Health insurance employment in perspective

Yesterday’s Hartford Courant reports that just over 19,000 CT residents are employed at CT’s large health insurers – Aetna, United, CIGNA, HealthNet, Anthem and ConnectiCare. While impressive, those numbers pale in comparison to the number of CT residents employed in providing health services, according to the CT Dept. of Labor’s July report – 198,800. That number is conservative as it does not include health services workers employed by government. Health insurance constitutes 1% of CT’s workers while health care services makes up 12%.
Ellen Andrews

CT family premiums fifth highest in nation

This won’t surprise anyone who buys their own coverage (or buys it for their employees), that a new report by the Commonwealth Fund finds that CT’s family premiums were the fifth highest in the US last year. Rates increased by one third from 2003 to 2008, as did the US average family premium -- so at least we aren’t rising any faster than the rest of the country(I guess that qualifies as good news). Single coverage fared slightly better rising 29%. But to put those costs in context, we have very high incomes here in CT as well – so I guess their point is we can afford to pay more? We are fifth lowest in the nation for premiums as a percent of median household income. Still, spending 14.3% of income on health care is no bargain. The report outlines how much CT consumers could save by modest reductions to the increase in health insurance costs.
Read the report and you’ll be able to ace the September CT Health Policy Web Quiz.
Ellen Andrews

Undecipherable health insurance documents

I was very happy when I finally received the document from my health insurance company explaining my medical coverage. Now I could finally see exactly what medical benefits are covered. Or maybe not. I decided to review it so I would know what is covered and what isn’t. I didn’t get very far. The document is extremely unreadable and hard to understand. I gave up and decided that I will read relevant sections carefully when and if I need them. Why can’t these documents be written in plain English so that average people can read and understand them? What about people who read at low grade levels? These documents seem like they are written by lawyers with the express purpose of confusing the rest of us.

Here is an example from the plan document’s “Exclusions and Limitations” section. This is exclusion number 2 out of 75: “Benefits may be reduced; or denied if subject to the Managed Benefits Managed Care Guidelines. Any reduced or denied benefits paid by the Member do not count toward any applicable Cost Share Maximums shown in the Schedule of Benefits.” I think I figured out what it means but I had to read it several times.

A recent New York Times op-ed piece discusses this issue and gives the example of a man whose chemotherapy was denied by his insurance company. He couldn’t understand his insurance policy and why he was denied. When the Rhode Island Health Insurance Commissioner’s Office called the insurance company on his behalf, they were told that the claim was denied because they were still trying to figure out if the medical services were covered. They didn’t understand the policy either.

Starting next year, Rhode Island will require that all insurance policies are written at an eighth-grade level. The US House of Representative’s health reform bill has a proposal that some parts of insurance policies should be written in “plain language.” There is other proposed legislation at the federal level that would require “uniform and simplified coverage information.” Insurance policies must be understandable to be useful.
Jen Ramirez

Does expanding health insurance improve health?

An article in today’s Wall Street Journal addresses a question that doesn’t get the attention it deserves. Health reform debates too often miss the real point – we want to improve the health of people. A plastic health insurance card does not guarantee access to care, much less improved health – ask anyone on Medicaid/HUSKY/Charter Oak. WSJ asks the question of John Auerbach, Commissioner of Public Health in Mass the question. He points to three indicators that health is improving – all process measures – to argue that MA’s health reforms are improving more than the uninsured rate. First, the rate of adults smoking is down 8%, the biggest drop in ten years. The drop is primarily due to the expansion of Medicaid, which covers smoking cessation patches and counseling. (Note: CT’s Medicaid program is one of the few in the US that doesn’t cover smoking cessation treatments.) Second, there was an increase in the number of people getting age-appropriate colonoscopies. And third, more people in MA are getting flu shots.
Ellen Andrews

Test your knowledge of national health care reform

Take CNN’s quiz on national health care reform. Only eight questions. I’m not telling how I did.
Ellen Andrews

