Sunday, March 31, 2013

ObamaCare 411 smartphone app release Monday at LOB

This Monday Small Business for a Healthy CT will host a live demonstration of Obamacare411, a suite of user-friendly information tools, to answer questions and cut through the confusion of national health reform. January 1st consumers and small businesses will face a confusing array of new opportunities, responsibilities and costs. The Obamacare 411 learning center,, includes an Iphone App on the Apple Store, a website of tools, and a Help Book Series on The tools give consumers and small businesses individual answers to costs, subsidies, and what it all means for businesses and families. The demonstration will be 11:00 am Monday, April 1st at the 2nd floor atrium of the Legislative Office Building, Hartford CT.

Thursday, March 28, 2013

CT nursing collaborative funded to build capacity

The Robert Wood Johnson Foundation has awarded the CT Nursing Collaborative Action Coalition a two-year grant to prepare CT nurses to address coming health care challenges including an aging and increasingly diverse population. The program supports efforts to transform health care through “a more highly educated, diverse nursing workforce that will improve health outcomes for patients, families and communities.” CT is among twenty states that will share in the $3 million initiative.

Wednesday, March 27, 2013

What can Charter Oak teach the CT health insurance exchange?

A comparison finds lower consumer costs in the current Charter Oak plan than the Access Health CT (the CT Health Insurance Exchange) standard silver plan. Governor Rell created Charter Oak almost five years ago for the same purpose as the exchange – offering affordable, decent coverage options for CT’s uninsured. While Charter Oak premiums started out at an affordable $257 monthly premium, because of high cost sharing and limited provider panels, the plan grew less attractive to healthier people, driving enrollment down by 61% and premiums up to $589 monthly. It never came close to meeting expectations or addressing the needs of CT’s 300,000 uninsured. Unfortunately the exchange is poised to make the same mistake. Costs in the exchange standard silver level plan are higher than Charter Oak for most services. The total out of pocket maximum is $1,800 in Charter Oak but $6,000 for in-network care and $12,000 for out-of-network care in the exchange. CT’s exchange and Board need to sharpen their pencils to keep costs down for uninsured consumers. One of the best tools for that is active purchasing – negotiating rates with insurers – used with success by other states and most large groups. A bill directing the exchange to actively purchase coverage on behalf of consumers and small businesses is moving through the legislature.

CT individual premiums expected to rise 29% next year

A new analysis by the Society of Actuaries predicts that non-group health insurance premiums will rise from the current monthly average of $339 to $514 in 2014. According to the authors, acknowledged by HHS Secretary Sebelius, the increase will result mainly from provisions of the Affordable Care Act. CT can expect our individual market to grow by 77% to 255,216 people. Nationally 80% of that growth will be within insurance exchanges. The rate of uninsurance in CT is predicted to drop from 12.7% to 6% with reform.

Monday, March 25, 2013

HUSKY parents cut – costs outlined, rally planned

The Governor’s budget proposed cutting 37,500 working parents from Medicaid in 2014. Families affected have incomes between 133 and 185% of the federal poverty level -- $25,975 to $36,131 for a family of three this year. The administration argues that those parents will be able to purchase federally subsidized coverage in the new insurance exchange. A new analysis from the CT Health Foundation finds that out-of-pocket costs for those families will average $1,800/year and estimates that 7,500 to 11,000 working parents will not be able to afford coverage and will become uninsured. Total costs for HUSKY parents’ coverage will rise by one third – from $4,800 in HUSKY to $6,400 in the exchange. The Caring Families Coalition is planning a rally to protest the cuts Wednesday, April 17, 2013, 10:00-11:30 am at the State Capitol-North Steps. For more information, call 860-524-0502 ext. 12.

