CT Health Insurance Advisory Council hearing

Three of the four speakers at yesterday’s public hearing testified in favor of SB-957, An Act Establishing a Health Insurance Advisory Council. The Council’s mission is to advise the insurance department and “examine ways to ensure effective review by the Insurance Department of health insurance rates, ensure the affordability of health insurance in this state and monitor the implementation of the Affordable Care Act.” The Council would include consumers, insurers, brokers, labor, providers, small businesses, an actuary, and relevant agencies. The Council mirrors other collaborative, public Councils in our state that have been successful in improving health care quality, efficiency and lower costs. The Council would also help inform the public about their rights and responsibilities in reform, and provide a vehicle for policymakers to get feedback and ideas from the real world that they are now missing. Insurance Commissioner Leonardi testified that it would create an unneeded layer of bureaucracy and would create an environment that could drive insurers out of the state. Six groups, representing consumers, small businesses, communities and labor, testified or submitted testimony in favor of the bill; the insurance department and the CT Association of Health Plans opposed the bill.

CT exchange hire for call center has troubled history with the state

CT’s health insurance exchange has hired Maximus to provide the critical call center service for the new marketplace. Consumers with questions about the confusing new landscape -- seeking help applying for programs, figuring out which plan is right for them, trouble navigating the website, etc. -- will be directed to this call center. An article today by the Washington Post/AP outlines problems Connecticut has had with Maximus in past contracts. In 2007 the Attorney General was forced to sue Maximus over a non-functioning computer system, and in 1997 Maximus was criticized for poor performance administering the state’s child care program.

Health Insurance Advisory Council bill hearing tomorrow

Tomorrow the Insurance and Real Estate Committee will hold a public hearing on SB-957, An Act Establishing a Health Insurance Advisory Council. The bill would create a public, transparent Council to advise the state on regulating insurance, promoting affordable coverage, network adequacy, and implementing the important consumer protections in the Affordable Care Act. Council members would include advocates for the uninsured, Medicaid, labor, providers, brokers, insurance companies, small businesses, and relevant state agencies. January 1st of next year, every state resident will be required to secure health coverage. RAND estimates that 270,000 will be purchasing health insurance in Connecticut -- 140,000 of them without any federal subsidies. It is critical that people get the best price possible for coverage is meaningful and effective in improving people’s health and protecting their finances. The Council will bring public attention, education and wisdom to the table to ensure Connecticut realizes every possible benefit from the ACA’s opportunities.

Time cover article focuses on health care prices, including two CT hospitals

Bitter Pill: Why Medical Bills are Killing Us?, Time magazine’s latest cover story, is a fascinating look into medical prices – why they are so expensive and so unequal. The article includes a deep dive into several cases including Janice S at Stamford Hospital, and Emilia Gilbert from Bridgeport, part of the Yale New Haven health system. The extremely well-researched article details stunning, ten-fold higher prices charged to uninsured and marginally insured patients. The article describes “non-profit” hospitals making startling profits, paying eye-popping administrative salaries, and overtreatment driven by investments in shiny, new, expensive machines. Alternatively, Medicare’s system of determining what treatments actually cost, and paying only for services that make sense, is offered as a sensible option for expanding coverage. “Unless you are protected by Medicare, the health care market is not a market. It’s a crapshoot.” Uninsured patients were charged $3 for the marker used to identify the site of surgery on his back, $31 for the strap that held him onto the operating table, and $34 for a re-useable blanket -- all charges that Medicare and insurers would not have paid at all. One Tylenol pill cost $1.50 and a tube of bacitracin cost $108 for uninsured patients. The article highlighted conflicts of interest in physician payments from drug companies and device manufacturers, and the complete absence of comparative effectiveness research – learning which treatments are worth what we pay for them and identifying equal or better, less costly alternatives. The article ends with commonsense, relatively easy solutions to reduce and equalize prices. But the authors acknowledge that the interests profiting handsomely from the status quo make the solutions unlikely.

Exchange update: HUSKY parents at risk, out of network standard plan costs alarming

Public testimony before yesterday’s CT Health Insurance Exchange Board centered on the administration’s proposal to cut eligibility for HUSKY parents over 133% of the federal poverty level (currently $25,975 for family of three) saving the state $3 million in FY 14 and $30 million (net) the next year. The proposal assumes those families will purchase coverage in the exchange, but even with federal subsidies, premiums and out of pocket costs will be unaffordable to most. During public comment a woman spoke for her daughter-in-law who had to work. She gave a compelling description of the Hartford family of three making $45,000/yr, how tight their monthly budget is, and the likelihood that they will have to be uninsured if the cut passes. The Board also unanimously approved out of network costs for the standard plan. The costs will be double the already very high in-network out of pocket costs. Out of network co-insurance rates will vary from 50% to 80%, and maximum out of pocket costs are $12,500 for both the bronze and silver plans. This is particularly troubling as reports are surfacing that insurers are approaching providers to join “exchange-only” panels with payments at Medicaid rates. Out of network care may be a necessity if panels are very narrow. When asked if plans are only offering very low reimbursement rates, staff stated they would “have a conversation with the plan.” In other news at the Exchange Strategic Planning committee, staff described their very early plans to implement CT’s All Payer Claims Database. There were more questions than answers. The APCD will be controlled by the same Exchange Board with input from the APCD advisory committee of the Health Reform Cabinet – rather than set up independent governance as in all other states. Neither committee has an independent consumer member but do include insurers, providers, and state agencies. A bill has been raised to require providers to notify their patients that their information is to be shared in the APCD and give them the opportunity to opt-out of the database.

