SIM planning Committees Missing True Consumer Representation

The SIM (State Innovation Model) grant process is well into its final development and consumers are not at the table. In March, CT received millions of federal tax dollars through SIM to completely restructure the health care system that covers at least 80% of state residents. The final model design is due to the federal government in just a few weeks. Of the 75 SIM committee seats defining that health care system model, only three represent consumers of health care. Consumers/taxpayers are the ultimate funders of our health care system, and unlike other stakeholders, more than our incomes are impacted – our lives depend on a functional system. With only three seats for consumers, you’d think that they’d be filled by true consumers and independent advocates, those with direct knowledge of the challenges the SIM needs to address. Unfortunately, that is not the case. Since the implementation of health care reform began in Connecticut there has been a very obvious and, in my opinion deliberate, movement to exclude consumers from the decision making process. So few seats being allotted by the SIM committee organizers and the individuals chosen continue the lack of consumer input to our health care system. Connecticut is rich with passionate consumers and knowledgeable consumer advocates. Knowledge, experience and passion that are all being wasted. One would think the SIM leadership would want the very best input from all stakeholders, especially consumers, at the table to develop the best possible product. I guess not. Kevin Galvin Small Business for a Healthy CT

Intern Academy agenda updated

The agenda and speakers list for the June 18th CT Health Intern Academy have been updated. Free and open to anyone interested in learning more about health policy, the event will be June 18th, from 9:30 am to 2 pm at the Legislative Office Building. The agenda includes panels on Health Policy Trends, State & Congressional Advocacy, Health & the Media, Networks & Collaboration and a tour of the Capitol. Speakers include State Comptroller Kevin Lembo, along with small business, nonprofit, lobbying, insurer, broker, policy and fiscal analyst, provider, state legislative and Congressional staff, state agency, community organizer, reporter and social media experts. Lunch and parking are available, but registration is required. The Academy is made possible with support from the CT Health Foundation. For more information, visit www.cthealthinern.org.

Bill directing exchange to negotiate premiums died on House calendar

SB-596, a bill that would have implemented active purchasing in Connecticut’s health insurance exchange, died yesterday without action by the House on the last day of the session. The bill passed the Senate last week. The bill directed exchange staff to negotiate premiums with insurers. Negotiations in California and Massachusetts’s exchanges have kept costs down for consumers and small businesses. According to reports, the insurance industry lobbied heavily against 596. Members of the House worked hard to pass the bill, but were overridden by leadership. Exchange staff was not supportive of the bill. The administration agreed to language in a budget implementer bill that the exchange “may” negotiate premiums with insurers, a largely meaningless move. But in the end, an amendment was added removing even that language.

Anthem proposed rates for inside and outside exchange filed

Yesterday, Anthem’s proposed 2014 rates were posted on the insurance department’s website. Proposed base rates (costs for an average 21 year old in an average plan before adjustment for age, geography and benefit plan) average $296.49 and $440.30 per month for individuals and small businesses respectively. Rates reflect an 8.6% increase over 2013. These averages are for products inside and outside the exchange. Consumers will compare these rates with those proposed by HealthyCT, ConnectiCare and Aetna at $427, $397 and $364 per month for individuals. It is not clear that these numbers compare apples to apples.

Aetna exchange premiums lower than competitors; all higher than CA rates

Wednesday, Aetna submitted proposed rates for Access Health CT, the state health insurance exchange. Averaging $364 per month for individual coverage. By tier premiums average $177 for Catastrophic coverage, $356 for Bronze, $487 for Silver and $477 for Gold. (Yeah, I don’t get that either). Aetna follows HealthyCT and ConnectiCare proposals averaging $427 and $397 per member per month for all tiers. In comparison, the most affordable Silver option in California’s exchange is $276 pmpm, as much as 29% lower than current offerings. California’s exchange negotiated premiums with insurers. Connecticut policymakers still have options to lower premiums in our exchange. SB-596, directing the exchange to negotiate premiums with insurers, is awaiting a vote in the House.

Active purchasing bill passes Senate

This afternoon the Connecticut State Senate passed SB-596, a bill directing Access Health CT, the Connecticut Health Insurance Exchange, to negotiate with insurers to keep premiums affordable for consumers and small businesses. Other states and most large employers negotiate with insurers to control costs. The bill passed 23 to 12 on a party line vote. Republicans offered five amendments to dilute or delay negotiation which were defeated. Advocates for consumers and small businesses supported the bill in testimony; insurers were opposed. The bill now travels to the House for a vote.

