Exchange Board and staff water down already watered-down affordability and access provisions In a surprise to advisory committee co-chairs, CT Health Insurance Exchange staff submitted four alternative policy proposals at today’s Board meeting – they were adopted virtually intact by the Board. The staff alternatives were contrary to the recommendations adopted Tuesday by the Consumer and Qualified Health Plan Advisory Committees, with Exchange staff at every meeting. One staff change increased the number of options insurers can offer (in response to insurance industry comments); research shows that consumers prefer and make better choices with a limited number of well-vetted options. Another eliminated a secret shopper survey to ensure that the plan’s provider panels are accurate; in a Mercer study of HUSKY plans, shoppers were only able to get appointments with one in four providers on those HMO panels. Staff stated that accountability in secret shopper surveys seem “too adversarial” with insurers. Another proposal reduced the number of essential community providers that plans have to include in their networks, such as community health centers. The last one eliminated even the guidance that the Exchange will develop a plan of some undefined type to eventually, someday move along a continuum toward an active purchasing model. Active purchasing now saves MA exchange consumers millions in premiums by fostering competition and negotiating rates with insurers.

Staff reviewed comments to the draft health plan solicitation. Ten of the 22 comments mentioned were from insurers – half were accepted in the staff proposals, two were not, and three others were not relevant. Five comments came from NCQA, two from unknown sources, four from this consumer advocate (none were reflected in proposals) and one from a provider (was reflected in joint committee proposal).

The Exchange staff also announced they have hired Pappas Macdonnell, a Westport marketing firm with experience in selling corporate insurance and financial products. When asked if they have any experience in marketing to low-income, uninsured populations, one representative noted that he has worked on Democratic political campaigns.

In other news, they have settled on a new name for the Exchange – Access Health. They also have submitted an application for $2.6 million in federal funding for application assisters. They expect to award about 300 grants of about $6,000 each to community organizations to publicize the exchange, help people figure out what assistance they are eligible for, and help them enroll. They have hired three new Exchange staff this month.

The official vote tally for today’s vote to kill active purchasing

From Exchange staff: Below lists the results of the votes cast by the Consumer Experience and Outreach and Health Plans Benefits and Qualifications Exchange Advisory Committees with concern to the certification of Qualified Health Plans within the Exchange.-- Note -- a vote to approve is against active purchasing -- Results:
Twenty (20) – Approve Two (2) – Reject Approve
-- Sheldon Toubman Vicki Veltri
Gerard O’Sullivan Anne Melissa Dowling Deb Polun
Marcia Petrillo
Steve Frayne
J. Erlingheuser
Mark Espinosa
Gloria Powell Margherita Giuliano Tanya Barrett
Bonnie Roswig
Mary Fox
Alta Lash
Arlene Murphy
Sarah Frankel
Cee Cee Woods
Dr. Robert McLean Dr. Robert Scalettar Reject
-- Kevin Galvin Deirdre Hardrick

Joint exchange committees voting down active purchasing, cost control

While the votes are reportedly still coming in, it appears that the Consumer and QHP Insurance Exchange committees have voted against active purchasing. With active purchasing, other state exchanges are using the power of numbers, as large employers do, to negotiate better premiums, lower costs and better coverage for their members. MA has saved millions for consumers in their state with active purchasing. While the committees’ language includes a symbolic nod to possible future negotiation, it is far weaker than current state law. Reportedly, through a procedural maneuver, Exchange staff and committee co-chairs agreed to link all the proposals in one vote. Providers on the committees were picked off by adding back requirements that their organizations be included in network standards. Reportedly consumers lost votes we would have had if active purchasing had had a fair vote. All meetings this week and negotiations over language were conducted in secret. A critical negotiation session happened by conference call, but the public was not allowed to listen in. (The public was told to come to the LOB, from 6 to 7pm Monday to hear the call. However the building closes at 5:30.) This secrecy would not be allowed if the Exchange was part of state government – there are laws about that. But as a quasi-public entity, they can make their own rules. It is ironic as 50% of the Board members are public officials (71% if you count spouses and retirees), and all their millions in funding come from taxpayers. Exchange staff also incorrectly argued that they had to have this issue decided in time to release the health plan solicitation next month. However, state RFPs rarely release specifics on how they will score bids with the RFP release. Why would you? Now the HMOs know that as they prepare their premium bids, that the sky is the limit. We will post the vote tally as soon as we get it.

