New on cthealthbook.org

Two new pieces have been added to the policymaker briefing book (formerly the candidate briefing book) on www.cthealthbook.org – health insurance exchanges and CT free clinics

Rally shows deep support for SustiNet and the public option

Hundreds rallied last night at the Hartford train station to show their support for SustiNet. Speakers said the reported compromise legislation does not go far enough to reach the original vision – providing a decent, affordable coverage option to desperate consumers and small businesses. Supporters emphasized the need for a public option, SustiNet, to make national health reform work for Connecticut consumers. For more on the rally, click here and here.

Join us to show your support for SustiNet

Come to show your support for the SustiNet bill, CT’s hope to provide a publicly accountable, affordable insurance option for individuals and small businesses. Join us at a rally 6pm next Wednesday, April 27th at the Hartford Train Station, One Union Place in Hartford. For more on SustiNet, go to www.healthcare4every1.org.

Public hearings on health insurance exchanges

The state will be holding hearings on plans for creating a health insurance exchange for CT under national health reform. The exchange is meant to be a standardized, regulated, easy-to-understand marketplace for individuals and small businesses to purchase coverage and apply for assistance. Advocates have sent a letter to the state outlining our recommendations for development of the exchange. The five hearings will be held around the state in the evenings from April 25 to May 17.

Bad news on health information privacy for CT patients

The HITE-CT Board met last night and approved the insufficient opt-out privacy model for CT’s health information exchange that defaults people into the system unless they figure out how to get out. Board membership is dominated by bureaucrats, large health care institutions and attorneys who represent them.Consumer advocates raised many objections, did significant research on other states but were ignored. For example, in our three surrounding states which all have opt-in policies that require consent before personal health information is released between 86 and almost 100% of patients sign the consent form. UT, CO and VT have recently switched from opt-out to opt-in policies. Under HITE-CT’s proposed opt-out policy, CT providers will have to identify and segregate every indication of legally protected “sensitive” information in every medical record such as HIV, mental health, or substance abuse treatment – and accept the liability for ensuring no mistakes. None of these or a dozen other concerns raised by advocates were addressed. In fact, this advocate had difficulty being allowed to speak at meetings, despite being an appointed member of the Board.

Their current plan is that a sentence would be added to the HIPAA form patients already sign to acknowledge that the patient received an accompanying “Bill of Rights” about the HIE. The Bill of Rights (still not developed or even described) would include a phone number and website where patients could go to opt-out. This would require that, even if the patient ever actually sees the Bill of Rights, they would have to copy down the phone number or website, go through their doctor visit, go home, and call or go online to opt-out.

They also plan to have a general public education program, to notify people about their rights, but no budget or specifics are designated for it. Their poor record of engaging the public in the policymaking process does not inspire confidence.

This process makes it even more clear why we need legislation to protect our rights.
Ellen Andrews

RAND report predicts reform will save CT state government 10% on health care spending

A new economic modeling analysis by RAND for the Council of State Governments estimates that 170,000 more CT residents will gain coverage by 2016 under health reform bringing our uninsured rate from 11% to 5%. The report also predicts that slightly more employers will offer coverage; employers will remain the largest source of coverage for most state residents. RAND estimates that over 300,000 state residents will gain coverage through the state insurance exchange and Medicaid roles will increase by 130,000. State employee coverage enrollment is not expected to change but spending is expected to be $110 million less than it would have been without reform between 2011 and 2020. Unlike the four other states in the report, CT’s state government spending on health care is expected to drop by 10% during those years compared to what it would have been without reform. Other states studied are expected to see an increase in spending of between 3% (Montana) and 10% (Texas and Illinois). The study also underscores why Connecticut must build on the health care insurance exchanges established under federal reform with SustiNet. The insurance exchange will only cover about 40,000 of the state’s small business workers, despite the fact that they are five times more likely to be uninsured. It will be critical to have a strong, affordable, publicly accountable option like SustiNet available to ensure that every state resident and every small business has a real opportunity to benefit from national health reform. Connecticut is likely to see further savings with the implementation of other reforms, such as patient centered medical homes and payment reform, outlined and facilitated by SustiNet and not included in the RAND report. Ellen Andrews

Medicaid Council update

At Friday’s Medicaid Care Management Oversight Council meeting the Dental Health Partnership reported on a remarkable secret shopper survey of the program. They found that callers were able to schedule appointments with 88% of offices called; the average wait time for an appointment was 11.2 days. Not bad. But rather than sit on their laurels, the Partnership came up with a corrective plan for the gaps and will re-measure next year. The number of participating dental providers is up significantly. The Partnership is now looking at how to increase demand and appropriate utilization (when do you ever hear that from a state agency)? In addition to the tried and true they are using innovative outreach techniques such as Facebook and leveraging medical providers. Concerns were raised that this progress achieved due to the dental lawsuit not be lost or reversed when the four year agreement timeframe is over. Lawsuits work. CT Voices reported on HUSKY utilization patterns during 2008 when the program abruptly switched from capitated financing to an ASO model for just over a year. For measures of children’s health, utilization was either the same or better in 2008 than the year before including annual well-child visits and developmental screenings. This mirrors Mercer’s assessment that medical costs didn’t change much during the ASO period; they even dropped slightly. DSS announced that CT was awarded a $1 million state demonstration planning grant by CMS to integrate care for dual eligibles, but did not have time to describe their plans. The RFP for the Medicaid ASO is out, but that also was not discussed. We will have more on the content of the RFP soon. Ellen Andrews

April Webquiz – health conditions and risk behaviors in CT

Test your knowledge of health conditions and risk behaviors in CT adults. Take the April CT Health Policy Webquiz. If you missed it, March’s quiz on children’s health in CT is still online.