For budget and political reasons the SustiNet bill was changed last week. The new version creates a 14 member volunteer SustiNet Health Partnership Board of Directors across stakeholder groups tasked with making recommendations to the legislature by Jan. 1, 2011. The goals of SustiNet remain the same and much of the detail remained in the bill. The Board is to create committees on health information technology, medical homes, clinical care and safety guidelines and preventive care. The bill creates an independent information clearinghouse for the public on health plan options including SustiNet. The bill no longer outlines employer or employee responsibilities and does not include automatic enrollment. The bill creates task forces to address obesity, tobacco use and health care workforce shortages. Essentially, the bill creates a public volunteer entity to continue planning for universal health care and to allow CT to respond to federal health care opportunities as they arise. We expect more changes to the bill as it moves through the process. For the bill analysis, click here.
Ellen Andrews
Monday, May 11, 2009
Friday, May 8, 2009
Medicaid Managed Care Council/Charter Oak update
The news from today’s Council meeting is that while Charter Oak’s enrollment continues to increase – 8,210 as of May 1st -- the number of people denied coverage under the program is far higher -- 18,635 so far. While 705 of those were denied because they have coverage or have had it in the last six months, 16,672 are getting caught in the application process. The quick start application, which is short and is online, is only the beginning of the process. Applicants then get a follow up form requesting more information and that appears to be the problem. The Council should get a copy of that form at the next meeting. If consumers have not completed the entire process within 60 days, they must start all over again and re-apply from the beginning.
We also learned that to qualify for Charter Oak under the financial hardship exception to the six months uninsured rule, consumers must be spending over 33% of their income on health care. Members of the Council felt that this was an extremely high bar to set between consumers and affordable coverage. DSS noted that anyone who is paying between 25% and 32% of income on health care are held for a closer look by the Dept.; approximately 100 people are in that category now. DSS explained that the six month provision was meant to keep people from dropping private coverage, even if it’s more expensive, to come into Charter Oak. It is unclear what the state’s interest is in keeping people from benefitting from a more affordable coverage option if they are in the unsubsidized category.
On HUSKY, PCCM plans are moving forward and several questions were deferred to the upcoming PCCM Subcommittee meeting May 20th at 10:00am in Room 3800 of the LOB. We learned that from December 2007 to January 2009, while the health plans were not at financial risk and were not denying treatment, administrative costs were 13% for Anthem, 11% for CHN, 12% for Health Net and 14% for WellCare.
A lively exchange resulted from a presentation by the CT Health Foundation on their new reports outlining the potential impact of eliminating coverage for legal immigrants and implementing copays and premiums in HUSKY Part A. Pat Baker of the Foundation pointed out that research on imposing copays shows that both necessary and unnecessary services and drug use are reduced – that imposing copays on drugs that keep people well and out of the ER and hospital would be counterproductive. DSS argued that copays are used routinely in private plans and are necessary to keep the program within budget constraints. Members pointed out that this would be “penny wise and pound foolish” and that many private plans are moving to more sophisticated copay systems of reduced or eliminated costs on maintenance drugs, such as blood pressure regulators or asthma medications, that keep people well and out of more intense treatment.
Ellen Andrews
We also learned that to qualify for Charter Oak under the financial hardship exception to the six months uninsured rule, consumers must be spending over 33% of their income on health care. Members of the Council felt that this was an extremely high bar to set between consumers and affordable coverage. DSS noted that anyone who is paying between 25% and 32% of income on health care are held for a closer look by the Dept.; approximately 100 people are in that category now. DSS explained that the six month provision was meant to keep people from dropping private coverage, even if it’s more expensive, to come into Charter Oak. It is unclear what the state’s interest is in keeping people from benefitting from a more affordable coverage option if they are in the unsubsidized category.
On HUSKY, PCCM plans are moving forward and several questions were deferred to the upcoming PCCM Subcommittee meeting May 20th at 10:00am in Room 3800 of the LOB. We learned that from December 2007 to January 2009, while the health plans were not at financial risk and were not denying treatment, administrative costs were 13% for Anthem, 11% for CHN, 12% for Health Net and 14% for WellCare.
A lively exchange resulted from a presentation by the CT Health Foundation on their new reports outlining the potential impact of eliminating coverage for legal immigrants and implementing copays and premiums in HUSKY Part A. Pat Baker of the Foundation pointed out that research on imposing copays shows that both necessary and unnecessary services and drug use are reduced – that imposing copays on drugs that keep people well and out of the ER and hospital would be counterproductive. DSS argued that copays are used routinely in private plans and are necessary to keep the program within budget constraints. Members pointed out that this would be “penny wise and pound foolish” and that many private plans are moving to more sophisticated copay systems of reduced or eliminated costs on maintenance drugs, such as blood pressure regulators or asthma medications, that keep people well and out of more intense treatment.
