Friday, February 27, 2009

Health care forum at the LOB

Yesterday’s health care forum started with a strong presentation of the SustiNet proposal by Juan Figueroa of the Universal Health Care Foundation of CT and Stan Dorn of the Urban Institute. Juan described the inclusive process to develop the plan engaging diverse voices including business, providers, clergy, advocates, and consumers. Stan described the major tenets of the plan – creation of a large, new, self-funded coverage plan, improved care coordination, management of chronic disease, transparency, health information technology, and public health measures to reduce disease such as tobacco control and obesity prevention. Questions from legislators included costs, the structure of the program and the inclusive process to develop the plan. Many legislators thanked the speakers for developing a thoughtful, CT-based plan.

Next Scott Cleary of eHealthConnecticut and Greg Farnum from VT’s information technology plan presented on health information technology. Greg outlined VT’s successful health information exchange and how it is funded. Scott described two eHealthCT projects , with funding, starting soon including one to collect and analyze quality information and another for a health information exchange and e-prescribing for HUSKY, Medicaid and SAGA patients. Questions included how to fund information technology and the merits of an information exchange structure vs. creating a database with patient records held in a central service.

Next Bob Carey, formerly at the Commonwealth Insurance Connector, described MA’s health care reforms. He is a strong proponent of MA’s individual mandate. The individual mandate is the largest tax penalty in MA’s state system – reaching almost $1000 this April and more next year. He acknowledged that while public support for the plan is high now, the full impact of the mandate penalties has not hit people yet. He also noted that standards of what counts as coverage for purposes of the mandate have risen and that next year some people who have been purchasing insurance and paying premiums all year will be penalized as if they had been uninsured. He did acknowledge that, despite an individual mandate, MA will never achieve universal coverage (absent a single payer system). While MA’s rate of uninsurance has been cut in half by the reforms, the majority of newly insured joined expanded public programs such as Medicaid and SCHIP. The Connector only covers 20,000 people.

Legislative questions challenged the speaker on the wisdom of an individual mandate and trusting the private insurance market to offer decent options. The speaker stated that the mandate only falls on certain groups – he noted that a 50 year old making $90,000/year with children is unlikely to be subject to the mandate, but he is also unlikely to be uninsured. The mandate only applies to the uninsured – mainly young, low income consumers without an employer offer of coverage. The speaker was unfamiliar with autoenrollment, consumer education, certifications of responsibility/liability, and other policy alternatives to an individual mandate which are included in SustiNet. Other questions focused on health care workforce capacity, difficulty getting appointments for care, and emergency room utilization which did not decrease after the reforms. The speaker believed that the problem of capacity is partly one of perception – previously uninsured consumers assumed that now that they have coverage that they would be able to get appointments quickly. However he also stated that previously uninsured consumers used to going to the ER for care are not likely to change their behavior and try to make appointments for care.

Unfortunately, despite requests, no balancing viewpoints were offered outlining the weaknesses of a mandate from states that considered an individual mandate and decided against it. There was no description of CT’s context of weak insurance market regulation, high costs, or lack of federal funding to match MA’s generous subsidies for lower income consumers and expansions of public programs.

Other speakers included a panel on strengthening CT’s public health care systems, cost and quality issues, and a report from the Health 1st Authority on their report.
Ellen Andrews

Thursday, February 26, 2009

Deficit mitigation plan passes; Eliminates Medicaid payments for never events

Early this morning the General Assembly passed HB 6602, a bill to fill the billion dollar budget gap in the current state budget year that ends June 30th. Among other provisions, the bill eliminates Medicaid payments to hospitals for “never events”. Never events are preventable errors that result in serious harm to patients. Examples include wrong site surgery, surgery on the wrong patient and mismatched blood transfusions. This provision is estimated to save the state $425,000 this year and $1.7 million annually. Medicare stopped paying for never events in October. Nationally, never events may account for 2.4 million extra hospital days, $9.3 billion in extra health care spending and 32,600 preventable deaths.
Ellen Andrews

