that the nurses and techs were giving her great care and were very responsive to all her requests. That much was evident. And yet, despite all of their efforts to go above and beyond, the net effect of the first several days of her stay was that she was arguably worse off for having been there than not. Continue reading “Serve The Patient, Serve The Student, Starve The Bureaucracy”