Georgia and the ACA

In 2014 Georgia had the dubious honor of being the only state with 2 of the 10 most expensive health insurance markets in the country.  Southwest Georgia ranks as the second most expensive market in the country after an affluent area of western Colorado (#1).  Centered around Albany, GA, this area has a number of factors likely playing into the expensive premiums there.  Neighboring southern GA has many of the same issues:

*These two markets are fairly rural.

*Georgia's legislature chose not to expand Medicaid to residents making 101-138% of the Federal Poverty Limit even though the Federal government pays 100% of the expansion costs for the first couple of years and 90% of the costs after that.  Rural hospitals in GA thus continue to have to treat uninsured poor patients and pass along the costs in higher costs to their insured patients and these insured residents' insurance companies.  Compounding this scenario is the fact that southwestern Georgia is served by a single hospital system.  In terms of seeking medical care, there is no other game in town.

*Southwestern and southern Georgia are fairly poor, rural areas with relatively high levels of chronic disease.  In other words, the populations of these areas are sicker and poorer than other parts of the state.  

The differences in average premiums between relatively affluent north Georgia/Atlanta and southern, rural Georgia earned Georgia the distinction of having the greatest disparities of any state in terms of insurance premiums.  

Last year was the first year in which the Affordable Care Act's (ACA's) new health insurance exchanges were operating.  Starting in 2014, almost all Americans must now have health insurance or face a tax penalty.

Premiums varied widely.  Today's map shows the 10 most expensive health insurance markets for 2014.  Citizens can purchase a variety of plans from different private insurers.  The standard for comparison looks at Silver plans for a 40 year old non-smoker.  In 2014, the average monthly health insurance premium for a Silver plan for a non-smoking, 40 year old adult was $328/month.  Rates were lowest in 2014 in Minnesota and highest in western Colorado.

So, are there any patterns to markets with high or low premiums?  Yes.

*Some fairly wealthy areas such as western Connecticut and western Colorado have relatively healthy people but appear to be paying more.  Why?  I guess because insurers feel the markets in these areas can bear higher premiums.  That is just a guess.

*Other areas are a) remote with limited medical providers, b) are in areas where Americans are in fairly poor health, or c) both.  Georgia has the dubious honor of having 2 of the 10 most expensive markets in the country AND having the greatest disparities of any state between the high costs around Albany, GA, compared to the relatively lower costs in the Atlanta market.  Wyoming, northern Nevada, western Wisconsin, Alaska, and coastal Mississippi all have issues with few providers and/or sick populations.

*Vermont ranks in the 10 most expensive because of a policy in that state.  Unlike in other states which have opted to allow insurers to charge older residents more than younger people, Vermont law requires insurers to charge everyone regardless of age the same premium for the same plan.  As a result insurers increased premiums across the board in Vermont.

The new 2015 premiums came out in mid-November and there are relatively big fluctuations in premiums.  Minnesotans will be paying more.  Mississippians will pay less.  Overall prices nationally are either slightly down or steady after years of rapidly rising premiums.  The geography of premiums, however, continues to be sorted out as insurers and their actuaries figure out if they are charging enough to cover the health issues of their populations AND make a profit (since the Republican-invented ACA model relies on government subsidies and private insurance companies rather than the single-payer Democratic alternative).  It will likely be at least 3 years (circa 2017) before we can see more stable premium data as the system finds its groove.

Collegiate Recovery Programs

Collegiate recovery programs are a new concept for me.  I discovered of their existence in 2014. Only about 50 U.S. colleges and universities offer these programs to support college students who are recovering from alcoholism and drug abuse.

If you consider the usual images of college social life, they often focus on heavy drinking and experimentation with illicit drugs.  College can be a tough place for a student in recovery.  Collegiate recovery programs help provide a range of services to assist students in recovery.  Most require a student to have been in recovery for a minimum of 6 months.  Some provide counseling.  Almost all seek to provide social gatherings and academic advising that take the special needs of students in recovery into account.

Georgia offers such programs at Georgia Southern University (with students from East Georgia College also served) and Kennesaw State University with a new effort/program at the University of Georgia.

Updated Marriage Map

Today civil marriages for same-sex couples became legal in Florida.  If we add in Missouri and Kansas (see below), 37 states and the District of Columbia now offer civil marriage licenses to both same-sex and opposite-sex couples.  Basically the number of states where same-sex civil marriages are legal doubled in 2014 after a string of court rulings based on the Windsor case.  One article I read stated that 4 out of 5 Americans now live in a state where same-sex couples can legally wed.  Using 2010 Census data, I came to the figure of 73% of the population living in a state with marriage but those data are 5 years old now.

There are many complications to this story however:

*The US Supreme Court avoided taking up the constitutionality of same-sex marriage bans in 2014.  After a split in appellate court rulings developed after a 2-1 ruling by the 6th Circuit in Cincinnati upheld the bans, the US Supreme Court has agreed to discuss whether to address the question of same-sex marriage bans and the US Constitution.  The Court will decide whether to take a case or pass again on the issue in January.

*Same-sex couples can only marry in a handful of jurisdictions in Missouri, but the state government recognizes these marriages.  Other jurisdictions continue to refuse licenses to couples pending more litigation.

*Neighboring Kansas is also a strange case.  A handful of jurisdictions there issue licenses but the state continues to refuse to recognize these marriages in spite of a ruling striking down marriage bans by the 10th Circuit.  

*Idaho's governor and attorney general are also appealing the striking down of that state's ban.

*Couples were briefly allowed to marry in Arkansas and Michigan.  After the 6th Circuit's ruling upholding Michigan's ban, Michigan's governor rushed to announce the marriages that had already occurred there using legally issued licenses at that time never happened and were void.  Even if that state's ban is upheld in appeal, the retroactive voiding of these marriages is likely to be more litigation.

*All this litigation by state officials seeking to uphold marriage bans is proving costly to states.  As state officials are losing more than 27 cases in 2014 over the unconstitutionality of these laws, they must by law pay the court costs of the citizens challenging these bans.  

I feel that it is likely the US Supreme Court will take up the constitutionality of same-sex marriage bans in 2015 and issue a ruling.  The number of states with and without marriage now closely resembles the lineup of states before major court decisions on interracial marriages and school desegregation.  Most of the states have already adopted the new policies with the usual holdouts in the former Confederacy as well as the 6th Circuit states and the sparsely populated Dakotas and Nebraska remaining.  I should add that Puerto Rico and other US territories are also holdouts.  I predict that by January 2016 civil marriages will be open to both opposite-sex and same-sex couples alike with future generations wondering what all the fuss was about.