Just 6 days to comment on exchange health plan solicitation

Stakeholders had only six days to comment on the 40 page health plan solicitation from the CT Health Insurance Exchange – and it’s already over. Stakeholders in CA and MD had months to comment, with multiple drafts, meetings and opportunities to craft better proposals. The CT Health Policy Project’s initial comments centered on active purchasing, network adequacy, and the proposed “iterative process”. MA’s Connector has used active purchasing to save consumers millions in premiums – CT should do the same. When consumers are required to purchase coverage in the exchange, they must be able to get an appointment with a provider. HUSKY secret shoppers were only able to get appointments with 1 in 4 providers on the health plan lists. Using the standards from HUSKY contracts, thoroughly vetted in CT, and intensely monitoring compliance is key. The exchange’s proposal to initially implement a weak exchange and implement some standards later will sound eerily familiar to CT advocates – with a very poor history. Other comments include better cost sharing structures, standardize rating options so differences are meaningful, wellness programs that aren’t a screen for cherry-picking, constructive connections to the Medicaid program, accreditation standards, quality improvement plans (at least have one), and CID rate reviews as a floor. Perhaps the most troubling thing about the proposal is how much is taken on faith in attestations from insurers. Will anyone be monitoring to see if the promises are real?

Exchange advisory committees reject “any-willing insurer”

Today in a joint meeting of the Health Plan Benefits/Qualifications and Consumer Experience/Outreach committees of the CT Health Insurance Exchange voted against the staff recommendation “that the Exchange not deny any carrier QHP certification on the basis of its approved rates”. The only votes for the staff’s any willing insurer proposal were from Aetna and CT Insurance Dept. representatives. The committees asked staff to come back with a new proposal that includes rate negotiation.

CT Insurance Exchange holding public events

In response to concerns about the lack of public input, CT’s Health Insurance Exchange will be holding seven “Healthy Chat” events in the next month. Similar to Consumer Conversations last month but sponsored by the exchange this time, they will be reporting on their activities but will also be taking questions. We will be asking why they aren’t willing to negotiate with insurers to keep premiums affordable. The events will all be 5:30 to 7:00pm with registration at 5:00. The events will be in Hartford on November 27th, Waterbury on November 29th, New London on December 4th, New Haven on December 6th, New Britain on December 11th, Stamford on December 13th, ending with Bridgeport on December18th. For more details, click here.

Where Are The Consumers in the Consumer Committee??

I attended this week’s CT Health Insurance Consumer Experience and Outreach Committee meeting to give the Committee an update on the success of the previous week’s Advocate’s “Conversation with Kevin Counihan” event sponsored by Small Business For A Healthy Connecticut and CT Health Policy Project. My point was to emphasize the importance of consumer involvement at the upcoming combined meetings of the Consumer and Qualified Health Plan Committees. My attention was immediately drawn to all the empty chairs at the Committee table. Of the fifteen Committee members listed on the Exchange web site (a list that is not accurate), seven were present and one was participating by phone. Of the eight Committee Members attending, three were Exchange Board Members. With consumer voices being so few in the Exchange structure the Committee absences are particularly troubling. WHERE IS THE CONUMER’S VOICE IN THIS?
Why were the seven Committee members not there?
Why was the Co-chair not there?
Where were the consumers to access their right to address the Committee? The audience was primarily made up of insurance industry representatives and lobbyists. I commented that there were probably more folks in the room with (.Gov) email addresses than there should have been or needed to be for a meeting of consumers. With nearly half of the Committee members missing, what are the Committee members that were present going to do to impress the importance of attendance to the members who were missing? Might it make sense to have Committee meeting times after normal working hours to better accommodate the consumer audience? Might the Committee adopt the practice of having Public Comment at both beginning and end of each meeting again to better accommodate the consumer audience? What are the Committee’s plans to have consumer attendance at the upcoming combined Committee meeting? I’m not sure how we can expect the general public to take the implementation of Health Care Reform seriously when the people charged with representing us do not show up to meetings. Kevin Galvin

Why CT’s health insurance exchange needs to negotiate

CT’s health insurance exchange is not planning to negotiate with insurers to improve value and control costs for consumers. As of January 2014, consumers will be mandated to secure coverage. Consumers eligible for affordability assistance must purchase in the still developing exchange to get the subsidies. Massachusetts’s exchange (the Connector) negotiates, termed active purchasing, with insurers saving consumers $16 to $20 million annually. In contrast, Utah’s exchange does not negotiate with insurers but includes any qualified insurer, as the CT exchange is planning, and premiums are HIGHER inside the exchange than in the outside market. There is some disagreement about whether the Board and the Qualified Health Plan Committee have already made the decision. No public comment was solicited on the issue and the decision memo was posted a day after the QHP committee meeting. For more on the issue, go our Policymaker Brief.

CT health reform progress up to 16.7%

CT inched up only 0.3% in progress toward health reform last month. We have completed 16.7% of the tasks needed to be ready for January 1, 2014 when individuals will be legally required to secure health coverage. Highlights remain Medicaid and patient-centered medical homes. Unfortunately, problem areas continue to be the insurance exchange and insurance review. Last month, CT health care thoughtleaders gave CT a C+ grade for reform progress. For more, visit the CT Health Reform Dashboard at www.cthealthreform.org.