Insurance exchange rate proposals in for HealthyCT

Insurance premiums for HealthyCT, the new nonprofit health insurer co-op, have been posted on the insurance dept.’s website. HealthyCT is the only insurer that has submitted rate proposals for 2014 so far, despite an April 30th due date. Average monthly premiums for individuals will be $427/month and for small groups $445/month. While the benefit plans will change next year and previous prices are not strictly comparable, in 2010 individual premiums in CT averaged $306 per month. 2014 rates will vary by customer based on age, residence, and the plan selected; rates must still be approved by the insurance department. Policymakers have options to control premium increases but they must act soon to be effective.

Still waiting for insurance exchange rates, UnitedHealthcare is out

Rate proposals by insurers planning to participate in CT’s health insurance exchange were due to the Insurance Dept. last Tuesday, but none have been filed according to the Hartford Courant. However HealthyCT says they filed with the department on Friday. The exchange is blaming federal regulations and delays. UnitedHealthcare notified the exchange last week that they will not be participating in the exchange, leaving Anthem, Aetna, HealthyCT, and ConnectiCare. Insurer rates have been eagerly anticipated by advocates and others hoping for affordable premiums. Concerns about rate shock have been heightened by 25% increases in rates submitted to Maryland’s exchange. Several options are available to the exchange and state policymakers to keep premiums affordable, but some require legislative action. The legislative session ends in four weeks.

“RATE SHOCK” Fact or Fiction

Since the passage of the Affordable Care Act one of the principle concerns has been: what will health insurance cost. The potential fallout from high price health insurance has been termed “RATE SHOCK”.

Stakeholders and advocates have voiced concerns over “Rate Shock” from very early on. The CEO of the CT Health Insurance Exchange, Connecticut’s Health Care Advocate and the Deputy Insurance Commissioner have all voiced concerns publically over what impact “Rate Shock” will have once the Exchange is open for business. It has been a discussion at Exchange Board Meetings.

So if “Rate Shock” is a real concern voiced by so many deeply involved in the success of health care reform, then why would the Universal Health Care Foundation of CT characterize “Rate Shock” as a “myth” and “scare tactic” in a recent blog post? Their position defies words and logic.

Their opinion that a “large majority” of the uninsured and underinsured will be eligible for Medicaid or subsidize is correct BUT there is a huge portion of our population that is going to need to buy health insurance with little or no subsidy -- in short they will be buying it retail.

If this portion of our population sees the health insurance options available as too expensive, they could simply opt out of buying coverage at all and just pay the penalty. This would not be good for the overall success of the Exchange and health care reform in general. In short, “Rate Shock” With Maryland’s Exchange just announcing their plans will reflect a 25% price increase, there is no reason to believe Connecticut will be any different.

Should we be “scared”? No.. Should we be informed, educated and involved? Yes.. Should legislation be passed directing the Exchange to use “Active Purchasing” Yes.. Should legislation be passed to adjust the “Medical Loss Ratio”? Yes. Should legislation be passed directing the Exchange to use “secret shoppers to insure we have true “network Adequacy”? Yes.. Should we work to make the best health insurance buying environment possible? Yes. Should we mischaracterize the reality of “Rate Shock” as a “myth” and “scare tactics”? No

Kevin Galvin Small Business For A Healthy Connecticut

Health Insurance Rate Shock: What Connecticut Can Do

All indications are that Connecticut health insurance costs will rise significantly next year. Fortunately there are several tools available to policymakers to mitigate that trend for Connecticut consumers and small businesses who will be mandated to secure coverage as of January 1st. A new brief outlines state affordability options including a stronger state MLR limit, active purchasing, reinsurance, capping rate increases, limiting insurer losses, and state supplemental subsidies. It is also critical to address the underlying causes of rising health costs that drive insurance prices including misaligned payment incentives, overtreatment, poorly coordinated care, waste, excessive administrative costs, and consumer disengagement. Affordable insurance coverage is critical for successful health reform. State policymakers should use every available tool.

Rate Shock Officially on the Exchange Board’s Radar

We appreciate OPM Secretary Ben Barnes for bringing up the subject of health insurance affordability and “Rate Shock” at this week’s CT Health Insurance Exchange Board meeting by floating the idea that legislation be passed allowing a lowering of the Medical Loss Ratio. As in other states, lowering the Medical Loss Ratio will most assuredly bring health insurance costs down. The unanimous vote of the Exchange Board finally acknowledges that the high cost of health insurance products coming onto the Exchange is a factor in the overall success in attracting Connecticut residents to the Exchange to purchase health insurance.

Now let’s hope that competitive bidding known in the industry as active purchasing also be made part of the Health Insurance Exchange’s practices. Active purchasing has a proven record of controlling health insurance costs.

