Health Insurance Exchange Board meeting update

Today’s Access Health CT Board meeting was largely uneventful; despite that, the room was packed. The highly anticipated report from Wakely’s actuaries on their meetings with the plans to give premium proposals a “second look” was not ready. This is in lieu of negotiating premiums – a bill directing the exchange to do that died in the House this session. We heard a lot about how the process is “iterative” and that it will take three years for the exchange to be fully operational. Unfortunately, people and health plans are not being given three years before the individual mandate and insurance reforms take effect. We heard about a very large marketing campaign that is starting to explain the ACA and the exchange to Connecticut. They have hired more staff and more consultants. They have spent $58.7 million so far this fiscal year (ends this month). Next year’s budget is $74.9 million (about $250 per uninsured state resident) and calls for 59 staff. The marketing budget is $9 million for next year to include TV, radio, billboards, social media, newspaper inserts, and outreach events. They have received 26 applications for the approximately $50,000 navigator grants – they will only fund six. We are hopeful, to avoid the mistakes of HUSKY, that the twenty organizations not chosen will be engaged in outreach somehow. They’ve received 422 in-person assister applications ($6,000 each) from organizations representing 722 grant requests. They will only fund 300. There was a long discussion of differing lists of essential community providers (ECPs). In November the Board voted to require plans to include 75% of ECPs and 90% of federally qualified health centers. It took several lists and lots and lots of meetings, but they finally decided on a CMS-based list of ECPs in CT. Concerns were raised that the requirements could constrain competition and raise premiums. CA was able to keep premiums affordable with smaller provider panels, along with negotiating premiums with plans. Concerns have been raised elsewhere that an exhaustive list of ECPs reduces the number of key providers required to be in the network. Concerns were also raised over the types of providers labeled ECPs – for instance, including school-based health centers, while critical members of the state’s overall safety net, that typically are not open after school hours or in the summer and will not serve the vast majority of exchange members who are likely to be adults. They also changed some standard plans (again), to raise copays and coinsurance on one Bronze plan and delete another. 

ECHN seeks to join growing list of CT hospitals merging and converting to for-profit

The Hartford Business Journal is reporting that ECHN, parent of Manchester Memorial and Rockville General Hospitals, is close to selling to Vanguard Health Systems, Inc., a for-profit chain based in Nashville. ECHN made $3.7 million margin (profit) in 2012. The article reports that Bristol and Waterbury hospitals are also in discussion with Vanguard. This continues a consolidation trend among Connecticut hospitals. Advocates have been concerned about the consolidating market, impact on competition and, consequently, health costs. There are also deep concerns about access to care for Connecticut’s 300,000 uninsured and underinsured residents in Connecticut’s growing for-profit hospital environment.

Intern Academy resources online

Tuesday’s CT Health Intern Academy attracted over 100 participants to a day of health policy and skill training at the Capitol. Many thanks to our expert speakers including policy, advocacy, budget, media and organizing specialists, Kevin Lembo, CT State Comptroller, our keynote speaker, and to the CT Health Foundation for supporting the event. Feedback has been very positive. In addition to background videos, now online are slides, speaker answers to questions from students, glossary of terms, resource list, speaker bios and slides. Pictures and answers to audience questions we didn’t get to will be up soon. We will soon be planning Roundtable discussions on current CT health policy topics to build on the Academy themes. Check the site often for opportunities for input into selection of those topics.

Videos posted for Intern Academy

As context for Tuesday’s CT Health Intern Academy, we have posted four 5 to 7 minute video backgrounders  on CT’s health policy system – nuts & bolts, the uninsured, health care costs, and the Affordable Care Act – and three on health advocacy in CT – nuts & bolts, legislative and budget. Also posted are a glossary of terms and a list of resources. We are up to 74 registrations currently. For more info and to register for the event, go to www.cthealthintern.org.