Wednesday, February 25, 2009

Health First Authority finalizes their report to the legislature

At their last meeting, by an eight to two vote, the Health First Authority approved their final report to the legislature. However it may not be their last meeting and it may not be the final report. The report was described as defining a broad strategy rather than detailed plans. As cost estimates for the Authority’s recommendations were not ready, they will reconvene when those numbers are ready and may add a supplement to the report. The Lt. Governor was concerned that approving the report without those numbers could “raise false hope that we could afford all those recommendations.” Members can also add supplemental comments that will also be attached to the report. The insurance industry representative argued for an individual mandate to be included in the report. Several members raised concerns about recommendations for “pooling” in the bill; that in CT’s health policy context those references will be read as an endorsement of proposals for opening the state employee pool. The Chairs emphasized that pooling refers to the broad strategy and not any specific bill. Pooling has been widely endorsed and has precedents in CT including the Charter Oak Plan and CBIA’s small business pool. One observer commended the group for moving from an insurance/coverage focus to a focus on health. The two no votes were from the Lt. Governor and Brian Grissler of Stamford Hospital.
Ellen Andrews

Tuesday, February 24, 2009

COBRA calls to the consumer helpline

I have been getting more phone calls from people who are losing their jobs and are looking for health insurance. We discuss COBRA as an option but it is usually too expensive for them. For one consumer and his two children, it would cost $1000 per month for the COBRA premiums (under the recently passed stimulus bill, the cost to the family would be about $350 per month). Another family would have to pay $1500 per month for COBRA (approximately $525 a month under the stimulus package). Most of them will be living off of only their unemployment benefits and those aren’t high enough to pay for COBRA as well as other necessities, even with the reimbursement from the federal government. Most of these calls have been from people with children, who I can refer to the HUSKY Medical program. I’m glad that they at least have that option. But what about people without children? If they are single individuals, they have fewer options for health insurance and I grudgingly refer them to the Charter Oak Health plan. I say grudgingly because I don’t like to refer people to services when I don’t know that they will definitely get their needs met. But they don’t have many other alternatives.
I received a call from someone who wanted me to help him apply for assistance with COBRA premiums. I explained that these would occur through the federal stimulus package and it hadn’t passed Congress yet. Now that it has passed, I will be able to contact people from the list on my desk who called about COBRA to explain how to get part of their COBRA premium paid for. I’m sure they will be very happy and relieved. I appreciate that the federal government included this provision for COBRA in the stimulus package but it only lasts nine months and reimburses for 65 percent of the premium. That may not be long enough for some people. Even with a 65 percent reimbursement, COBRA may still be unaffordable for others.
These calls from people who are losing not only their jobs but their health insurance at the same time are highlighting a serious issue with our system of health insurance in the U.S.: health insurance is often based on employment and in tough economic times when you lose your job and your insurance at the same time it is doubly difficult to deal with. It’s also not easy to find a new job when so many are being laid off, which means that people are forced to struggle with finding insurance on their own. This is often expensive or sometimes not even available.
Jen Ramirez

Monday, February 23, 2009

Frustrated testimony at the LOB

I testified recently at an Appropriations Committee hearing for the Department of Social Services budget and found myself thinking about how inaccessible and intimidating the whole process is for “regular” people (those who aren’t advocates or testifying on behalf of their agencies). I had to be at the Legislative Office Building (LOB) by 9 am to stand in line for a lottery number that would decide when I would testify. I got there a little early to get a good place in line and by the time they starting handing out numbers, there had to be over 60 people in line. I can imagine that some people would have had to wait an hour or longer for their lottery numbers. Around 200 people signed up to testify (so many that they decided to divide everyone into two hearing rooms to go faster). I know that there are some organizations that recruit consumers to testify and people from the organizations will stand in line for the consumers to sign them up. But what about people who have an important story to tell who aren’t connected to an organization? They would have to know where to look on the General Assembly website to even know that a hearing is taking place (or go to the LOB in person to pick up a Bulletin - of course they’d also have to know that that is where the hearings are listed). And what working person can be an hour or more late for work so they can stand in line to sign up to testify?
I can also imagine that the hearing process would be intimidating for a consumer who had never done it before or who was doing it on their own, without guidance from an organization or someone that has some experience in the process. Even the way some hearing rooms are set up – with the committee members sitting at the front of the room, in seats that are higher up than the rest of us – is intimidating.
I went back to the LOB for the start of the hearing at 4 pm. The previous hearing was running late so ours didn’t start until 4:30. How could a working person spend so much time just for the three minute time period they are allowed to tell their story? I waited until 8:45 pm to testify. Approximately 97 people testified in that hearing room. It was a large commitment of time for what is most likely a small impact. The legislators that were still there had been in meetings all day – were they really able to listen to and absorb what each person was saying?
Jen Ramirez

