Insurance Committee to hear exchange active purchasing bill

The legislature’s Insurance and Real Estate Committee has raised SB-596, An Act Concerning the Duties of the CT Health Insurance Exchange, and will hold a public hearing on the bill Thursday. SB-596 requires the CT Health Insurance Exchange to actively purchase health coverage for the estimated one in ten state residents who will purchase health insurance there. The bill directs the exchange to negotiate premiums with insurers to keep insurance affordable for the individuals and small businesses. Starting next year, every state resident will be required to have health coverage. Federal affordability subsidies will only be available for insurance purchased through the exchange, creating a large, new, captive, and lucrative market for insurance companies. The exchange Board and staff have rejected active purchasing, claiming it would be “too adversarial” toward insurance companies. Active purchasing has kept premium costs under control in other states. MA’s exchange negotiates premiums with insurers and has kept the rise in premiums to half what is it outside the exchange. In contrast, Utah’s exchange does not negotiate premiums and premiums inside the exchange are higher than outside. Advocates have called for CT's exchange to actively purchase coverage on behalf of consumers. The public hearing on SB-596 will be this Thursday, January 31st at 1:00pm in Room 2D of the Legislative Office Building. Sign up begins at 11am in Room 2800 of the LOB, where you can deliver 30 copies of written testimony for distribution to committee members.

CT still earns a C+ on reform

Connecticut health care thought leaders give our state a C+ on health reform again this winter; grades have varied between C and C+ over the last year. Connecticut also again earned a C+ for effort in this survey. Among issue areas only Medicaid improved since last Fall. Five areas lost ground particularly health information technology and public education. The overwhelming suggestion to improve progress is to engage consumers in policymaking and improve the CT Health Insurance Exchange. The Thoughtleader Survey is part of the CT Health Policy Project’s Health Reform Dashboard project at www.cthealthreform.org.

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

Bills filed to fix insurance exchange and strengthen premium rate review

Sen. Joe Crisco, Co-Chair of the Insurance and Real Estate Committee, has filed bills to protect consumers in health reform. An Act Concerning the Duties of the CT Health Insurance Exchange directs the exchange to actively negotiate premiums with insurers on behalf of consumers. Other states are using negotiation to keep premiums more affordable. An Act Concerning the Insurance Department’s Review of Health Insurance Premium Rates directs the department to consider consumer out-of-pocket costs, affordability, provider rates, executive compensation in approving insurer rates and to directly monitor provider network adequacy. Both concepts are included in 31 Ways to Save Money in CT’s Health Care Budget.

ManUp: Comptroller’s roundtable on men’s health; New site collects CT financial resources and reports

Comptroller Kevin Lembo is holding a roundtable on men’s health January 23rd at 10:30 am in Room 2A of the LOB. The roundtable is part of the ManUp public education campaign to improve men’s use of preventive care and improve health outcomes. Roundtable speakers include providers, consumers and insurers. OSC has also launched Open CT linking a huge array of state fiscal reports and resources across agencies, with information explaining how things work. A HUGE advance for state fiscal transparency. Analysts across the state send a big thank you to OSC.

Medicaid Council new site and meeting update

The Medicaid Oversight Council has a new, comprehensive website. It is now easy to find the calendar for the Council and its many committees, presentations, quarterly reports, agendas, minutes, legislation, and program information. A huge step forward in transparency and sharing information that can improve health. Many many thanks to Council staff. Last week’s Council meeting was relatively uneventful. Concerns were raised about the state’s decision to stop person-centered medical home bonus payments to community health centers. Part of the deficit mitigation plan passed in December, the cut was news to advocates, clinics and many legislators. It is not specified in the bill that passed. At the meeting we learned that it was negotiated by leadership in both Houses and the Governor and was shared with Senate Democrats. Medicaid now has 851 total practices included in the PCMH program – some fully accredited and some on the glide path to certification. DSS described their plans to raise Medicaid primary care rates to Medicare levels for services provided by physicians and some providers working under the supervision of a physician. Under the ACA, the cost of those increases are fully paid by the federal government for two years; the state is considering the future costs of sustaining those rate increases beyond 2014. The rate increases are expected to begin in July, retroactive to Jan. 1st. Because CT Medicaid rates are already well above other states and very close to Medicare levels on average, physicians in our state are not expected to see a large increase. DSS also outlined broad plans to reform hospital payments toward value-based purchasing. Immediate plans include updating inpatient payments to DRGs (as are used in Medicare to better reflect patient acuity) and update the complex current outpatient coding system to a universal system. Eventually DSS plans to move to paying for episodes of care, following many other payers. In other news, we learned that only about half of children covered by Medicaid in either 2010 or 2011 received an initial or periodic screening; about half received dental care as well.