Hospital community benefits reports out

The Office of Health Care Advocate has released their community benefits report on what hospitals are providing to residents of their communities to improve health, not just the health of their patients. Under state statute, uncompensated care does not qualify as a community benefit. The data is self-reported and there are very likely differences in definitions, but some interesting comparisons can be made. For example, Lawrence & Memorial is reporting spending over $31 million in 2007 on community benefits, 127 times the $250,000 reported by Hartford Hospital. At that rate, L&M is spending 12% of their revenue on community benefits. Hospital reports of the number of people served by programs varied from zero to 337,379. It is interesting however to scroll through the services listed in the data Appendix to see which hospitals report programs in specific areas such as mental health, substance abuse, hypertension screening, or physical exams for adults. Five hospitals report that they are not working with their local health departments to reduce the transmission of infectious disease in the community. Only Yale-New Haven and Bridgeport report participating in needle exchange programs. Fascinating stuff.
Ellen Andrews

New London getting a health needs assessment

Over the next three years, the Ledge Light Health District will be assessing conditions in the New London area that contribute to better health for residents. The study, funded by the CDC, will consider assets that contribute to healthy lifestyles, reducing smoking, and managing chronic problems such as diabetes and heart disease. The goal is to make recommendations to enhance physical activity, good nutrition and smoking cessation. The 2007 New London County Health Needs Assessment found that 19% of New London residents under age 65 were uninsured and 11% of city residents missed a needed medical visit due to cost.
Ellen Andrews

Charter Oak celebrates first anniversary

Friday, Governor Rell announced that her Charter Oak Health Plan has enrolled 10,257 previously uninsured CT residents as of the program’s first anniversary. The program is an affordable option for many people and is providing care to thousands. An important advantage of Charter Oak is that no one is denied coverage due to pre-existing conditions, a common reason for denial of private insurance coverage. The program is available to residents at any income level, with subsidies for lower-income residents. Unfortunately 24,452 people have applied for coverage through Charter Oak and were denied; reportedly most were denied because they had not been uninsured for six months. Advocates have been concerned that the state’s six month exclusion policy would leave too many people uninsured too long, risking both their health and finances. While the numbers are improving, providers have been reluctant to sign up with Charter Oak, making access to care difficult in the program. Only half of CT’s acute care hospitals have signed up and only four are participating in all three HMOs. Legislators reportedly have asked for information about what care is being delivered to Charter Oak members.
Ellen Andrews

Prescription assistance bus in CT

The “Help is Here” bus travelling across the country offering help applying for drug company assistance programs is in CT this week. Drug company assistance applications can be confusing; each company has different eligibility standards and discounts vary widely. The assistance program you apply to depends on which drugs you are taking. Questions you will need to answer at the bus include age, address, income, number of people living in your household, brand name of your prescriptions, and details about any coverage you have. The bus’ services are offered free of charge. This morning, Tuesday, from 10am to noon the bus will be on South Main Street in West Hartford, and this afternoon at Charter Oak Health Center in Hartford from 2-4pm. Wednesday the bus will be on Main Street in Manchester from 10am to noon and at the State Capitol (in a press conference with Sen. Prague) from 2-4pm. On Thursday the bus will be at Hammonasset State Park in Madison from 10am to noon and in Norwich from 2-4pm. For more info on the bus, call (202) 835-3460. If you can’t make it to the bus, you can also apply online or call 1-888-477-2669. The bus is sponsored by the Partnership for Prescription Assistance, a collaboration of drug companies.
Ellen Andrews

CT health insurance premiums grew 7 times faster than our incomes since 2000

From 2000 to this year, family premiums rose 7.4 times faster than median earnings in Connecticut according to a new report by Families USA. Premiums are up 96% while earnings inched up only 13%. Also stunning is that while employers’ average share of that premium rose 91%, workers share jumped 114%. The cost shift to consumers continues.
Ellen Andrews

