Exchange Board approves expensive standard benefit plan

At today’s meeting the CT Health Insurance Exchange Board unanimously approved an admittedly unaffordable standard benefit plan. The plans include costs up to hospital (inpatient and out) deductibles $4,000, copays of $30 for primary care visits (not for preventive care – that is not allowed under the ACA), $45 for specialists, and $500 for outpatient surgery (after the deductible). While better than the staff’s first proposal, advocates have serious concerns about the affordability and poor incentives built into the plan. In a classic case of not understanding their market, there are $150 copays for ER visits, $75 for urgent care, and $50 for walk-in centers. This was to encourage people to access care in less expensive settings. However for low-income formerly-uninsured people, all these prices are eye-popping and out of reach. They may rely on the uninsured pattern of waiting until a problem goes away, or becomes a true emergency and more expensive to treat. The proposal was developed by exchange staff, CID staff, and three insurer representatives. It was initially approved by a select group of advisory committee members, also including insurers and providers. None of the meetings were public. Today’s meeting was held in Hartford away from public buildings, and was moved up half an hour without notice. Public comment is allowed in that first half hour. The standard plan must be offered by every insurer participating in the exchange, but they have the opportunity to offer non-standard plans as well. The standard plan was advertised as allowing consumers to make an apples-to-apples comparison between insurers. But it appears to be more of a diamonds-to-diamonds comparison. Our best hope is that insurers will come up with better value, more affordable plans in their optional offerings. As a consumer advocate, it is scary to pin all our hopes on insurers. Standard plan my comments