Medicaid Council update

Today’s Medicaid Council focused on the SIM planning process working to reform CT’s health system across payers. The project is planning a large public input solicitation over the next few months through the Health Care Cabinet. The project is working to engage consumers and develop a person-centered lens for policymaking. We’ll have more on SIM, opportunities and concerns, in coming blog posts. DSS gave an update on policy changes passed in the legislative session. Concerns centered on the elimination of spend down eligibility for LIA members, linked to the large expansion of Medicaid eligibility for that group as of Jan. 1^st, requirements for prescription drug step therapy, and implementation of ER copayments of $7.90 for non-urgent visits. For the latter, hospitals must ensure that the medical problem wasn’t urgent, and that an alternative non-urgent care source was available before charging the copay, and that the hospital must make a referral to an alternative. Concerns were also raised about very high rates of Charter Oak members failing to pay premiums over the last year, approaching 20% of the total population in some months. Charter Oak monthly premiums are not widely different from what many will pay on the exchange. While Charter Oak is going away as the exchange comes online, the experience provides important clues to ensuring the exchange is successful. 

Insurance executives salaries excessive

The CEO of Wellpoint, owner of Anthem, was the highest paid insurance executive last year at $20.6 million according to an analysis by C-HIT. Despite complaints about ACA and Wall Street regulations, salaries for the top five executives at the five largest insurers ranged from $21 to $47 million. Health care executives are the highest paid across industries. Advocates and providers called for compensation reforms to control health care costs and align incentives to reward quality care, not care denials.

Intern Academy agenda updated

The agenda and speakers list for the June 18^th CT Health Intern Academy have been updated. Free and open to anyone interested in learning more about health policy, the event will be June 18^th, from 9:30 am to 2 pm at the Legislative Office Building. The agenda includes panels on Health Policy Trends, State & Congressional Advocacy, Health & the Media, Networks & Collaboration and a tour of the Capitol. Speakers include State Comptroller Kevin Lembo, along with small business, nonprofit, lobbying, insurer, broker, policy and fiscal analyst, provider, state legislative and Congressional staff, state agency, community organizer, reporter and social media experts. Lunch and parking are available, but registration is required. The Academy is made possible with support from the CT Health Foundation. For more information, visit www.cthealthinern.org. 

Bill directing exchange to negotiate premiums died on House calendar

SB-596, a bill that would have implemented active purchasing in Connecticut’s health insurance exchange, died yesterday without action by the House on the last day of the session. The bill passed the Senate last week. The bill directed exchange staff to negotiate premiums with insurers. Negotiations in California and Massachusetts’s exchanges have kept costs down for consumers and small businesses.

According to reports, the insurance industry lobbied heavily against 596. Members of the House worked hard to pass the bill, but were overridden by leadership. Exchange staff was not supportive of the bill. The administration agreed to language in a budget implementer bill that the exchange “may” negotiate premiums with insurers, a largely meaningless move. But in the end, an amendment was added removing even that language.

Anthem proposed rates for inside and outside exchange filed

Yesterday, Anthem’s proposed 2014 rates were posted on the insurance department’s website. Proposed base rates (costs for an average 21 year old in an average plan before adjustment for age, geography and benefit plan) average $296.49 and $440.30 per month for individuals and small businesses respectively. Rates reflect an 8.6% increase over 2013. These averages are for products inside and outside the exchange. Consumers will compare these rates with those proposed by HealthyCT, ConnectiCare and Aetna at $427, $397 and $364 per month for individuals. It is not clear that these numbers compare apples to apples.

HUSKY parents stay in Medicaid in state budget

The budget that passed the Senate yesterday and the House this weekend makes no changes to HUSKY parents eligibility. In February the Governor proposed reducing eligibility for HUSKY parents to 133% of the federal poverty level, removing 37,500 working people from the program and saving the state $5.9 million next year and $59.5 million the year after. The proposal assumed those parents would be able to purchase coverage in the new health insurance exchange. However independent analyses predicted that many would not be able to afford coverage in the exchange and would become uninsured. The budget that passed did not include the Governor’s proposal.

June CT Health Policy Webquiz: CT’s All Payer Claims Database

Test your knowledge of All Payer Claims Databases and what one could mean for Connecticut. Take the June CT Health Policy Webquiz.