Extreme out-of-network charges for CT health care services

A new survey of out-of-network physician claims finds some extremely high examples of over charging in CT. The highest example includes a bill for $26,881 for a lower back spinal fusion; the Medicare rate for that service is $1,572.95 or 17 times less. The report includes ten examples of out-of-network charges ranging from 1,709% to 648% of Medicare fees. The survey, sponsored by America’s Health Insurance Plans – an industry lobbying organization, asked for outliers; these are not average out-of-network fees. AHIP argues that, as the nation considers health care reforms, the role of provider fees in rising costs must be considered.
All the examples in the survey were for consumers with insurance. According to Vicki Veltri of the Office of Health Care Advocate, CT consumers accessing care out-of-network may be responsible for the difference between the charges and what insurers will pay. For example, if a provider is charging $200 for a service that the insurer believes should only be $100 (the “usual and customary” charge) and the consumer’s policy includes a 30% coinsurance on out-of-network services, the insurer will pay only $70 and the consumer may be responsible for the remaining $130. Of course, there are no rules for uninsured patients. Any consumers facing these costs are urged to call the Office of Health Care Advocate who has been able to reduce or eliminate those bills in some cases. The Office can be reached toll-free in CT at 1-866-HMO-4446. For a tip sheet on negotiating with your provider from the Consumer Health Action Network, click here.
Ellen Andrews

Value-based purchasing and VT health care reform updates

Our second day of health panels at last week’s CSG/ERC annual meeting in Burlington VT started with a set of talks on value-based purchasing and how states can take advantage of this critical health reform trend. Value-based purchasing reorients financial incentives to align all stakeholders and reward improvements in health. The current fee-for-service system rewards volume over value; costs skyrocket but quality doesn’t follow. If we pay separately for each test and procedure, regardless of value, it should not be surprising that we get more tests and procedures. Panelists included Doug Emery of Bridges to Excellence, Frank Johnson from Maine’s state employee health plan and Susan McDonald from the Minnesota Governor’s Health Cabinet.

The second panel included speakers from Vermont updating policymakers about their ambitious reforms passed in 2006 and concerns about maintaining their progress under federal health reform plans. VT’s reforms include over 60 different programs including covering the uninsured, medical homes, chronic disease management and a nationally acclaimed health information exchange. VT’s uninsured rate has dropped by almost a quarter since the reforms were implemented. Speakers included Jim Hester, Director of the legislative Health Care Reform Commission, Susan Besio, Director of Medicaid, Hunt Blair, Deputy Director of VT Health Care Reform, Cy Jordan, Medical Director of the VT Program for Quality Health Care, and Sen. Jane Kitchel.
Ellen Andrews

Farm to School panel at CSG/ERC meeting

This week I am in beautiful Burlington VT, on the shores of Lake Champlain, at the Council of State Governments/Eastern Regional Conference annual meeting. Our first health track panel was on farm to school programs. F2S programs are about far more than getting local foods into school cafeterias; it’s also about in-class nutrition education, farmers visiting schools and students taking field trips, school gardens, taste testing programs, after school cooking and gardening programs, harvest of the month programs, and composting. Our panel was a joint one with the Agriculture and Education committees and the benefits cross those areas and more. It’s about reducing and preventing obesity, supporting small farmers, encouraging community participation and economic development. There are over 2,000 F2S programs in 41 states. Twenty two states have F2S state legislation and the federal farm bill and child nutrition reauthorizations have opportunities. We heard about innovations across the country, but the Burlington school district is a national leader in F2S. Every day during the school year, local food will be offered in the Burlington schools. Research shows that F2S programs are associated with better eating knowledge and behaviors by kids in the programs. A very popular new initiative is VT Junior Iron Chef which started in Burlington and is catching on across many states as a way to engage young people in local food.
Ellen Andrews