Friday, February 20, 2009

US Supreme Court rejects federal pre-emption of state law in VT drug case

In a 6 to 3 vote, the Supreme Court Wednesday held that federal law does not pre-empt the right of patients to sue in state court over a federally regulated medication. The case involved a VT musician who lost her arm after Phenergan, an anti-nausea drug, was administered by “IV push” rather than “IV drip”. Both Wyeth, maker of Phenergan, and the FDA were aware of the dangers of administering the drug through IV push, but the FDA did not prohibit the practice and Wyeth never sought prohibition on the label. A VT jury awarded Ms. Levine $6 million. Wyeth argued that because the drug is regulated and was approved by the FDA, that Levine had no right to sue in state court. The Supreme Court disagreed in this case closely watched by the pharmaceutical industry. For more background on the case click here and here.
Ellen Andrews

CT insurers push plan for universal health care; Rests on individual mandate

According to today’s Hartford Courant, CT’s insurance industry is promoting a plan to cover everyone in the state. The industry is proposing to create a pool for individuals who can’t get or can’t afford insurance in the market now. They expect state subsidies to make the coverage affordable – there is no mention of the industry or employers providing subsidies. They resist the idea of including other groups in the pool such as state employees, municipalities, HUSKY, small employers, or nonprofits which have been proposed by others in various versions. Not surprisingly, the insurers’ price for creating this pool would be that everyone in the state would be legally required to buy their product – an individual mandate. However, despite a legal mandate that all drivers have auto insurance, 12% of drivers in CT are uninsured. The proposal blames the victims of uninsurance for the problem and places the costs of health care reform on those least able to pay. The CT Health Policy Project has outlined many significant challenges to implementing an individual mandate in our state in a brief and policy paper.
Ellen Andrews

Governor releases deficit mitigation proposed cuts for this year

Yesterday Governor Rell released a proposal to mitigate the state budget deficit for the current fiscal year that ends June 30th estimated at $1.1 billion and growing. She wants the legislature to act on it next Wednesday. While her proposals look very familiar, this is not the same as the cuts she proposed earlier this month for the two-year budget that starts July 1st. For this year, she has proposed that the legislature agree to cut most dental services to adults – people can only get care when their teeth get bad enough to be an emergency – and she wants to require prior authorization for the services left for children. She also wants to cut services to legal immigrants – again the only time they can get care is when a health problem has gotten bad enough to be an emergency. (FYI – The federal SCHIP bill that passed earlier this month allows the state 65% reimbursement to cover legal immigrants, so we’d only save 35 cents for every dollar cut). She wants to increase HUSKY Part B premiums for kids. She wants to weaken the definition of medical necessity – the guidance used to decide if patients get treatment. She has proposed a host of pharmacy cuts that echo her budget proposal for next year – prior authorization expansions, making it more difficult to get refills, reimbursement cuts, no over-the-counter drugs, among others. She also wants to cut funding that the legislature added for community health centers who always pick up the slack when the state cuts other health care funding.
Ellen Andrews

Thursday, February 19, 2009

Sheri Aquilino speaks out

The following email arrived at our office yesterday from one of our Board members at the CT Health Policy Project. Sheri Aquilino and her two children used to be on HUSKY; she now has coverage for her family through her job. She feels strongly that people need to understand what the Governor’s proposals for HUSKY premiums and copays would mean to working families like hers.

