Our nation is on the cusp of historic public policy change. In the next several weeks, the most sweeping health reform legislation in 40 years will likely become law. Despite the heated town halls of August and the steady stream of information coming from the legislative debates in Washington, many Georgians are still wondering: What does this mean for me?
Currently, most of us have health insurance through our employers, and for many in this category, that works well enough. But with unemployment rates rising, people changing jobs more frequently, and fewer businesses offering coverage, a growing chunk of Georgians don’t have that option. Without access to an employer plan, the choices are bleak.
Recently unemployed Georgians had continued their previous coverage for a limited time through COBRA at a subsidized rate, but that subsidy recently expired. Another option is to purchase an individual health insurance policy, but this marketplace is fraught with problems. Many of the horror stories you have heard about claims denials and pre-existing condition exclusions have happened to Georgians who have tried to do the right thing only to find the insurance policy they purchased offered minimal protection when they got sick.
Because insurers are not required to sell standardized policies, plan designs can be hard to understand. Further, because Georgia is not a “guaranteed issue” state, health care consumers — even those willing and able to pay high premiums — can be turned down entirely because of their health status. These and other Georgians who can only find policies that exceed their ability to pay are effectively shut out of private health insurance.
Public programs like Medicaid and PeachCare pick up some of the slack by providing coverage to the most vulnerable children and families; but these programs feature strict eligibility requirements. Consequently, many Georgia consumers are ineligible for public programs and unable to purchase an affordable and meaningful private health insurance policy. In other words, they join the ranks of the 1.6 million uninsured Georgians.
Addressing these gnawing challenges — fragmentation, unaffordability, lack of transparency, and the growing number of folks who are out of options altogether — is at the heart of the framework for reform that is materializing in Congress. From this framework, a clear picture of what many of these changes will mean for Georgia’s health care consumers is emerging.
In a reformed system, insurance plan designs will be standardized so that consumers will know what they are buying, all policies will be “guaranteed issue,” pre-existing conditions can no longer be excluded from coverage, and premiums cannot vary based on health status. To ensure affordability, sliding scale subsidies will be available to low- and middle-income consumers for premiums and limits will be placed on out-of-pocket costs. The Medicaid program also will be expanded such that the working poor can enroll in an insurance plan that meets their needs.
While there are still pieces of national health reform up for debate and areas for improvement, the consensus framework does something unprecedented: It creates a clear and affordable pathway to meaningful coverage for most Georgians.
Cindy Zeldin is executive director of Georgians for a Healthy Future.
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Credit: Jason Getz / Jason.Getz@ajc.com