New report finds adults in Medicaid expansion states like CT have better access to care, fewer financial barriers

A new report from the CDC provides the first analysis of the population-based impact of the Affordable Care Act. The analysis used data from the 2014 Behavioral Risk Factor Surveillance System, a state-based ongoing survey of adult Americans about health risk behaviors, chronic conditions, health care access and use of preventive care. As for previous studies, this study found that challenges to accessing care are highest for adults with less than a high school education, are unmarried, unemployed, racial/ethnic minorities and people living in poverty. Adjusting for age differences, the study found a sizeable difference between states that chose to expand Medicaid and those that did not for health coverage (85.3% vs. 79.1%, respectively), having a usual source of care (73.8% vs. 69.7%), and experiencing a cost barrier to receiving needed care (15.3% vs. 18.5%). Interestingly there was almost no difference in the age-adjusted rate of having had a routine check up in the last year (65.0% vs. 64.9%). The report also compares rates of preventive care, cancer screenings and specific cost barriers by income level, region of the country, and type of coverage. For example, 27.8% of uninsured American adults reported that they had to pay off medical bills over time in 2014 while only 21.9% of people with public coverage and 22.1% of privately insured Americans faced that barrier. About half as many uninsured American adults received flu vaccines in 2014 (18.0%) than those with public (37.4%) or private (36.7%) coverage. Connecticut compares well in most categories with the rest of the nation.

	Age-standardized rates
	Insured at the time of the interview	Routine checkup in the last year	Cost barrier to needed health care in the last year
US Medicaid expansion states	85.3%	65.0%	15.3%
US Medicaid non-expansion states	79.1%	64.9%	18.5%
CT	88.8%	67.0%	13.4%

Sen. Blumenthal meets with CT health leaders to discuss effective drug cost control

Thursday Senator Blumenthal met with over a CT dozen health leaders at Charter Oak Health Center in Hartford to learn more about the drivers of rising drug costs, the impact on the health of state residents, the burden on public and private sector budgets across the state, and what can be done. He heard that Hartford Hospital’s budget for just 12 generic medications is up $2 million over the last three years. New Haven’s emergency medical services are now spending half their pharmacy budget on opioid-overdose medications, and another 40% on epinephrine. We heard that patients with multiple sclerosis needing costly new medications are being refused entry to institutions because bundled payments do not adequately cover these extreme costs. We heard from a mother who now spends over $6,000 on epi-pens each year to protect her family. Rising drug prices are crowding out other critical spending, in health care and beyond. Concerns were raised about federal ACA repeal and Medicaid block granting proposals, and the impact on access to lifesaving medications in addition to the rest of our state’s health care needs. Senator Blumenthal noted that the federal government is at an “enormous point of opportunity and obligation to do something.” In addition to bills he is co-sponsoring on Medicare negotiating drug prices, drug importation from Canada and other countries with similar regulations to the US, and banning pay-for-delay legal tactics to inhibit generic competition, he asked for more ideas. He heard about ensuring any ACA repeal preserves the elimination of Medicare’s donut hole, removing barriers to generic entry to market, and federal march-in rights “to address concerns about the commercialization of technology developed with public funds”, among other ideas. He heard about state efforts to control costs, but clearly heard that the federal government needs to join those efforts to be successful. We talked about next steps to bring effective relief to consumers, payers and providers facing extremely squeezed resources.

Just under half of CT’s private sector workers have employer health insurance; CT 8th highest among states in high-deductible plans

Between 2014 and 2015, 48.7% of private sector workers in CT were enrolled in coverage at work, according to a new analysis by SHADAC. That rate is a combination of the percent of private establishments that offer health coverage (86.3%), the percent of workers who are eligible (78.0%), and the percent who accept, or “take up”, the offer 72.3%). The number of private sector workers in high-deductible health plans continued its climb in 2015reaching 50.5% in CT compared to 39.4% across the country. CT was the eighth highest in high deductible plan rates among states. Interestingly, high deductible health plans in CT among all firms has varied little since 2011, but the rate among small businesses has dropped from 80% in 2012 to 52% in 2015. Total premiums in CT continued their gradual rate of increase for both individuals and families and the premium share paid by employees has held generally steady.  SHADAC includes state-specific fact sheets in their report.

