Exchange staff back off eroding essential health benefits

At yesterday’s CT Health Insurance Exchange meeting we learned about an attempt by Exchange staff and the Insurance Dept. to reduce the Essential Health Benefit Package that had been agreed to earlier this year in a contentious but inclusive and public process. Like the last process that rejected active purchasing, this process happened in evening conference calls not open to the public in a very short time frame. This time, however, providers and advocates on the committees voted down the benefit package erosion (active purchasing was not part of the reconsideration) and the staff finally agreed to pull the proposal from the Board committee agenda yesterday. However at the meeting, staff stated that they plan to lobby the fed.s to let them re-consider, and lower, the agreed-upon essential benefit package. The issue is CT mandates for coverage in state law – whether they cost or save money in premiums and how much. A public commenter noted that affordability is very important, but eroding mandates may not work to keep costs down. Active purchasing is proven to reduce costs, but the Board and staff have rejected that proven tool and have indicated no interest in re-visiting that decision. Other news included a strong theme of affordability in the Healthy Chat public events. Staff noted that many people were new faces to health care, not traditional activists. They also noted that people had “done their homework” and were very sophisticated in their understanding of active purchasing and its potential for affordability. The staff is still working on the details of the health plan benefit standards and benefit design, how plans will be rated for innovation and plans for quality monitoring. Advocates will be watching this process carefully for further standards that erode consumer protections, if there is any transparency or opportunities for meaningful public input.

HHS approves CT insurance exchange plan

Along with six other states, CT’s health insurance exchange received approval yesterday from the federal agency providing funding. CT was among the first six states to apply to HHS for approval – 14 states have applied to date. No state’s application has been denied. CT’s exchange has been criticized for their plan to accept any willing plan and refusing to negotiate with insurers to control costs and reduce consumer premiums. CT’s exchange also voted not to conduct a secret shopper survey to monitor whether people who purchase their insurance plans can find a provider. The exchange has also been criticized for having no independent consumer Board members, having Board members with close ties to the insurance industry and for members with insurance company investments.

Outreach recommendations for reform

Small grants, engaging an army of trusted community messengers, ubiquitous marketing, and robust monitoring will be critical to enrolling the estimated 130,000 newly eligible CT Medicaid members in January 2014, according to a report by the CT Health Policy Project. Best opportunities for outreach include small businesses, providers, current HUSKY members, faith-based communities, connecting with employers and other state programs, targeting life transitions, improving application and enrollment processes, and thanking outreach partners. It will require strong, concerted efforts to overcome the program’s stigma and other barriers to enrollment. The report draws on the experience of community organizers, consumer advocates who worked on HUSKY outreach, providers that care for CT’s uninsured patients, and lessons from other states. While aimed at Medicaid, many of the report’s findings also apply to the new CT Health Insurance Exchange. Report