Kaiser compares Congressional health reform bills

The Kaiser Family Foundation has posted a comprehensive comparison of the US House and Senate health reform plans.

Governor’s mitigation plan slashes health programs; 13 better alternatives offered

Yesterday the Governor released her plan to address the $470 million deficit for this fiscal year. This is on top of the cuts made in the budget that passed into law a few months ago. Her proposal includes cuts to the diaper bank, autism pilot, drugs in public coverage programs, new premiums and increases in HUSKY, higher copays in HUSKY and Medicaid, eliminate vision and transportation in SAGA, delay HIV/AIDS waiver, cut lead poisoning programs, genetic disease programs, school based health centers, eliminate adult dental care in Medicaid and SAGA, cut Healthy Start, cuts to community health centers, hospitals and nursing homes. Her proposal also empties all the money out of several funds including stem cell research and the Tobacco and Health Trust Fund.
Sadly, there are alternatives that could save the state money as well as improve health care. We have offered thirteen of them.
Ellen Andrews

Insurance Dept. hearing on United Healthcare buying HealthNet

Monday’s CT Insurance Dept. (CID) hearing on the acquisition of Health Net’s license by United Healthcare was fascinating. If you didn’t hear anything about it, you’re not alone. It was not well publicized, there was little time to respond, and the hearing was not held at the Legislative Office Building, but in a windowless room, down a maze of halls, in the back of the CID offices in Hartford. Just to set the tone of the hearing, the pens for visitors to sign in with at the CID offices carry the United Healthcare logo. The CT Health Policy Project, the CT State Medical Society, the American Medical Society and Patient Advocacy Institute had already been denied intervenor status in the proceeding; apparently CID does not believe that consumers and providers have a critical interest in the proposal.

In an unprecedented arrangement, United is not merging with Health Net (which is leaving CT), but simply buying all their information about us. They can then choose which of us, possibly based on our health status, they will offer to insure. They can also decide what they will charge us. United could more than triple their share of CT’s health insurance market; studies have found that less competitive markets lead to higher premiums for everyone. CT’s health insurance market is already too concentrated and we are at high risk for anti-trust concerns. Also, consumers who are lucky enough to be defaulted into a United policy may have to change doctors and medications. United’s provider panel is sparse in areas of the state and they have a different formulary than HealthNet. Also, as a matter of privacy, United will now have sensitive personal health information on about 200,000 state residents that we never consented to share with them. Health Net is now under investigation for losing a hard drive with Medical claims data. I also pointed out that all those 200,000 HealthNet members already had the choice of insuring with United and rejected it. To default them into a plan they already rejected is not doing them any favor.

For two hours, United’s own lawyers were able to ask their own executives and consultants softball questions extolling the virtues of the proposal. Then CID staff asked technical questions for another hour. Interestingly, United happened to have a large chart display just to respond to one of the CID staff questions. Then we had our turn at the podium. The CT State Medical Society, the Office of Health Care Advocate, the Center for Medicare Advocacy, the American Medical Society, the Patient Advocacy Institute, Middlesex Professional Services and the CT Health Policy Project all testified in opposition. We got very few questions. Then the United witnesses were asked softball questions by CID staff allowing them to rebut any of our concerns (I’m told lawyers call that rehabilitating the witness). One of those questions to the insurer asked whether actual workers in a small business have a role in choosing the insurance plans offered. United, as experts on small businesses like ours, answered that only owners have that choice. I guess that means that consumers really don’t have a voice in choosing health plans, only employers. (In our small group the opposite is the case, but I wasn’t given an opportunity to say that). We were only allowed to submit any written comments for a few hours, however United was given until 4pm the next day to submit anything they choose.
Democracy in action.
Ellen Andrews

Congressman Larson to hold forum on Women’s Health

Women’s Health Care: A Call to Action, sponsored by Congressman John Larson, will be this Tuesday from 8:00 to 9:30am at the Hartford Hilton, 315 Trumbull St. Speakers include Judith Stein of the Center for Medicare Advocacy, Teresa Younger of the Permanent Commission on the Status of Women and Ellen Andrews from the CT Health Policy Project. To register, contact Congressman Larson’s office at (860) 278-8888.