Hi Ellen:
This article [Critics: Health Care Changes Would Burden State’s Poor, Arielle Levin Becker, Harford Courant 2/17/09; describing Governor’s proposed HUSKY cuts and impact on CT families] really upset me. And I can only speak on behalf of the single Moms (as I was once where Maria was), but do the legislature and Governor realize that they are making these Moms choose between putting food on their table/heating their homes/keeping the electricity on or going to the doctor because they or their children are sick? And, like the woman in the article, most single Moms who are working are struggling everyday to keep their heads above water. There are no extras in their households; just the basics. Hey, my kids had no idea what cable TV was when they were young, and most of their clothes were hand-me-downs from friends and family, from a consignment store or Goodwill.
And, still being a single Mom who now has health insurance through her employer (and I make a little over $36,000 per year), I had a difficult time paying my own co-pays and the kids co-pays this summer. I was seeing a specialist late summer/early fall and it was $45 every time I walked in the door (once a week for 3 months); $45 co-pay for MRIs; etc. And that didn't include my son's $25 - $45 co-pays every two weeks; and my daughter too. Plus, the co-pays for medications anywhere from $25 to $75 a prescription. I had to cut back on groceries, hair cuts, clothes, NO EXTRAS AT ALL. I had to make hard choices and basically the mortgage came first, food second, etc., etc.
One final note before I shut up, but most single Moms live week-to-week and are two paychecks away from being homeless!!!!
Sheri Aquilino

Wednesday, February 18, 2009

Young invincibles myths and coverage on parents’ policies

Today’s NY Times has a great article outlining the struggle of uninsured young adults to get health coverage. They describe the difficulty of living in an expensive city working at low wage jobs that don’t offer benefits. Coping strategies include sharing medications, jury rigging insulin injections, self-diagnosing using on-line sources, and giving up fast food to stay healthy. In October, Alanna Boyd, a 28 year old receptionist, was hospitalized 46 hours for a digestive illness; her bill is $17,398. She commented, “I could have gone to a major university for a year. Instead I went to the hospital for two days.” New York’s Governor has proposed allowing children to stay on their parents’ health benefits to age 29.
As of Jan. 1st of this year, unmarried children living in CT can now stay on their parents’ employer-sponsored health policies until age 26; they don’t have to be in school or living at home. Parents will have to pay taxes on the value of benefits for non-dependent children, but it can be a significant bargain compared to individual coverage. For more info, go to our Consumer Health Action Network tip sheet on the subject. For a list of all our tip sheets, in English and Spanish, click here.
Ellen Andrews

Tuesday, February 17, 2009

The federal stimulus and SCHIP: How much help is there for CT’s health?

A new analysis by the CT Health Policy Project details significant relief for CT’s consumers and our state budget in new federal legislation. CT can expect $1.3 billion in higher Medicaid reimbursements raising our matching rate from 50% to 56.2% until the end of next year, but the money comes with strings. To qualify the state cannot reduce Medicaid eligibility or change procedures or methodology; the Governor’s proposal to eliminate self-declaration of income could violate that requirement. As our unemployment rate hit 7.1% and is expected to rise higher, the provision subsidizing 65% of COBRA costs for recently laid off workers and their families will be critical to keeping people from losing coverage. Significant incentives through Medicaid and Medicare will help providers and hospitals adopt electronic health records, improving cost, quality and efficiency. There is also increased DSH funding for hospitals who serve low income patients who cannot pay their bills.

Reauthorization of SCHIP increases CT’s allotment available to cover HUSKY Part B children, however CT has never come close to using our entire share. In fact, the Governor has proposed to increase premiums for HUSKY Part B children which would make the program unaffordable for more children. One ray of hope in the SCHIP bill grants federal matching funds for legal immigrants; until now states did not get reimbursed for recent immigrants and CT has had to pay for their HUSKY coverage with all state funds. The Governor has also proposed eliminating coverage for legal immigrants, but now the price tag for the General Assembly to save that provision has been cut in half.
For more detail, go to The Federal Stimulus Package and passage of the SCHIP bill: How much health care help can CT expect?
Ellen Andrews

