Monday, June 30, 2008

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 or call 1-877-77CTOAK (1-877-772-8625).
Ellen Andrews

Friday, June 27, 2008

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

Wednesday, June 25, 2008

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

Monday, June 23, 2008

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

Tuesday, June 17, 2008

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

Friday, June 13, 2008

Governor vetoes pooling bill

Today Governor Rell vetoed HB-5536, An Act Establishing the Connecticut Healthcare Partnership. While she applauded the intent of the bill, to reduce health care costs for municipalities, nonprofits and small businesses by pooling them with state employees, she is concerned about potential costs to the state. She also cited legal problems with the bill, doubts about estimated savings for municipalities, and concerns that the bill does not address the problem of Connecticut’s uninsured. She called on legislators to work with her office to refine the concept next year.
Ellen Andrews

Thursday, June 12, 2008

Houston to hire nurses as ER alternative for non-urgent care

In 2006 Harris County, which includes Houston, spent $50 million on emergency room care for patients with problems that could have been treated in a doctor’s office, according to the Houston Chronicle. The city wants to hire “tele-nurses” to work with 911 dispatchers offering first aid advice or help getting an appointment for care with a doctor or clinic for callers who do not have a true emergency. The Director of Emergency Medical Services says that many patients call 911 because they have no insurance, no transportation to the hospital or they have insurance but can’t get after hours care or cannot judge how serious a problem may be. “The whole idea is to educate people, help them get self-care when appropriate,” according to the Executive Director of the Harris County Health Alliance. “It’s just about getting these folks to connect to what we call a ‘medical home,’ a regular source of care.” Ambulance rides cost $415 each plus $7.50 per mile and ambulances responding to non-urgent problems take vital resources away from true emergencies. Richmond, VA has a similar program.
Ellen Andrews

Friday, June 6, 2008

For-profit Medicaid managed care plans provide less care according to study, Implications for return to capitation in HUSKY

A study published in Medical Care Research and Review in April found that access to health care is lower for Medicaid managed care members in for-profit HMOs than for those enrolled in nonprofit plans. The author found that members of for-profit plans were 14% less likely to have had a doctor visit in the last year (statistically significant) and 6% more likely to report an unmet need for medical care and for prescription drugs (not significant). More research needs to be done. However, this study does suggest that moving 337,181 HUSKY consumers back to capitated HMOs, including two for-profit companies, on July 1st is unwise. Another reason to delay re-contracting HUSKY.
Ellen Andrews

Thursday, June 5, 2008

International study finds health inequities are about more than health coverage; editorial explores implications for US Presidential elections

A new study published today in JAMA compares health inequities across 22 European countries. Not surprisingly, rates of death and poor health are linked to lower socioeconomic status. However the scale of the disparity varied widely between countries. The authors attribute the variations in part to causes of death due to smoking, alcohol use and access to good quality health care. Interestingly, the variation between countries did not track with the generosity of welfare policies. Southern European countries tend to have less generous and less universal policies than Northern countries, but smaller health inequities, possibly due to healthier diets and lower smoking rates among women. The authors conclude that, while “a reasonable level of social security and public services may be a necessary condition for smaller inequities in health, it is not sufficient.” They suggest that improving educational opportunities, income distribution, healthy behaviors and access to quality health care may be most important. The accompanying editorial links the study to our upcoming Presidential elections. Virtually all of the 22 countries in the study have national health care policies, but wide health inequities remain. “[P]olicies related to preventive social, economic and behavioral interventions might well have a greater effect on reducing disparities than traditional medical interventions, even if as an unintended by-product.” As we’ve hard from states that are implementing “universal” health care reforms, like MA, VT and ME -- it’s not all about insurance.
Ellen Andrews

Tuesday, June 3, 2008

Massachusetts uninsured cut in half

The results are in. Massachusetts’ comprehensive health care reforms passed in 2006 have led the state’s rate of uninsurance to drop by almost half – from 13% in fall 2006 to 7% a year later. 355,000 more adults in Massachusetts now have affordable coverage– more than the entire uninsured population of Connecticut. The reform law, Chapter 58, included significant Medicaid expansions, subsidized private insurance offerings through an independent, trusted, and transparent resource, insurance market reforms and required individual and employer contributions. A survey published today in Health Affairs also found that under Chapter 58 the number of residents with high out of pocket costs and those reporting having trouble paying medical bills are down. The survey reported an increase in preventive care doctor visits, dental visits, a reduction in the number of adults who did not get needed care in the last year, but unfortunately no drop in ER visits. There was an increase in the number of respondents who had trouble finding a doctor or getting an appointment, but a decrease in the number who reported getting fair or poor care in the past year. 71% of state residents support the reforms. Researchers found no evidence of “crowd out” – employers dropping coverage or benefits in response to Chapter 58 requirements. Among the remaining uninsured adults, most are young and working with incomes below 300% of the federal poverty level. Only 11% have access to health benefits through work and 78% considered getting care through the new state programs. 80% reported that it would be difficult to come up with the cost of coverage, 41% had trouble paying other bills, and almost a third were not aware of the individual mandate. As for that mandate – the Dept. of Revenue reports that 86,000 tax filers paid the penalty ($219 for an individual) for remaining uninsured. Next year that penalty goes up to as much as $912.
Ellen Andrews

Monday, June 2, 2008

New from the Consumer Health Action Network

New materials for consumers from the Consumer Health Action Network:
CT Hospital Free Care and Financial Discount Programs – a compilation of financial assistance policies from CT hospitals
Two new tip sheets – Preparing for a Doctor’s Visit, Help Working with Your Doctor
Latest newsletter – Help to Lower Your Drug Costs

For more help, search our list of over two dozen tip sheets and our newsletter archives

For help accessing health care in CT, call our helpline toll-free 1-888-873-4585 or email