New in the Book Club: Super Freakomonics

Who knew that economics, microeconomics at that, could be entertaining? Super Freakonomics, our newest Book Club addtion, includes more examples of why everything, even things that don’t seem it, involves competing incentives and how to find simple, cheap solutions by thinking about things differently including information technology and ER overcrowding, measuring the skill of doctors, and getting doctors to wash their hands with a screen saver. Did you know that walking drunk is more dangerous than driving drunk (the authors don’t promote either)? How the automobile saved New York City from a horse manure crisis. Does a sex change affect your salary since men make more than women? Really funny stuff.
Ellen Andrews

Medical home and PCCM meetings

Yesterday’s organizational meeting of the SustiNet Patient-Centered Medical Home Advisory Committee was very encouraging. There is a lot of energy across stakeholder groups, especially among providers and payers. We are soliciting input on who/what groups to consult for input and what issues to consider. Suggestions include business coalitions, NCQA, medical homes from other states, consumer and provider groups. Issues raised include integrating primary care with behavioral health, the role of chiropractic care, primary care shortages, health IT, the costs of implementation, and savings to the health care system. It was also noted that while policymakers are learning about the medical home model, most providers still need to understand it.

Unfortunately, the meeting of the Medicaid Managed Care Council’s PCCM Subcommittee that followed did not go as well. DSS has refused to remove the irrelevant and intimidating Freedom of Information clause in PCCM provider contracts. As one provider in the room put it – the first time a provider gets a request or a subpoena, that will be the end of the program. It is important to note that providers participating in HMOs are not required to sign similar contract language. DSS also continues to refuse to devote any resources to marketing PCCM, despite the overwhelming marketing allowed by the HMOs, paid for out of tax dollars. DSS estimated that the HMOs were spending 1% of the cap rates on marketing, which is roughly $7 million/year. Marketing activities by HMOs, approved by DSS, and paid for out of tax dollars, include free ice cream and haircuts to sign up with an HMO, a banner behind an airplane at a community festival, gifts, radio and billboard advertising, and raffles for school uniforms and supplies. DSS noted that when they talk to providers about signing up for PCCM, they also encourage them to sign up for the HUSKY HMOs and Charter Oak. It is unclear whether providers understand that they can sign up for just PCCM or if they believe they have to also sign contracts with the HMOs. DSS also announced that they will hire Mercer to conduct an evaluation of PCCM to be done by July. However, they acknowledged that the very small enrollment in the program so far makes it nearly impossible to make valid statements about how well the program is doing in providing care, reducing costs, or improving quality. Mercer was the DSS contractor that approved the 24% HMO rate increases for the HUSKY HMOs, which were called into question by the Comptroller’s independent audit, and derives a great deal of their business from managed care plans, in CT and nationally.
In the meantime, advocates are working without any tax dollars to market PCCM to both providers and consumers in New Haven and Hartford in anticipation of the program’s roll out there January 1st. We have an army of volunteers and energetic students mailing and calling providers, practice managers, community organizations and consumers. We are holding two forums open to anyone interested, and eligible to join, the program. By far the largest obstacle we are encountering is skepticism about DSS’s commitment to the program and a strong distrust of the state. If you are considering PCCM, for more information click here.
Ellen Andrews

Governor’s health reform council meeting

In Governor Rell’s message when she vetoed HB-6600, the SustiNet bill, she created a CT Health Care Reform Advisory Board. Her board mirrors the SustiNet Board in many ways, but largely includes people appointed by or who work for her. While the legislature over-rode her veto and the SustiNet Board has been up and running for months, the Governor has decided to convene her group anyway. They met for the first time yesterday. Membership is very conservative including the insurance industry, an insurance broker representing a very conservative small business coalition, state agencies, and some providers. No consumer voices are at the table. Members urged payment reform, health system reform, and health information technology. Covering the uninsured rarely came up; ensuring that people get the value they pay for out of insurance, curbing insurance company abusive practices, limiting administrative overhead and profits, and protecting consumer rights were never mentioned. There was a great deal of criticism of current federal reform proposals. Aetna made a remarkable, and expensive, offer – they will provide free actuarial support to cost out the group’s recommendations. I guess they are confident that the group will only endorse options they agree with. Aetna also got the Chair to agree to move up the date for final recommendations from January 2011 (after Governor Rell’s term is over) to the middle of 2010.
Ellen Andrews