Health First Authority update

Today’s Health First Authority meeting was uneventful. Sharon Langer from CT Voices for Children gave a primer on Medicaid and SCHIP. David Parrella from DSS gave an update on Charter Oak and the HUSKY transition (the same slides he used for Friday’s Medicaid Managed Care Council meeting). DSS has developed a concept paper for an 1115 Affordable Choices waiver to cover Charter Oak, HUSKY, and SAGA and submitted the paper to CMS. DSS refused to share the concept paper with the Authority. Discussion topics included client churning (no answers about why), rate increases (too little, too late), the spending cap (how it restricts the state from accessing federal money), and affordability standards (CT is less generous to uninsured consumers than Massachusetts). There was a presentation by Paul Lombardo of the Dept. of Insurance on MA’s health reforms and by Paul Grady of Mercer on value-based purchasing. Materials from the meeting are online. The next meeting is Sept. 11th at 9am.
Ellen Andrews

Medicaid Managed Care Council update

We got a first look at the HUSKY HMOs’ provider networks at Friday’s Medicaid Managed Care Council meeting and it wasn’t good. CHN, which has been a part of HUSKY from the beginning, has robust panels of providers across the state. However, the two new HMOs – Americhoice (United) and Aetna – have a long way to go. As of July 11th CHN had 2,109 primary care providers available to serve HUSKY consumers, while Aetna Better Health had 367 (190 of those are in New Haven County), and Americhoice had only 140 primary care providers statewide. Both Aetna and Americhoice each have a county with only two primary care providers taking HUSKY and Charter Oak patients. And the HMOs are still in negotiations with hospitals for contracts.
We also learned that undocumented immigrants are not eligible for Charter Oak, even the unsubsidized portion of the program. We learned more about how cost sharing the in the program works – the out-of-pocket maximums are on top of the deductibles and copays. Many on the Council were concerned that the state is still at financial risk for behavioral health and drug costs under Charter Oak. Sen. Harp noted that during budget negotiations this spring, HUSKY expenditures were down significantly – suggesting that the state was saving considerable sums without capitation. CMS has asked for that analysis – how much the state spent before and after the state removed capitation in November. DSS also stated that they have no intention to respond to the state’s budget deficit by proposing cuts to HUSKY or Charter Oak.
Ellen Andrews

CT’s Health Partnership bill featured in NY Times article

Today’s NY Times includes an article outlining proposals to make health coverage more affordable for small businesses. Small companies pay 18% more than large businesses for the same coverage. The recent CT Healthcare Partnership bill proposing to open the state employee pool to small businesses was vetoed by the Governor; however she indicated that she wants to work with legislators next year to craft a bill she can sign. The article also applauds CT for earlier legislation that added some fairness and stability to rate setting for small businesses. CT Comptroller Nancy Wyman is quoted, “This is not an easy problem to solve. We know it.”
Ellen Andrews

Sinking or Swimming in the High-Risk Pool?

On the front page of the New York Times this morning, I saw an article that highlights a problem with proposals to model a new component of national healthcare coverage on states’ high-risk pools. Earlier this year, I had been looking at the Connecticut High-Risk Pool (created by the Connecticut Health Care Act of 1975).

What it is? Connecticut High Risk Pool is managed by the Health Reinsurance Association (composed of all private insurance companies and HMOs that offer health insurance in CT) and offers a comprehensive healthcare plan to eligible Connecticut residents who cannot get other coverage because of pre-existing conditions. State law caps HRA rates at 125% -150% of standard insurance rates.

Who it “serves”? Connecticut residents between 19 & 65 and their dependents can be eligible for the high-risk pool. The Health Reinsurance Association offers several plans, but the range of cost is largely covered by two closely related examples:
· The special Low-Income Portability TAA Plan costs a 45 year-old male $317.63 per month; a 45 year-old female would pay $395.40 a month.
· The same plan for a non-low-income individual costs $972.53 per month for a 45 year-old male and $1210.65 for a 45 year-old female.

