Eligibility income levels increase tomorrow

Many programs, including HUSKY and Medicaid, base eligibility determinations on the Federal Poverty Level – an antiquated mechanism, that shortchanges CT, of determining what the basics of life cost. Anyway, those dysfunctional standards are updated every year and the new levels become effective tomorrow. Here are the new numbers, with calculations for HUSKY program eligibility categories. For more help in finding out what you may be eligible for and accessing health care in CT, go to our Consumer Health Action Network website or call 1-888-873-4585, toll-free in CT.

Notes from Massachusetts

It’s always dangerous to visit other states – you are reminded of how far Connecticut has to go. I spent yesterday in Boxborough, MA at Health Care For All’s fifth annual policy & organizing conference. The prevailing climate was of advocates, providers and state administration very comfortable working together toward a common goal – getting every MA resident affordable coverage and high quality services. There was a friendliness and mutual respect between stakeholders that was refreshing. I didn’t just rely on speakers but quizzed everyone I sat next to.

They have a great deal to be proud of – over 300,000 state residents now have insurance who didn’t before -- about the total number of CT’s uninsured. They are addressing health disparities, reining in costs, and how to fund the higher than expected demand for coverage. As one speaker put it, they are victims of their own success. They recognize the big challenges ahead and already have an ambitious agenda for cost control.

The individual mandate compromise still has an edge for many advocates, but everyone is trying to work through it and respect the final agreement. The state has hired an army of lawyers and other counselors to help people navigate the very confusing process and to hear appeals. First year penalties for consumers who do not purchase coverage are coming due with tax returns in the next few weeks. There are still no numbers on how many will have to pay 2007 penalties ($219 for individuals). For 2008 penalties will go up to 50% of the least costly health insurance available. There are plenty of details, questions and forms, including the new Schedule HC to be filed with every tax return, but there is lots of help. One big question is how much this is costing to administer.

In response to a question, Nancy Turnbull, a member of the Connector Authority Board and a lecturer at Harvard, gave this list of lessons learned to share with other states.
1 – Get as much federal money as possible
2 – Defer hard decisions to the implementation stage – you need real world experiences to make informed choices, and any decisions made earlier would have been behind closed doors, which never contributes to good policy making
3 -- Be ready for big buy-in costs – e.g. significant funding for providers, very modest employer contributions
4 – “What you can get business to agree to is not much”
5 – It was the right strategy to get coverage first and wait to control costs – one thing at a time
6 – Reform can’t happen without a broad based consumer advocacy coalition

One speaker thought the reason that reform worked in MA and other states are struggling is that others are letting the perfect be the enemy of the good – not true here in CT.
Ellen Andrews

Unnatural Causes: Is Inequality Making Us Sick airs tonight

The first of a seven part documentary on health disparities, Unnatural Causes, begins tonight at 10 pm on CPTV. Tonight’s show, In Sickness and in Wealth, focuses on overarching themes. “What are the connections between healthy bodies, healthy bank accounts and skin color?” The episode follows a CEO, a lab supervisor, a janitor and an unemployed mother to describe how class shapes opportunities for health in America. Watch the trailer here.
Thanks to the CT Assoc. of Directors of Health for the heads up.

Appropriations passes a budget

Today, the Appropriations Committee passed their version of the state budget, about $100 million below the Governor’s proposal. The Committee cut $110 million from Medicaid, HUSKY and nursing homes for cost and caseload updates – the Committee believes that the Medicaid budget has been inflated in recent years by the administration and wants to use that excess funding for other priorities. Committee Chairs voiced concerns that many of last year’s initiatives have not been implemented by the Dept. of Social Services while money sits waiting and the need grows. The Committee also did not approve the Governor’s proposal to add $5 million more to the current $11 million Charter Oak Plan budget, stating that it was premature to add to a program that hasn’t been implemented yet. The Committee added $10 million for increased nursing home staffing levels, $1.5 million to restore Medicaid podiatry and chiropractic care, and increases to various providers. The Committee rejected the Governor’s proposal to weaken Medicaid’s medical necessity definition and restored the Governor’s cut to medical interpretation services. The Committee added money to the Dept. of Public Health for more HIV/AIDS surveillance staff, more health planning staff, a nursing loan forgiveness program, more school-based health centers, and a comprehensive cancer plan. Overall, the Committee came in almost $78 million below the Governor’s proposal for Medicaid and $109 million under for DSS overall.
Ellen Andrews