Friday, February 13, 2009

Behavioral Health Partnership Update

DSS delivered some very good news at Wednesday’s meeting of the Behavioral Health Partnership Oversight Council. The Behavioral Health Partnership (BHP) provides mental health and substance abuse services to HUSKY, SAGA and DCF clients; DSS hired Value Options to administer the program but retains a great deal of oversight. The BHP was created when behavioral health services were carved out of the HUSKY HMOs and by most accounts, things have improved significantly. (Note the very good news from last week’s Medicaid Managed Care Council meeting in improved access to dental care and a two fold increase in participating providers when those services were carved out). Discharge delays, behavioral health hospital patients who are ready to leave but can’t because appropriate community treatment is not available, are down significantly. The percent of discharges in delay dropped from 18.6% in the third quarter of 2007 to 10% last quarter; the number of cases in delay status dropped from 125 to 74. Credit went to a significant expansion of community treatment options and more focused treatment plans. (The success of carve outs strongly suggests that DSS should stop dragging their feet, stop over-accommodating the HMOs, and honestly implement PCCM).
Unfortunately that was the end of the good news. Rep. Walker asked DSS to explain the large number of children arrested at residential treatment centers. DSS and BHP will get back to the Council. Concerns were raised about the HUSKY transition to mandatory HMOs. Consumers are getting mixed messages and contradictory information. Many are concerned about the lack of providers in the new plans and the large rate increases given to the HMOs.
Then the news got worse – DSS described the Governor’s proposed budget cuts. Providers are troubled that they would not receive any rate increases under the Governor’s proposal and that payment for this year’s rate increases has been delayed making it a target for cutting to cover this year’s deficit. Many Council members were disturbed about proposals to charge clients copays for services – that patients will not get needed services, causing more expensive problems later, because they can’t afford the cost. Unfortunately, if that happens we wouldn’t know, because the Governor has also proposed eliminating funding to evaluate the BHP. Discussion also centered on the Governor’s proposal to weaken the definition of medical necessity that serves to protect consumers and guide appropriate service provision in the program. The Governor estimates $4.5 million in savings next year and $9 million the year after that – presumably in services no longer provided. The Council asked for specific examples of services being provided now that wouldn’t be under the new definition and why DSS believes these services are inappropriate or unnecesary.
Ellen Andrews

Thursday, February 12, 2009

St. Raph’s defaults on $88 m in debt; imbalance in state funding blamed

New Haven’s Hospital of St. Raphael is facing a $35.5m budget hole and cannot make payments on $88 million of debt, according to the New Haven Independent. The hospital is working with insurers who cover the debt on an emergency spending plan that includes closing an ambulatory center that now loses money (awaiting state approval to close), getting better deals from suppliers, closing their visiting nurse operations, billing system improvements, and reducing staff levels through attrition and not filling vacant positions. No layoffs are planned at present. The hospital is also considering the future of mental health services which lose $6.7 million through Medicaid every year.
One large part of the budget hole is that St. Raph’s is paid $1,812 less per Medicaid patient by the state than Yale-New Haven Hospital, only blocks away serving the same population. New Haven area legislators Sen. Toni Harp, Rep. Toni Walker and Rep. Pat Dillon are working on legislation to equalize Medicaid payment rates. HB-5419 would require the state to pay the same rates to hospitals in the same community. For historic reasons, Catholic hospitals are often paid less because rates were set when volunteer nuns and clergy provided care. DSS testified against the bill due to budget constraints.
Ellen Andrews

Wednesday, February 11, 2009

More companies conducting dependent coverage eligibility audits

Until recently most companies have just taken an employee’s word that the people they list for coverage under their family benefits are eligible. However, as health costs rise and margins drop more employers are checking, according to the Wall Street Journal. Almost three in four large US companies intend to conduct “dependent eligibility audits” this year, looking for divorced ex-spouses, older children who are not full time students, boyfriends and girlfriends listed on workers’ benefits. One large retail company’s audit revealed that 12.6% of dependents were not eligible and their coverage was dropped, saving the company $25 million in the first year beyond the cost of the audit.
Ellen Andrews

Tuesday, February 10, 2009

CT insurers push plan for universal health care; Rests on individual mandate

According to today’s Hartford Courant, CT’s insurance industry is promoting a plan to cover everyone in the state. The industry is proposing to create a pool for individuals who can’t get or can’t afford insurance in the market now. They expect state subsidies to make the coverage affordable – there is no mention of the industry or employers providing subsidies. They resist the idea of including other groups in the pool such as state employees, municipalities, HUSKY, small employers, or nonprofits which have been proposed by others in various versions. Not surprisingly, the insurers’ price for creating this pool would be that everyone in the state would be legally required to buy their product – an individual mandate. However, despite a legal mandate that all drivers have auto insurance, 12% of drivers in CT are uninsured. The proposal blames the victims of uninsurance for the problem and places the costs of health care reform on those least able to pay. The CT Health Policy Project has outlined many significant challenges to implementing an individual mandate in our state in a brief and policy paper.
Ellen Andrews

Charter Oak calls to the Consumer Helpline

I have been receiving a lot of calls on our Consumer Helpline (1-888-873-4585) from people having trouble signing up for the Charter Oak Health Care plan. Many of them are having difficulty in even getting answers to their questions from the toll free number that is the only one available for them to use. The number will keep them on hold for 10 or 15 minutes, only to transfer them to an automated voicemail where they are instructed to leave a message, which may or may not be returned.