In my opinion, the high-risk pool is dangerous because it appears to offer safety-net coverage, while actually being priced out of reach of the very people who most need it. While the new Charter Oak Health Insurance program may help cover many Connecticut residents who would earlier have had no option but the high-risk pool or no coverage, the program’s co-pays and deductibles may still bar our state’s sickest residents from participating.
Connie Razza

Book Club -- Sway

I just finished Sway: The Irresistible Pull of Irrational Behavior by Ori and Rom Brafman. A fascinating book that details the psychological forces that keep us from making good decisions. There are dozens of great examples, but my favorite is the “twenty dollar auction”. One the first day of class, a Harvard business school professor plays a game with his students auctioning off a twenty dollar bill. The highest bidder gets the bill, but the second highest bidder also has to pay his bid and receives nothing. Bargain hunting students quickly move the bidding up to $12 or $16, when the contest slows down and only the two highest bidders continue. At $17 for instance, the second highest bidder can spend another $2 and go to $18 hoping to win the bill or risk losing his entire $16. The students “roar with laughter when the bidding passes $20”; the record is $204. The professor has never lost money in the game; all proceeds go to charity. Students are caught “chasing the loss” – the deeper the hole, the more they dig. This illustrates loss aversion, one of several psychological forces that drive our irrational behavior. Thankfully, the authors do not just describe these traps, but provide guidance to avoid them – critically important in policymaking. For more book reccomendations, go to the CT Health Policy Project Book Club.
Ellen Andrews

Family Values - a small but significant gap in Connecticut’s health care system

There are a number of people who cannot get healthcare coverage in Connecticut no matter where they turn: Documented immigrants over 65 years of age who have had green cards for less than 5 years. The people affected by this gap are often parents who have come to be with their children and help raise their grandchildren.

This morning, the Consumer Health Action Network hotline (toll-free 888-873-4585) answered a call from a daughter who had brought her 70-year-old parents to Connecticut. They both have had their green cards for 3 years. She has tried many avenues to get healthcare coverage for them.
· Most private insurers will not look twice at the application when they learn that her parents are over 65 years old. One company that did consider the couple came back with a monthly premium of $1400 for one parent, for coverage that would not address any pre-existing conditions.
· Medicare requires that immigrants hold their green cards for 5 years before they are eligible for coverage.
· Medicaid does not cover anyone over 64 who isn’t eligible for Supplemental Security Income, doesn’t receive Medicare, or hasn’t spent a significant amount on medical expenses already.
· The new Charter Oak Health Plan is designed for 19 to 64 year olds and does not make exceptions to those parameters.

It’s a small gap, frankly, but an important one to fill. Models exist for how to fill this gap (for instance, our neighbor to the South, New York). Let’s get to it and make sure that we make sure that as many of the currently uninsured will be able to get healthcare coverage.
Connie Razza

COBRA calls to Consumer Network Helpline

In the past three weeks, the Consumer Health Action Network (888-873-4585) has received a number of calls about COBRA. COBRA (which stands for the Consolidated Omnibus Budget Reconciliation Act) is the federal law that allows workers and their dependents to continue group health coverage at their own expense after employer coverage ends because of termination, reduced hours, and other reasons. This trend is disturbing because it indicates at least one if not more of several problems:
· More Connecticut residents are losing their jobs;
· Employers don’t know their obligations under COBRA; and/or
· Employers are counting on their employees not knowing their rights under COBRA.

The program is complicated, but here are some basics:
· In Connecticut, all employers are covered by COBRA law.
· Employees are eligible for COBRA insurance when they retire, quit, are laid off or fired for anything other than gross misconduct, or have reduced hours.
o Employees are covered up to 18 months under the federal COBRA law. If the employee is between 62 and 65 and eligible for COBRA, Connecticut law requires the employer to offer COBRA coverage until the person reaches 65 (when Medicare starts), regardless of the number of months involved.
· COBRA insurance will also cover surviving, divorced, or separated spouses; dependent children; or dependent children who lose their dependent status under their parent’s plan.
o Depending on the reason for loss of coverage under an employer plan, spouses and dependent children may be eligible for COBRA benefits up to 36 months.
· Retirees can qualify for COBRA if their former employer files for bankruptcy.

COBRA coverage can be expensive, especially for people who have just become unemployed, but it is an important option for people to keep coverage through transitions. It is critical that everyone know their rights.
If you have questions about COBRA, go to http://www.cthealthpolicy.org/action/tips/200612_cobra.pdf or call the Consumer Health Action Network Helpline toll-free in CT at 1-888-873-4585.
Connie Razza