Family Values - a small but significant gap in Connecticut’s health care system

There are a number of people who cannot get healthcare coverage in Connecticut no matter where they turn: Documented immigrants over 65 years of age who have had green cards for less than 5 years. The people affected by this gap are often parents who have come to be with their children and help raise their grandchildren.

This morning, the Consumer Health Action Network hotline (toll-free 888-873-4585) answered a call from a daughter who had brought her 70-year-old parents to Connecticut. They both have had their green cards for 3 years. She has tried many avenues to get healthcare coverage for them.
· Most private insurers will not look twice at the application when they learn that her parents are over 65 years old. One company that did consider the couple came back with a monthly premium of $1400 for one parent, for coverage that would not address any pre-existing conditions.
· Medicare requires that immigrants hold their green cards for 5 years before they are eligible for coverage.
· Medicaid does not cover anyone over 64 who isn’t eligible for Supplemental Security Income, doesn’t receive Medicare, or hasn’t spent a significant amount on medical expenses already.
· The new Charter Oak Health Plan is designed for 19 to 64 year olds and does not make exceptions to those parameters.

It’s a small gap, frankly, but an important one to fill. Models exist for how to fill this gap (for instance, our neighbor to the South, New York). Let’s get to it and make sure that we make sure that as many of the currently uninsured will be able to get healthcare coverage.
Connie Razza

COBRA calls to Consumer Network Helpline

In the past three weeks, the Consumer Health Action Network (888-873-4585) has received a number of calls about COBRA. COBRA (which stands for the Consolidated Omnibus Budget Reconciliation Act) is the federal law that allows workers and their dependents to continue group health coverage at their own expense after employer coverage ends because of termination, reduced hours, and other reasons. This trend is disturbing because it indicates at least one if not more of several problems:
· More Connecticut residents are losing their jobs;
· Employers don’t know their obligations under COBRA; and/or
· Employers are counting on their employees not knowing their rights under COBRA.

The program is complicated, but here are some basics:
· In Connecticut, all employers are covered by COBRA law.
· Employees are eligible for COBRA insurance when they retire, quit, are laid off or fired for anything other than gross misconduct, or have reduced hours.
o Employees are covered up to 18 months under the federal COBRA law. If the employee is between 62 and 65 and eligible for COBRA, Connecticut law requires the employer to offer COBRA coverage until the person reaches 65 (when Medicare starts), regardless of the number of months involved.
· COBRA insurance will also cover surviving, divorced, or separated spouses; dependent children; or dependent children who lose their dependent status under their parent’s plan.
o Depending on the reason for loss of coverage under an employer plan, spouses and dependent children may be eligible for COBRA benefits up to 36 months.
· Retirees can qualify for COBRA if their former employer files for bankruptcy.

COBRA coverage can be expensive, especially for people who have just become unemployed, but it is an important option for people to keep coverage through transitions. It is critical that everyone know their rights.
If you have questions about COBRA, go to http://www.cthealthpolicy.org/action/tips/200612_cobra.pdf or call the Consumer Health Action Network Helpline toll-free in CT at 1-888-873-4585.
Connie Razza

State taking applications for Charter Oak

This morning at the Town Line Diner in Rocky Hill, the state began signing up consumers for the Charter Oak Plan. The Governor held a press conference at the diner announcing the opening of the plan and two consumers filled out applications. New information includes premiums which vary between $75 and $279/month and an annual cap on services of $100,000 in addition to the lifetime $1 million cap. Annual deductibles still range from $150 to $900 – above that amount consumers will have to pay 10% of inpatient hospital bills and 20% of outpatient surgery. The three participating health plans are Community Health Network, Aetna Better Health and AmeriChoice (United Health Plan).

Charter Oak covers hospital care, doctor or clinic visits, X rays and lab tests, prescriptions, and some mental health and substance abuse treatment. There is no pre-existing condition exclusion and subsidies in premiums and deductibles based on income.