Other callers know about the Charter Oak Health Plan but think of it a last resort for health insurance, because they are aware of the extremely limited number of doctors who participate. Another consumer, who considered Charter Oak, said that the premiums were too expensive and she didn’t think she could afford the co-payments and the $900 deductible for hospital care. It was her opinion that doctors should accept a certain number of Charter Oak patients – as a form of charity care. One consumer had actually been waiting for months to find out if she was eligible for Charter Oak. She was told she was eligible and that she would receive an enrollment kit, an insurance card and a provider directory. She didn’t receive any of them and so she didn’t really know if she was enrolled in the program. She wasn’t able to get necessary health care. She called the toll free Charter Oak number (1-877-77CTOAK) several times and left messages and her calls weren’t returned. She asked to speak to a supervisor and no one would allow her to speak to one.
A second consumer, a cancer survivor, has been trying for months to sign up for Charter Oak because her COBRA is about to run out. Thankfully, she may be eligible for HUSKY medical so she won’t have to keep trying to straighten out her Charter Oak application.
Unfortunately, the only phone number I’ve been able to use or give to people is the one they’re already trying and not having success with. I have been giving these consumers the phone number for the Office of the Health Care Advocate (1-866-HMO-4446). Someone from that office informed me that Infoline (211) also has access to the applications and people can call there to find out the status of their applications.
Jen Ramirez

Monday, February 9, 2009

Medicaid Managed Care Council/PCCM update

At Friday’s Council meeting DSS announced that not only did they default HUSKY families in Anthem and traditional Medicaid to only the two new HMOs – Aetna and AmeriChoice -- but that they will continue defaulting into only AmeriChoice all through February. Reportedly 63,000 HUSKY members were defaulted on February 1st.The reason given is to prop up the new HMOs’ bottom lines. The disconnect was pointed out between DSS’ policy of deep concern for the HMOs and their finances compared to PCCM policies arbitrarily limiting the number of providers and families with access to this new option. Several Council members mentioned that they have heard great enthusiasm about PCCM from providers. There are only 104 members in PCCM to date due to DSS’ decisions to limit enrollment, which benefits the HMOs. Council members urged DSS to conduct outreach to consumers about PCCM, similar to what the HMOs are funded to do. PCCM providers have as yet received no reporting or other guidelines in the program; providers have also been told that they are “double-dipping” (a prohibited practice) if they have other care managers on their staff care for PCCM members. DSS promised to address these concerns.

A DSS survey of HUSKY providers found that 53% participate in all three health plans. This calls into question the ratios of providers to members used to determine adequate access under the HMO contracts – as over half of providers are triple counted.

In very good news, Donna Balaski, heading DSS’ dental carve out, reported that there are now 469 dentists participating in HUSKY, including 206 newly enrolled dentists. Prior to the carve out, there were only 174 participating in the health plans. This is a 270% improvement in a very difficult environment. Access to dental care in HUSKY has historically been even worse than other health care and dentists’ resistance to HUSKY and the health plans was very strong. Donna deserves a great deal of credit – she has been tirelessly travelling the state, talking to everyone she can find, and working WITH advocates – not standard operating procedure at DSS.
Ellen Andrews

Saturday, February 7, 2009

Ten Ways to Save Money and Improve Health Care Quality

For Ten Ways to Save Money that Improve Quality in CT’s Health Care – so we don’t have to cut important resources for working CT families -- visit our OP-ED on CT News Junkie. For sources and more details, click here.