Anthem not bidding on Charter Oak or HUSKY

Last week, Anthem sent a letter notifying DSS that they will not be submitting a bid for the joint HUSKY/Charter Oak Plan RFP. Initial responses are due to the state on Friday. Anthem’s concerns include inadequate funding for full-risk HUSKY and Charter Oak; advocates and other state officials have also been concerned about the programs’ financial sustainability. As of March 1st, about half (159,158) of HUSKY members were enrolled with Anthem, almost twice as many as the next largest plan. With the largest provider panel, it is hard to imagine how either HUSKY or Charter Oak could function without Anthem’s participation. However, Anthem is not walking away from HUSKY families – they are happy to continue indefinitely with the current non-risk arrangement and would consider participating in Charter Oak in a similar arrangement. They are also interested in bidding on the programs in the future if current legislative proposals restructuring the programs pass. Proposals making their way through the legislative process include HB-5618 to delay HUSKY procurement and separate it from Charter Oak, and HB-5617 which makes several improvements to Charter Oak’s design.
Ellen Andrews

Consider an internship at the CT Health Policy Project

Are you interested in making a difference for CT consumers struggling to get the health care they need? To help policymakers find solutions for complex and costly health system problems? Working with experienced professional staff and other interns from diverse fields and perspectives?
Consider an internship with the CT Health Policy Project. For almost a decade, we have been providing CT consumers and policymakers with the information they need to make the best decisions. Intern projects include consumer outreach and advocacy, policy analysis, communications, and public education. CTHPP interns have included high school, college and graduate students as well as mid-career or retired volunteers and supporters.

To learn more, go to our internships webpage.

The mortgage crisis and medical debt

I was floored when I picked up the paper the other day and read that the Federal Reserve is bailing out Bear Stearns, the fifth largest investment bank in the nation. Until the moment it teetered on the brink of failure, Bear Stearns asserted that it had avoided crisis. I wasn’t upset because of the bail out itself, but because it comes only shortly after the moralizing in Washington about not protecting individual homeowners from their own bad decisions.

Sure. Some homeowners may have taken out irresponsible loans on purpose, trying to capitalize on a housing bubble that seemed like it would never burst. But many other factors contributed to the housing crisis we now face.

Medical costs – particularly those costs that individuals bear – are rising so dramatically that folks are struggling to find ways to pay for the medical care that they need. More and more, we are relying on borrowing to cover our medical debts. A recent report confirms what we know anecdotally: even among people who have health insurance, the burden of healthcare costs is too great.

More to the point, many Americans have been forced to turn to the equity in their homes to try to cover their medical expenses. According to a 2005 Harvard study of personal bankruptcies filed in 2001:
Medical debt was also associated with mortgage problems. Among the total sample of 1,771 debtors, those with more than $1,000 in medical bills were more likely than others to have taken out a mortgage to pay medical bills (5.0 percent versus 0.8 percent). Fifteen percent of all homeowners who had taken out a second or third mortgage cited medical expenses as a reason. Follow-up phone interviews revealed that among homeowners with high-cost mortgages (interest rates greater than 12 percent, or points plus fees of at least 8 percent), 13.8 percent cited a medical reason for taking out the loan.
(The Harvard team responsible for this study is preparing an update looking at 2007 bankruptcy data.)

So, now that – in the wake of the Bear Stearns bail out – some politicians in DC are talking seriously about how to help individuals, let’s hope they consider the full breadth of the problem.
Connie Razza