Ellen Andrews
Thursday, May 7, 2009
Notes from community outreach
Yesterday I did an outreach event for about 25 participants in the STRIVE- New Haven program to let them know about different health insurance options. STRIVE does “employability skills training workshops” for residents of greater New Haven to help them find and keep jobs. STRIVE is a comprehensive job and life-training program with a great record of success.
The purpose of these outreach events is to go out into the community and to provide information and answer questions about health insurance coverage and where to find health insurance in Connecticut. Some of the health insurance options I talked about were individual insurance, employer-based insurance, COBRA, Charter Oak, HUSKY, SAGA, and free bed funds from hospitals. I was impressed by the STRIVE program as well as the professionalism of the participants, who demonstrated what they were learning in the program. They were interested in the different topics and asked questions to get more information (each person would stand and introduce themselves when they had a question). Participants asked questions about HUSKY, community health centers, and SAGA Medical (including spenddowns). All of the men wore ties with dress shirts and pants and the women wore clothes suitable for the workplace. I handed out a lot of our tip sheets, which are a great resource to provide more information about the topics I was covering. The audience was receptive and engaged; it was definitely a successful outreach event.
Jen Ramirez
The purpose of these outreach events is to go out into the community and to provide information and answer questions about health insurance coverage and where to find health insurance in Connecticut. Some of the health insurance options I talked about were individual insurance, employer-based insurance, COBRA, Charter Oak, HUSKY, SAGA, and free bed funds from hospitals. I was impressed by the STRIVE program as well as the professionalism of the participants, who demonstrated what they were learning in the program. They were interested in the different topics and asked questions to get more information (each person would stand and introduce themselves when they had a question). Participants asked questions about HUSKY, community health centers, and SAGA Medical (including spenddowns). All of the men wore ties with dress shirts and pants and the women wore clothes suitable for the workplace. I handed out a lot of our tip sheets, which are a great resource to provide more information about the topics I was covering. The audience was receptive and engaged; it was definitely a successful outreach event.
Jen Ramirez
Wednesday, May 6, 2009
New book for the book club
According to the Environment Protection Agency, a human life is worth $6.1 million. That estimate came out of cost-benefit analyses of arsenic from drinking water. Priceless, by Frank Ackerman and Lisa Heinzerling (2004), provides a fascinating look at the assumptions and questionable methodologies used to develop cost benefit analyses across fields. The costs of arsenic in drinking water, and resulting bladder cancer, was extrapolated from a survey conducted in a shopping mall in Greensboro, SC in the late 1980s asking shoppers how much they would be willing to pay to avoid chronic bronchitis. Apparently many cost benefit analyses are based on that same small survey of mall shoppers. How lives are valued in cost benefit analyses invite twisted ethical conclusions that would make most Americans cringe. A fascinating book that questions the ability of science to answer complex human questions.
For more books, go to the CTHPP Book Club.
Ellen Andrews
For more books, go to the CTHPP Book Club.
Ellen Andrews
Tuesday, May 5, 2009
Legislative briefing on health care reform
A special briefing on health care, “Health Care Reform: Opportunities for New Directions”, was held yesterday at the Legislative Office Building in Hartford. Spectators almost filled the room. Speakers included Congressman Christopher Murphy, 5th District; Joy Johnson Wilson, Health Policy Director for the National Conference of State Legislators; and Enrique Martinez-Vidal, Vice President of State Coverage Initiative for the Robert Wood Johnson Foundation and Academy Health. The briefing was sponsored by the Annie E. Casey Foundation and the Universal Health Care Foundation of Connecticut.
Congressman Murphy thinks there are excellent prospects for reform at the federal level because of the economy, the desire of the American people, and a President who has made health care reform a priority. The downturn in the economy has led more people to see health care reform as urgent, especially as more people are losing their jobs and their employer-sponsored health coverage along with them. Because their constituents see reform as important, this is reflected in Congress. There are different types of health reform plans at the federal level, including single payer, making it easier for groups to combine for the purposes of providing health care, and some type of mandate (either individual or employer).