Wednesday, February 4, 2009

Governor releases her budget proposal

As promised, the Governor’s state budget proposal for the next two years released today includes painful cuts. Overall, Medicaid would be cut $283 million (6.8%) in the first year and $317 million (7.2%) in the second year. SAGA would be cut $13 m (5%) and $14 m (6.5%) in the two years. Among the proposals are charging copays to Medicaid clients, premiums for HUSKY adults, increasing HUSKY Part B premiums for children, eliminating most dental care for adults, no coverage for legal immigrants living in the US less than five years, eliminating prenatal care for undocumented immigrants, eliminating interpretation services, eliminating vision and transportation services in SAGA, Medicare Part D cuts, pharmacy cuts, cuts to community health centers, school based health centers, local health departments, AIDS programs, nursing loan forgiveness programs, and new barriers to accessing care and applying for HUSKY. She also proposed eliminating the Office of Health Care Advocate (OHA). OHA has returned $5 to consumers in health care services for every dollar spent on the office. OHA is also funded not by the General Fund, but through an assessment on insurers in a fund with a surplus. Cutting the office will do nothing to address the state’s budget crisis. Cutting the office would only return OHA’s $1 million budget back to insurance companies as well as saving them $5 million/year in unpaid consumer bills. For more detail on the health impact of the Governor's proposal, click here.
Ellen Andrews

Primary Care Authority meeting

At today’s meeting, the Primary Care Authority accepted UConn’s report *check link * assessing CT’s primary care workforce capacity. The upshot of the report is that by a simple calculation of licensed providers per population we are OK. But that is only part of the story – that is probably an overestimate. The list of gaps in data is long – which providers are no longer practicing, which are sub-specialists and not practicing primary care, how many are part-time, etc. It appears that rural areas have fewer providers, but as DPH allows either home or work addresses on licenses, this is hard to pin down as well. Most primary care providers (PCPs) are doctors (75%), the rest are nurse practitioners (20%), physician assistants (3%) and nurse midwives (2%). The authors developed a measure that merges rates of uninsured residents with PCP capacity and found that Windham county faces the largest stresses to its primary care structure, New Haven the least, although CT’s are similar to MA’s. Not surprisingly, the authors expect a shortage of PCPs in CT soon due to the population’s growth and aging, increasing rates of chronic illness and the dwindling number of med school graduates going into primary care.
Ellen Andrews

Tuesday, February 3, 2009

Health Policy Basics

We are fortunate at the CT Health Policy Project to have over a dozen work study students, interns, and volunteers working with us at any given time. All staff receive training on taking consumer calls and working cases, details of public and private health care assistance programs, research, advocacy and the basics of health policy. In response to requests, our health policy basics training paper is now available on our website. For more about how to get involved, email us at

Monday, February 2, 2009

New blog by Kevin Lembo, state Health Care Advocate

Check out Kevin Lembo’s new blog at Kevin is CT’s State Health Care Advocate in his day job. Fascinating take on federal and state health care updates. He points out that this is his personal blog, not an official State of CT site. Thankfully so -- makes it much more interesting.
Ellen Andrews

February health policy web quiz

Test your knowledge of an individual insurance mandate – what it would mean for CT, the challenges, and costs. Take the CT Health Policy Project February health policy web quiz.
For more on the individual mandate, go to our policy paper or issue brief.

Sunday, February 1, 2009

CT’s state and national legislators express concerns about forcing HUSKY families into inadequate HMOs effective today

Friday morning state legislators gathered for a press conference outlining their concerns that DSS plans to force 60,000 HUSKY consumers today into new HMOs that are not ready for them. DSS chose to default today any HUSKY families who are still in Anthem’s network or in traditional Medicaid into only two of the three HMOs that will continue in the program – Aetna and AmeriChoice. DSS has decided to only default members into the two new HMOs and not into the other HUSKY HMO, CHN, because the new HMOs need the money, disregarding the needs of families. Aetna and AmeriChoice’s networks of providers are far less robust than CHN’s which is built on CT’s network of community health centers. As Rep. Nardello stated, “A HUSKY card without anyone to go to is a false promise.” Legislators and advocates are concerned that HUSKY members without access to providers will be forced into the ER for needed health care, raising program costs even higher.
In a letter, CT’s Congressional delegation echoed state legislators’ fears and expressed concern that CMS’ oversight of DSS and the HUSKY program has been inadequate. The letter also points out that the financial impact of this shift is unknown, but may cost far more than retaining the current system.
In an environment of shrinking state and federal revenues, closing off options and forcing clients into inadequate health plans that received an unprecedented 24% rate increase this year is imprudent for taxpayers and dangerous for HUSKY families.
Ellen Andrews