While Charter Oak is an important new option for CT’s uninsured, it is not right for everyone. As with all insurance, consumers need to do their homework. Charter Oak may not be right for consumers who:
Have insurance now – there are exceptions, but you may not be eligible if you’ve had insurance in the last six months
Don't have money in the bank available for health costs -- $900 deductibles plus 10% of hospitals stays can get very expensive
Have high prescription needs – prescriptions are limited to $7,500/year
Need to see a specific doctor – the provider panel is likely to be very limited
Need dental or vision care – they are not covered
Need mental health or substance abuse treatment – coverage is limited

Consumers who want more information or to sign up can go to http://www.charteroakhealthplan.com/ or call 1-877-77CTOAK (1-877-772-8625).
Ellen Andrews

New uninsured numbers – CT residents more likely to be uninsured than other New Englanders

Between 2004 and 2006, 8.9% of New England residents were uninsured, but 10.7% of CT residents lacked insurance, according to point in time surveys by the National Health Interview Survey. Not surprisingly, low income CT residents (below 200% of the federal poverty level) were 2.4 times less likely to have coverage. 12.2% of CT residents, including one in four children were covered by Medicaid. This is lower than our neighbors in Maine (23.3%), Massachusetts (14.6%) or New York (18.7%). 13.2% of all Americans rely on Medicaid or SCHIP for their health coverage.
Ellen Andrews

CT assessing the strength of our public health system

Yesterday over one hundred CT public health leaders gathered in Farmington for the first of a two day project developing a detailed assessment of our state’s system to protect the public’s health. The project is being led by DPH using CDC’s National Public Health Performance Standards. Five generous souls from New Jersey are serving as independent, disinterested facilitators and two advisors from the CDC set the context for the assessment. The standards measure the CT system’s strengths and weaknesses against ten essential services. I was assigned to the policy breakout session; our group included a very diverse set of backgrounds with many members who had never met. Many felt that just taking a day to reflect on the system and hearing about it from others’ perspectives was instructive. Voting on the questions was entertaining with a lot of lobbying and peer pressure. I can’t wait for next week.
Ellen Andrews

Health First and Primary Care Authority Updates

Last Thursday both Authorities met in separate meetings.
The Health First Authority is collecting information on CT’s spending on health care and Medicaid rates. Urban Institute researchers shared info from a 2003 Health Affairs article showing that CT’s Medicaid rates averaged 83% of Medicare, compared to 69% nationally. MA pays 80%, NY 45% and RI 42%. These rates do not include increases implemented this winter. The Authority then discussed the options they will consider for their report, due in December. Options include a single payer system (required by the statute, they will be taking only written comment on this one), universal primary care only public coverage (the Primary Care Authority is working this one out),and a building block/gap filling approach. The building block approach could include improving Medicaid, new alternatives for the currently insured, an Insurance Partnership plan based on Rep. Donovan’s pooling bill, a Healthy San Francisco-type model, a MA-type Connector plan, and a public gap-filling model run like a self-insured employer plan. Most discussion centered on the building block idea. There was little enthusiasm for any of the options.
The Statewide Primary Care Access Authority met later on Thursday. They had a presentation by OHCA on their preventable hospitalization report. Later they moved on to outlining the structure of their report and the universal primary care system proposal. Suggestions included coverage of prescription drugs, wellness services like Weight Watchers and smoking cessation, specialty care, mental health, and oral health care. They will explore guidelines for FQHCs, pediatrics and adult medicine coverage and build on the list. They discussed loan repayment and removing regulatory barriers to expand the health care workforce. They also discussed creating a standardized process for defining where to place future safety net provider expansions.
Ellen Andrews

Health care jobs carry CT’s employment outlook

The current issue of The CT Economic Digest, from the CT Dept. of Labor, reports that between December and April both CT and the US have had four consecutive months of contracting employment. (Apparently this isn’t bad enough for economists to label it a recession yet.) Historically CT’s employment downturns average 24 months while US cycles only average 13.8 months. However the good news for CT is health care. CT created 6,233 new health care jobs in the first quarter of 2008, compared to last year. Most of the gains were at hospitals, nursing and residential care facilities and in ambulatory care. Just behind health care in job creation, government added 4,367 jobs. Job losses were worst in the manufacturing sector. Predictions are that overall CT job losses will continue into next year, but that health care will create 7,970 new jobs between the fourth quarters of 2007 to 2009.
Ellen Andrews