According to Congressman Murphy, a public plan, which would compete in the private market, would test out a single payer system on a smaller scale. He also said that the work on health care reform that is being done in states like Connecticut is pushing the federal government to take action. When asked about the timetable for reform, Mr. Murphy stated that they are hoping for something by the end of the summer. But to use the reconciliation process, Congress won’t be able to vote until October 15, 2009.
Ms. Johnson Wilson spoke about challenges and opportunities for states, some of which are overlapping. The economy presents a challenge because of limited funding and all of the other problems that come with a recession but an opportunity because it forces us to concentrate on the problem of health care reform and reduce inefficiencies. The American Recovery and Reinvestment Act (ARRA) of 2009 has placed more restrictions on funding than did previous federal economic assistance to states.
On the federal level, some areas of consensus are: the expansion of Medicaid, improving quality, expanded use of health information technology, refocusing on primary care and preventive health, and increasing transparency and accountability. Some of the areas on which there is disagreement are: a public plan option, individual or employer mandates, and changing the tax treatment of health care premiums in the employer-based system. According to Ms. Johnson Wilson, draft bills for health care reform will be available in the next 2-3 weeks. The goal is for the bills to be reviewed on the floor before the recess in August. Congress will have to find offsets for some of the spending on health care.
Enrique Martinez-Vidal gave some examples of insurance market reforms that states are working on, including extending coverage for dependants past the age of 18, eliminating pre-existing condition exclusions when someone is going from one insurance policy to another (including the individual market), and merging the small group and individual markets. Some of the cost containment and quality improvement goals for the states are: an emphasis on preventive care and primary care, care management for chronic illness, health information technology, and value-based purchasing.
Jen Ramirez
Congressman Murphy thinks there are excellent prospects for reform at the federal level because of the economy, the desire of the American people, and a President who has made health care reform a priority. The downturn in the economy has led more people to see health care reform as urgent, especially as more people are losing their jobs and their employer-sponsored health coverage along with them. Because their constituents see reform as important, this is reflected in Congress. There are different types of health reform plans at the federal level, including single payer, making it easier for groups to combine for the purposes of providing health care, and some type of mandate (either individual or employer).
According to Congressman Murphy, a public plan, which would compete in the private market, would test out a single payer system on a smaller scale. He also said that the work on health care reform that is being done in states like Connecticut is pushing the federal government to take action. When asked about the timetable for reform, Mr. Murphy stated that they are hoping for something by the end of the summer. But to use the reconciliation process, Congress won’t be able to vote until October 15, 2009.
Ms. Johnson Wilson spoke about challenges and opportunities for states, some of which are overlapping. The economy presents a challenge because of limited funding and all of the other problems that come with a recession but an opportunity because it forces us to concentrate on the problem of health care reform and reduce inefficiencies. The American Recovery and Reinvestment Act (ARRA) of 2009 has placed more restrictions on funding than did previous federal economic assistance to states.
On the federal level, some areas of consensus are: the expansion of Medicaid, improving quality, expanded use of health information technology, refocusing on primary care and preventive health, and increasing transparency and accountability. Some of the areas on which there is disagreement are: a public plan option, individual or employer mandates, and changing the tax treatment of health care premiums in the employer-based system. According to Ms. Johnson Wilson, draft bills for health care reform will be available in the next 2-3 weeks. The goal is for the bills to be reviewed on the floor before the recess in August. Congress will have to find offsets for some of the spending on health care.
Enrique Martinez-Vidal gave some examples of insurance market reforms that states are working on, including extending coverage for dependants past the age of 18, eliminating pre-existing condition exclusions when someone is going from one insurance policy to another (including the individual market), and merging the small group and individual markets. Some of the cost containment and quality improvement goals for the states are: an emphasis on preventive care and primary care, care management for chronic illness, health information technology, and value-based purchasing.
Jen Ramirez
Monday, May 4, 2009
May CT Health Policy Web Quiz
Test your knowledge of CT hospital finances, take the May CT Health Policy Web Quiz. This month’s quiz was written by Karen Nepomuceno, Policy Intern at the CT Health Policy Project.
Friday, May 1, 2009
Health care reform briefing for legislators
Monday there will be a special briefing for legislators, open to the public, on Health Care in 2009: Challenge and Opportunity. Speakers include Sen. Chris Dodd, Congressman Chris Murphy, Enrique Martinez-Vidal of Academy Health’s State Coverage Initiative, and Joy Johnson Wilson from the National Council of State Legislatures. The briefing will be in Room 2C of the LOB from 10am to noon on Monday May 4th. The briefing is sponsored by the Universal Health Care Foundation of CT and the Annie E. Casey Foundation.
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