Advocates ask DSS yet again for a robust evaluation of risky experiment before expanding

Twenty-three independent advocates sent a letter today again urging the state to conduct a common-sense evaluation of the first wave of a risky new program before expanding the program, as promised. Advocates have learned that the planned evaluation will not be available until two months after the RFP for the second wave is finalized and released. In addition, current plans for the evaluation are weak, very similar to cursory evaluations of HUSKY MCOs that found no problems over many years despite obvious lapses and overspending. We also understand that data will not be available for a robust review in time to inform the second wave even if there were a meaningful evaluation. January 1^st Medicaid enrolled over 100,000 members into a shared savings program, PCMH+, a new financial model that has struggled to save money and improve quality where it’s been tried. Advocates are concerned because this is a return to financial risk models that have failed spectacularly in the past. Since Medicaid moved away from financial risk five years ago, access to care and quality are up substantially and the state has saved almost $500 million. Another 200,000 members are tentatively scheduled to be defaulted into PCMH+ next January 1^st before anyone knows if the historical problems have returned. The letter also outlines several other PCMH+ assurances of consumer protections that have not been honored.

Governor proposes new health reform planning agency, and more cuts to HUSKY parents

The Governor’s state budget proposal, released today, includes $5.8 million in rearranged funding and staff for a new Office of Health Strategy, effective July 2018, to “enhance coordination and consolidate accountability for the implementation of the state’s health care reform strategies.” The office will combine OHCA (formerly a separate agency, but now part of DPH that oversees CON applications), SIM, the new HITO (state HIT director yet to be hired) and the Office of Healthcare Advocate. The office will also take over development and administration of the APCD that has been repeatedly delayed.

The budget also returns to last year’s proposal to cut more HUSKY parents from coverage. About 10,000 HUSKY parents lost coverage last summer in previous budget cuts. The Governor is not proposing eligibility cuts for children or pregnant women.

Regarding federal plans to cut Medicaid reimbursement to states, the budget predicts that “Reductions in federal support will likely force Connecticut to limit services, to drastically cut coverage to thousands, and as a result, could shift health care provision to inappropriate and more costly venues such as hospital emergency rooms, shelters and prisons.” While federal Medicaid proposals are uncertain, the state has an internal working group assessing the threat and developing policy options.

Other proposals include:

·      Funding for universal access for children to HPV vaccines (personal favorite)

·      Increase in the cigarette tax to $4.35/pack

·      Places a $1,000 annual cap on Medicaid adult dental care

·      Reduces funding to local health departments and school-based health centers

·      Adds positions at DPH to monitor and oversee health care mergers and acquisitions – health care consolidation reduces competition which raises prices and lowers consumer choice

·      Adds DPH positions to create a licensing program for Urgent Care Centers

·      Reduces taxes on health insurance premiums

Senators Sanders and Cruz debate the ACA tonight

We don’t usually highlight federal actions on this blog, but this event promises to be very interesting. Tonight at 9pm CNN is hosting a debate between Sen. Bernie Sanders (VT) and Sen. Ted Cruz (TX) on the Future of Obamacare. Senator Sanders has been an outspoken critic of President Trump’s plans to repeal the Affordable Care Act, while Sen. Cruz supports the President’s plan. The Senators will field questions from around the US during the 90-minute Town Hall-style debate.

ICER revises value assessment methodology, public comments open

The non-profit Institute for Clinical and Economic Review has posted for comment their updated Value Assessment Framework. ICER is an independent research institute that analyzes evidence on the effectiveness and value of drugs and other treatments, including evidence-based calculations of prices for new drugs that accurately reflect their value in long-term patient outcomes and highlighting prices that may be unaffordable for the entire health system. ICER’s assessments have been essential to government and private payers in assessing the value of new drugs and other treatments and keeping health care affordable. The new improvements to the framework have earned positive feedback. It builds on ICER’s work over the last two years with stakeholders to improve transparency and reflects input from over 50 patient groups, life science companies, insurers and policymakers. Improvements include emphasis on patient-reported outcomes, expanded standards for cost-effectiveness ratios, and use of real, rather than list, prices that take account of rebates.

CT Health Reform Dashboard update reflects Medicaid concerns

February’s CT Health Reform Dashboard update reflects growing concerns about CT’s Medicaid program. Problems with the new EVV system threaten consumer access to home care, provider sustainability and privacy rights. The experimental PCMH+ program began a month ago, but no information on the program has been shared and plans for evaluation too little and too late to identify harm, overspending or erosion of CT Medicaid’s hard-won progress over the last five years. But, even if they stumble upon a problem, it will be too late to fix it. The Cabinet continues exploring prescription drug cost control with a lot of room for agreement on that pressing budget issue. In good news, state oversight of YNHH’s acquisition of L&M is getting better with insistence that community representatives and consumer advocates be included in the solution.