Friday, March 22, 2013

Insurance Exchange web portal needs work

The access health CT (formerly the CT Health Insurance Exchange) web portal got a chilly reception from stakeholders at its first demonstration Wednesday. The web portal is the foundation of the state’s health reform efforts. People searching for coverage, in public programs or private insurance, will be directed to the website. The audience of brokers and consumer advocates had many concerns. The slides were very difficult to see. There were 34 webpages estimated to take over 50 minutes to complete to get to the point of a determination of what people qualify for. There were numerous places where the wrong answer would disqualify applicants. Terms were not adequately explained, i.e. Are you offered affordable coverage at work? Only four slides were devoted to comparing health plan offerings. All 75 exchange plan offers will be displayed, prioritized by price, but there is an option to filter in several ways. Unfortunately the quality filter is only by NCQA rankings – every CT plan now has a B rating (80 to 90 points) with little meaningful difference between them. People are told as they start each section what documents they will need, requiring several stops, and making it very difficult to navigate the system anywhere but at home. Using Social Security Numbers to link to a federal data hub including income information, credit bureau reports, citizenship, DMV, and other sensitive sources raises privacy concerns. Help cues are links out off the page. The process requires people to estimate their incomes and itemize deductions for both 2013 and 2014 at the end of 2013 – very difficult for low-income, often hourly workers often with more than one job. If a family member is eligible for Medicaid, at the end of all this they are shifted to the DSS Medicaid application system as it exists now. Advocates raised numerous concerns that the system did not fully explain people’s rights and risks. Exchange staff and consultants noted that they are collecting feedback and revising the system.

Monday, March 18, 2013

Room change -- Insurance exchange experts panel coming to CT

Tomorrow’s panel -- Health Insurance Exchanges: How Connecticut Can Benefit -- a panel of national and state experts sponsored by the Council of State Governments/Eastern Region will be in Room 2D (not 2C) of the LOB at 1:30pm. (It’s a very busy day at the Capitol.) The panel will describe what is happening in leading exchange states, federal guidance and expectations, and where CT is currently. Speakers include Dave Chandra, Senior Policy Analyst, Center on Budget and Policy Priorities, Christie Hager, Regional Director, US Dept. of Health and Human Services, and Vicki Veltri, CT State Health Care Advocate. Kevin Lembo, CT’s Comptroller, will moderate.

Saturday, March 16, 2013

Small business absence in Exchange planning

Kevin Galvin’s blog today notes the continuing absence of a small business voice on the CT Health Insurance Exchange Board, while the insurance industry’s voice is growing.

Friday, March 15, 2013

Choosing Wisely grand rounds

Tuesday’s John Boden Symposium at Middlesex Hospital featured Michael LeFevre, MD, from UMissori-Columbia and Vice-Chair of the US Preventive Services Task Force, speaking on Choosing Wisely: How Doing Less Results in Better Care. The symposium was over-subscribed with 100 clinical staff eager to hear how they can provide better quality care by avoiding unnecessary treatments and screenings. Choosing Wisely is a national collaboration of forty four medical and consumer groups that have identified over 100 tests and treatments that are over-used. Examples include scheduling early elective C-sections, early imaging for low back pain, and routine antibiotics for sinusitis. Dr. Levre outlined the harm that comes from unnecessary screenings, unnecessary treatments after false positives, and cancers caused by routine, unnecessary imaging. One hospital estimated that they could pay for all their charity care if they could get providers to stop doing PAP smears on women who’ve had hysterectomies. If we don’t get this right, we can’t fix quality or control costs in our health system.

Thursday, March 14, 2013

CT Insurance Exchange standard plan – it got worse

Unaffordable in its first version, the CT Health Insurance Exchange Board today voted unanimously to raise deductibles and copays on the standard plans for in-network care, blaming federal regulatory constraints. The new standard plan for the Silver level raises the annual deducible (applicable to hospitals) from $2,500 to $3,000 and annual prescription deductible from $200 to either $400 or $500. The Silver out-of-pocket maximum is $6,250. For the Bronze level, the most likely to have affordable premiums, the standard plan deductible is now $3,250 for everything, including prescriptions and office visits, and people must pay 60% co-insurance on most services after the deductible. (Does this really qualify as insurance anymore?) The out-of-network cost sharing was not changed -- $12,500 maximum out-of-pocket in Bronze and $12,000 for Silver. All three consumer members of the advisory committee voted against this proposal. Each insurer is required to offer the Exchange Board-approved standard plan at each metal level. They can also offer one other flexible option that will hopefully be more affordable. However, the Board also voted not to allow the plans to offer a less costly flexible option at the Silver level (it’s a win/lose thing). Some Board members voiced concerns about affordability, but the debate was left to the very end of a 3 hour meeting, after long process and progress updates, leaving little time for a full discussion. Then every Board member voted for the new standard plan.
In other developments, they decided to raise copays for each maternity care visit up to the specialist rate ($45 for most plans). It was unclear why these visits are not primary, preventive care and exempt from co-pays entirely. They also voted to fund the $25 to 30 million cost of the exchange bureaucracy by assessing a fee on the entire small group and individual markets. So people who choose plans outside the exchange will pay higher premiums to pay for the exchange. As large groups won’t have to pay the fees, this will make the disparity in premiums between even worse; small businesses pay 18% higher premiums than large groups now on average. The Exchange is also seeking to gain “access” to DOL and DMV data for eligibility verification – raising privacy and security concerns about sensitive income and other information which may not be limited just to Exchange applicants. And the Board gained a new member – again with only insurance industry experience.