Kevin Galvin, Small Business for a Healthy CT

Exchange Board Balance

In late fall of 2012 two Exchange Board seats became vacant due to resignations and a third was dropped completely with the resignation of the Special Advisor to the Governor on Health Reform. That seat no longer exists. After more than three months, one seat has been filled by Mr. Paul Philpott currently a Realtor in Connecticut and retired for the Connecticut Insurance Industry. Although I commend Mr. Philpott for his willingness to take this challenging voluntary position, Mr. Philpot is yet another person from the insurance industry on what was supposed to be a Board populated by "consumers". As of Thursday's Exchange Board meeting the "Small Business" seat has yet to be filled. This appointment has been the responsibility of State Representative Larry Cafero. It is unfortunate Representative Cafero has chosen not to make this appointment during such a critical time for our Exchange. But our legislature has given the Exchange some attention. The Insurance and Restate Committee recently voted unanimously to add a broker seat to our Exchange, a clear violation of the letter and spirit of the Affordable Care Act. Unfortunately small businesses, the largest employer in the state and nation, do not presently have a seat at Connecticut’s Health Care Exchange table.

Kevin Galvin Small Business For A Healthy Connecticut

Positive active purchasing hearing

Fifteen of the nineteen testimonies for yesterday’s Insurance Committee public hearing on SB-596 were in favor of active purchasing. Proponents included the State Comptroller, State Health Care Advocate, small business and community groups, brokers, labor, patient safety, legal aid, consumer and faith-based groups. Opponents included CBIA, the HMO Association, NFIB, and the Exchange staff. The CT Health Insurance Exchange Board and staff have rejected negotiating premiums with plans to keep costs affordable. MA’s exchange has saved consumers millions through negotiation. Utah’s exchange does not negotiate, taking any willing insurer, and premiums inside the exchange are higher than outside. Committee members asked great questions about how much consumers could save, states that are making it work, operational questions, health cost drivers and solutions, philosophical questions about the role of government, and impact on the rest of the market. The committee was especially interested that CA is planning to negotiate rates with their plans and have received 30 letters of intent from plans, countering the concern that plans would not apply. Committee members were also interested in research on how much choice is optimal for consumers before it becomes overwhelming and counter-productive.

Bills filed to fix insurance exchange and strengthen premium rate review

Sen. Joe Crisco, Co-Chair of the Insurance and Real Estate Committee, has filed bills to protect consumers in health reform. An Act Concerning the Duties of the CT Health Insurance Exchange directs the exchange to actively negotiate premiums with insurers on behalf of consumers. Other states are using negotiation to keep premiums more affordable. An Act Concerning the Insurance Department’s Review of Health Insurance Premium Rates directs the department to consider consumer out-of-pocket costs, affordability, provider rates, executive compensation in approving insurer rates and to directly monitor provider network adequacy. Both concepts are included in 31 Ways to Save Money in CT’s Health Care Budget.

CT Insurance Exchange standard plan proposal too expensive for consumers

The draft standard plan proposal for the CT Health Insurance Exchange includes copays of $40 to $45 for a physician visit (CT 2011 average $23.79), $150 ER copays, and deductibles up to $3,000 for individuals and $6,000 for families (CT 2011 average $1,331 and $2,500 respectively). Better, more affordable plans are currently available in CT on eHealthInsurance.com. It is important to note that the Exchange will be marketing their plans to CT’s uninsured, who couldn’t afford the more reasonable options available now. In what is becoming standard process for the Exchange, the proposal was developed by Exchange staff with industry insiders in non-public meetings. The draft was open for public comment until today but it was never released to the public or posted on a public website. Some Exchange Board members didn’t know anything about the process. Click here for our comments.

Mickey Herbert joins Harvard Pilgrim

Former ConnectiCare CEO, Mickey Herbert, has joined Harvard Pilgrim Health Care as a consultant. Harvard Pilgrim has applied for a license to expand to CT’s insurance marketplace. He resigned from the CT Health Insurance Exchange Board a month ago, adding to growing conflict of interest concerns. Concerns have been raised about Board members ties to and investments in insurance companies despite strong conflict of interest limits in state law.

Five large CT insurers interested in exchange

Aetna, Anthem, ConnectiCare, HealthyCT (the new nonprofit co-op plan), and United all sent letters of intent to the CT Health Insurance Exchange signaling their intent to participate. The other large insurer in the state, CIGNA, does not participate in CT’s individual market, according to exchange staff. Harvard Pilgrim did not submit a letter, but may be awaiting licensure. While not binding, the response is very good. As advocates predicted, there was little need to worry about insurers not participating in the exchange. Advocates have criticized the exchange for designing policies very favorable to insurers, lax in accountability, and unaffordable for consumers and small businesses.