CT Insurance Exchange standard plan proposal too expensive for consumers

The draft standard plan proposal for the CT Health Insurance Exchange includes copays of $40 to $45 for a physician visit (CT 2011 average $23.79), $150 ER copays, and deductibles up to $3,000 for individuals and $6,000 for families (CT 2011 average $1,331 and $2,500 respectively). Better, more affordable plans are currently available in CT on eHealthInsurance.com. It is important to note that the Exchange will be marketing their plans to CT’s uninsured, who couldn’t afford the more reasonable options available now. In what is becoming standard process for the Exchange, the proposal was developed by Exchange staff with industry insiders in non-public meetings. The draft was open for public comment until today but it was never released to the public or posted on a public website. Some Exchange Board members didn’t know anything about the process. Click here for our comments.

Medicare announces new ACOs in CT

CMS announced approval of 106 new Medicare Accountable Care Organizations (ACOs) today, including six serving patients in CT. ACOs are integrated networks of local providers across the care continuum that share in the savings generated by coordinating care while maintaining quality. Among the new approvals are Hartford HealthCare, St. Francis HealthCare, and ProHealth serving only CT and Pioneer Valley Accountable Care (CT and MA), Accountable Care Clinical Services (CT & 4 other states ), and Accountable Care Organization of New England (CT and MA).

Mickey Herbert joins Harvard Pilgrim

Former ConnectiCare CEO, Mickey Herbert, has joined Harvard Pilgrim Health Care as a consultant. Harvard Pilgrim has applied for a license to expand to CT’s insurance marketplace. He resigned from the CT Health Insurance Exchange Board a month ago, adding to growing conflict of interest concerns. Concerns have been raised about Board members ties to and investments in insurance companies despite strong conflict of interest limits in state law.

CT hospitals among worst in Medicare performance payments

CT’s hospitals are the lowest among all 50 states in earning Medicare quality payments starting this month – only hospitals in DC performed worse. Medicare’s value-based purchasing program will tie a portion of hospitals’ payments to the quality of care they deliver. Only 4 of CT’s 29 acute care hospitals will receive a quality bonus; the rest will be penalized. Nationally, 52% of hospitals will receive bonuses and 48% penalties. In sum for all CT hospitals, Medicare payments will drop by 0.15%; the national average is an increase of 0.02%. Based on 2010 financial reports, this could cost CT hospitals $6.7million.

Five large CT insurers interested in exchange

Aetna, Anthem, ConnectiCare, HealthyCT (the new nonprofit co-op plan), and United all sent letters of intent to the CT Health Insurance Exchange signaling their intent to participate. The other large insurer in the state, CIGNA, does not participate in CT’s individual market, according to exchange staff. Harvard Pilgrim did not submit a letter, but may be awaiting licensure. While not binding, the response is very good. As advocates predicted, there was little need to worry about insurers not participating in the exchange. Advocates have criticized the exchange for designing policies very favorable to insurers, lax in accountability, and unaffordable for consumers and small businesses.

January webquiz – CT Medicaid primary care rate increases

Test your knowledge of CT Medicaid rates compared to Medicare and how much they will rise under the Affordable Care Act. Take the January CT Health Policy Project webquiz.