Health Care

This week, in a big win for consumers, a district court took action to block the proposed merger between health insurance giants Anthem and Cigna. This decision follows a ruling last month that blocked the proposed merger of two more of the nation’s biggest for-profit health insurers, Aetna and Humana. These decisions come after months of work by U.S. PIRG and a broad coalition of consumer and health care groups, urging close scrutiny of the mergers from state and federal regulators and raising questions and concerns about the potential impact of the mergers.

Here's that Rx refill you didn't order

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Health care analysts are wary of automatic-refill programs at major pharmacies, as unnecessary refills are billed to insurance companies and Medicare without customer approval.

News Release | Georgia PIRG | Health Care

Supreme Court Upholds Health Reform

Today’s decision is good news for consumers. Insurance companies can’t go back to the days of dropping your coverage once you become ill, or denying coverage to sick children. And beginning in 2014, the days of insurers being able to deny anyone coverage for “pre-existing conditions” will be history. 

Report | Georgia PIRG Education Fund | Health Care

Making the Grade

When it comes to health care, there are few magic-bullet solutions for the many problems consumers face in the marketplace: insurers don’t compete for their business, leading to higher prices and lower quality. Important information about coverage is buried in the fine print, making it ha rd to know what’s really covered or which plan is right. And costs are continuing their unsustainable rise.  

Yet there are policy solutions that can make a difference and give consumers a better deal on health care. One of the most important of these is the creation of new state-based health insurance marketplaces, called exchanges. These exchanges, authorized by 2010’s health reform law, offer the states the chance to address the win problems of cost and quality, and help consumers get a fair shake when buying insurance. 

Exchanges give individuals and small businesses the same advantages that large businesses generally enjoy when it comes to buying health insurance. Large businesses have strong negotiating power, allowing them to get a lower rate for coverage as insurers compete for their business. They also benefit from economies of scale that lower administrative costs, and have sophisticated human resources departments and brokers at their disposal, making it easier for employees to understand their options and decide which plan is right for them. 

In much the same way, exchanges give individuals and small businesses the ability to band together and gain the same benefits of size, negotiating power, and information. By providing better options and better information, and negotiating on behalf of its enrollees, the exchange can level the playing field for consumers. 

States thus have an important opportunity to improve their health care marketplaces through the creation of an exchange. And the health reform law gives the states substantial leeway to define critical aspects of the exchange, including who is eligible to buy coverage through it, how aggressively it will set standards and negotiate with insurers, and who will run it. A weak exchange could wind up taking its cues from the insurance industry, not consumers, and do little to shift the fundamental problems in most states’ health care markets. A strong exchange, though, can be just the tool states need to revolutionize their health care systems and improve quality while lowering costs.

As of this writing, several states have already taken this opportunity and established their exchanges. But not all exchanges are created equal, and many states have yet to commit to establishing one. This report assesses the progress that the states have made, and for the states that have begun to set up their exchange, evaluates them on the myriad policies and criteria that will determine whether it is ultimately successful in improving health care for consumers.

Report | Georgia PIRG Education Fund | Health Care

Building a Better Health Care Marketplace

Consumers across the state know that the health insurance marketplace is broken.  Insurers don’t compete for their business, instead offering take-it-or-leave-it deals.  Important information about coverage is buried in the fine print, making it hard to know what’s really covered.  Instead of working to lower costs and improve quality, too many insurers focus on covering healthy enrollees and dumping the sick.  And costs are continuing their unsustainable rise.  Nationally, the great majority of individual-market policyholders—77% —saw a premium increase from early 2009 to early 2010, with an average rate hike of 20%.  Small businesses, too, pay 18% more for insurance than their larger competitors and have seen repeated double digit premium increases.

The creation of a new health insurance exchange offers our state the chance to build a better marketplace for health care.  The exchange can help individuals and small businesses by increasing competition and improving choices in the state’s insurance market.  By providing better options and better information, and negotiating on behalf of its enrollees, the exchange can level the playing field for consumers.

Success is not assured, however, as states confronting the task of setting up their exchange must grapple with important policy questions.  This report is a blueprint for creating a strong, pro-consumer exchange that lives up to its promise of a better marketplace.

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