Wednesday, March 13, 2013

6 of 14 state exchanges actively purchasing coverage – but not CT

A new update on health insurance exchanges by the Kaiser Family Foundation finds that six states – CA, MA, NY, OR, RI and VT – of the 14 that have made a decision, intend to actively purchase coverage. Those six exchanges will be negotiating with insurers to get the best value for consumers in their states. CT is among the states that have chosen instead to act only as a clearinghouse for any insurer that meets minimal standards. Among the two state exchanges currently operating, MA actively purchases coverage for their customers and have cut premium increases in half, while prices inside UT’s exchange, which operates as a clearinghouse, are higher than outside. A bill is currently moving through the General Assembly directing CT’s exchange to actively purchase coverage.

Tuesday, March 12, 2013

Insurance exchange experts panel coming to CT

Next Tuesday CT will host -- Health Insurance Exchanges: How Connecticut Can Benefit -- a panel of national and state experts sponsored by the Council of State Governments/Eastern Region. The panel will describe what is happening in leading exchange states, federal guidance and expectations, and where CT is currently. Speakers include Dave Chandra, Senior Policy Analyst, Center on Budget and Policy Priorities, Christie Hager, Regional Director, US Dept. of Health and Human Services, and Vicki Veltri, CT State Health Care Advocate. Kevin Lembo, CT’s Comptroller, will moderate. The panel will be in Room 2C of the LOB at 1:30pm, next Tuesday March 19th.

Thursday, March 7, 2013

We are 17.7% of the way to health reform’s Jan. 1 deadline

CT policymakers have completed 17.7% of the tasks necessary for health reform; most are due on Jan.1st of next year. Medicaid, patient-centered medical homes and payment reform and quality improvement are leading reform according to March’s Health Reform Dashboard. CT still has problems with the CT Health Insurance Exchange (now access health CT), health information technology, and insurance market reforms.

Tuesday, March 5, 2013

LIA waiver denied

The administration’s plan to apply an asset test to families of young people in the Low Income Adults program (formerly SAGA) was not approved by the federal Medicaid agency Friday. Advocates objected to the plan stating that it was designed to address a problem that rarely happens, college-aged children in wealthier families on Medicaid, and it would have further stressed an already overwhelmed DSS. In their denial letter, HHS stated that “eliminate[ing] coverage for as many as 13,381 very low-income individuals” is “not consistent with the general [Medicaid] statutory objective to extend coverage to low-income populations.”

Friday, March 1, 2013

Exchange prices will likely be very high

The Hartford Courant is reporting that premiums in the CT Health Insurance Exchange – Access Health CT – will be between 10 and 100% higher than current levels. “Thousands of Connecticut residents will have a shock this summer when they see the prices for 2014 medical coverage that they're counting on buying through the newly formed state health insurance exchange.” Unfortunately, it doesn’t have to be this way. Active purchasing is an important tool used in other states to control costs; most large employers negotiate premiums with insurers to get the best deal. California’s exchange is planning to negotiate premiums and 30 insurers have signaled that they will participate. However the CT exchange’s Board voted down premium negotiations. The legislature’s Insurance and Real Estate Committee has approved a bill directing CT’s exchange to negotiate premiums on behalf of consumers.