Seeking community input on public education about the ACA and insurance

The Affordable Care Act has a lot of moving parts – both opportunities and responsibilities – for consumers and it can be very confusing. Part of the rollout of the Affordable Care Act includes recruiting In-Person Assisters to help people who are uninsured get insurance.
Organizers expect that hundreds of IPAs will be housed in community-based organizations across Connecticut or in small businesses that already focus on helping the community. Grants of about $6,000 will help cover expenses for each In-Person Assister. The Office of State Health Care Advocate is seeking input as they develop the program. Please take a few minutes to complete a survey.

More Insurance Exchange forums scheduled

The CT Health Insurance Exchange, renamed Access Health CT, is planning more Healthy Chat forums. The events are designed to answer questions about the exchange and the states plans for health reform. Events will be held in Norwich, Willimantic, Manchester, Meriden, Torrington, Danbury and Enfield from Feb. 19th through March 19th in the evenings. For more information, visit healthychatct.com.

Early results on CT’s state employee wellness program encouraging

Early lessons from CT Health Enhancement Program (HEP) for state employees and retirees found primary care visits are up, specialty care is down, ER visits are down, and adherence to maintenance medications for chronic illness is up. HEP is administered by the Comptroller’s Office. There is also early evidence that HEP is slowing the increase in health costs for state employees. Medical trend in the program fell from 13% in FY 2011 (pre-HEP) to 3.8% in FY 2012 and, despite higher use of maintenance medications, pharmacy costs were flat. Under HEP, state employees who commit to wellness responsibilities pay lower premiums, deductibles, copayments and may qualify for incentive payments. The results are part of an early report from a long-term evaluation of HEP by the University of Michigan’s Center for Value-Based Insurance Design. According to the researchers, “Connecticut’s experience demonstrates the ability of management and labor to reach consensus on significant changes to ‘business as usual’ in health plan design, even in challenging fiscal environments.”

Win support for your health justice idea

Submit your idea to achieve health justice for every CT residents to the Health Justice Challenge and you may win $10,000 to implement it. The Challenge, project of Health Justice CT, is a competition open to individuals and organizations to generate solutions to health disparities in CT. The deadline has been extended to next Friday, the 22nd.

Governor proposes to cut 40,000 working parents from HUSKY

The Governor’s budget proposal released today would move an estimated 20,000 working parents with incomes from 133% to 185% of the federal poverty level (currently $25,975 to $36,130/year for a family of three) from HUSKY to the CT Health Insurance Exchange. Right now those working parents pay no premiums or copays for comprehensive coverage. In the exchange, even with federal subsidies, those families would pay premiums up to $1,172 per adult, and further out of pocket costs up to $4,163. In total, those costs make up 18% of family income. Their alternative is to become uninsured and pay a $95 tax penalty. It is likely that many, even most, of the 20,000 parents at risk will not be able to afford exchange coverage, even with the federal subsidies, and will become uninsured. The federal government reimburses CT for half the costs of their care under HUSKY, so every dollar cut from the program only gains CT’s budget 50 cents. The still-developing CT Health Insurance Exchange has been criticized for designing expensive plans and inadequate provider network assurances. In 2003 CT cut a similar number of parents off HUSKY but the impact was delayed for most families by a lawsuit until the state reversed the cuts. During that year, the CT Health Policy Project followed eight HUSKY families with a parent who lost coverage to assess the impact. In one case, a New Haven widow could no longer afford her blood pressure medication, had a heart attack, ended up with thousands in hospital medical debt, and re-qualified for HUSKY due to her medical bills, but only for six months. Very soon after she again became uninsured, she had a more serious heart attack. The savings estimated by the Governor, $59.5 million in FY 2015, are very similar to the savings the state gained by switching HUSKY from capitated HMOs to a self-insured system. Even more savings are expected as the program moves to support care coordination. In addition, there are at least 31 ways to save money in CT’s health care budget that don’t harm consumers.

February webquiz -- CT hospital finances

Test your knowledge of CT hospital finances. Take the February CT Health Policy Quiz.

Positive active purchasing hearing

Fifteen of the nineteen testimonies for yesterday’s Insurance Committee public hearing on SB-596 were in favor of active purchasing. Proponents included the State Comptroller, State Health Care Advocate, small business and community groups, brokers, labor, patient safety, legal aid, consumer and faith-based groups. Opponents included CBIA, the HMO Association, NFIB, and the Exchange staff. The CT Health Insurance Exchange Board and staff have rejected negotiating premiums with plans to keep costs affordable. MA’s exchange has saved consumers millions through negotiation. Utah’s exchange does not negotiate, taking any willing insurer, and premiums inside the exchange are higher than outside. Committee members asked great questions about how much consumers could save, states that are making it work, operational questions, health cost drivers and solutions, philosophical questions about the role of government, and impact on the rest of the market. The committee was especially interested that CA is planning to negotiate rates with their plans and have received 30 letters of intent from plans, countering the concern that plans would not apply. Committee members were also interested in research on how much choice is optimal for consumers before it becomes overwhelming and counter-productive.