CT Health Insurance Exchange Watch

CT Health Reform Dashboard -- 10.7% progress to date

2012-03-05T09:55:00.002-05:00

The good news is that CT is making progress. This month we are 10.7% of the way toward health reform. The bad news is that we are up from 10.4% last month. Track CT’s progress on the CT Health Reform Dashboard at www.cthealthreform.org

Bill adding consumer and small business voices to Exchange Board passes Insurance Committee unanimously

2012-02-22T12:56:00.000-05:00

Yesterday the legislature’s Insurance Committee unanimously passed HB-5013 with substitute language. The new bill language adds one consumer and one small business representative to the CT Health Insurance Exchange Board and makes the State Health Care Advocate a voting member. The bill will be effective upon passage. The bipartisan bill partially addresses concerns raised by advocates, small businesses, editorial boards and others about the lack of consumer and small business voices on the Exchange. The bill now goes to the House floor.

Advocates speak up in Exchange Board meeting

2012-02-17T14:03:00.002-05:00

Yesterday, advocates spoke out during the CT Health Insurance Exchange Board meeting to protest the lack of consumer voices on the Board. The Board has been widely criticized for lacking any voting consumer members, despite federal regulations that call for consumers to comprise a majority of voting members. Several members of the Board called for more transparency, better communication and regular opportunities for public comment. Jeanette DeJesus, Special Advisor to the Governor on Health Reform, expressed support for the protestors. The Board is quickly staffing up and expects to have most of the important operational pieces in place by the next meeting scheduled for March 15^th. Advocates have called for legislation, effective immediately, to add consumer and small business votes to the Board before the next meeting to ensure stakeholder input into those critical decisions. CT is among a small minority of states moving this quickly to establish exchanges; most states have not yet decided whether to run their exchange themselves or let the federal government do it. The Board has hired a public relations firm to collect input from stakeholder groups including consumers, brokers, small businesses, insurers and providers. The consultants will be holding meetings across the state in the next week. Those meetings were to be invitation-only but Board members at the meeting insisted in opening them to the public.

Ellen Andrews

New press on insurance exchange’s problems

2012-02-15T08:01:00.002-05:00

The Hartford Business Journal has published a series of articles on the problems and challenges facing CT’s insurance exchange.

Mercer recommends letting CBIA run small business exchange

Advocates oppose CBIA role in exchange

Exchange having trouble finding a CEO

Survey finds CT employers cool to exchange

Insurance public hearing to add consumers and small businesses to insurance exchange board

2012-02-14T18:50:00.003-05:00

Today, the Insurance and Real Estate Committee held a public hearing on HB-5013 – a very weak bill that would have added only one, narrowly defined consumer advocate and one small business person to the exchange but not before July 1st. It also would have given the State Health Care Advocate a vote But again not until July 1^st – safely after all the important decisions have been made. The Board has been criticized for having three members representing insurance interests and no voting consumer representatives. The Board is now choosing a CEO and a team of other senior management (at eye-popping salaries) and considering whether to cede the small business exchange to CBIA. Many people, including consumers, advocates, brokers, small businesses, providers and labor representatives, spoke to the need for at least two consumer reps and two more small business people on the Board. Speakers also emphasized that the CEO being hired should be independent of the insurance industry, to help build some credibility for the exchange among the people who will rely on it for affordable coverage in 2014 when the individual mandate becomes effective. Speakers also strongly opposed allowing CBIA to run any part of the exchange. CBIA has lobbied against state and national reform in the past; handing the exchange to opponents of reform invites failure. Speakers also asked for the legislature to clarify that the Ethics Commission enforces conflict of interest provisions in the original law, specifically excluding Board members affiliated with insurance companies.

Ellen Andrews

CT Health Reform Dashboard -- 10.4% progress to date

2012-02-06T09:55:00.002-05:00

How is CT doing reforming our broken health system? Are we making smart choices? Are we taking advantage of opportunities? Having trouble keeping up with the many moving parts? Visit our CT Health Reform Dashboard at www.cthealthreform.org

Exchange Board seeking nominations for advisory groups

2012-01-25T07:44:00.002-05:00

The CT Health Insurance Exchange is soliciting nominations for four advisory committees – health plan benefits and qualifications, small business, consumer experience and outreach, and navigators. The committees are purely advisory to the Board and will “serve to assist the Exchange in establishing policy, refining goals, delineating functions, and providing on-going program evaluation.” The committees will not have voting rights or formal input into policy and will only serve to advise the Board. Committee chairs will be chosen by the Lieutenant Governor. If you are interested in serving, descriptions of the committees, Board members already chairing and populating committees, and a nomination form are online. Nominations are due February 3^rd.

CT Insurance Exchange seeks comment – sort of

2012-01-24T11:07:00.002-05:00

Criticized for spending too much time in secret executive session and insurance industry dominance, the CT Insurance Exchange is finally seeking public comment – sort of. They commissioned a report from Mercer to serve as the foundation for policy decisions in designing the exchange. The report covers a multitude of areas – CT’s insurance market, products currently offered to individuals and small businesses, and demographics and income profile of CT’s uninsured to name a few. The report is 408 pages. The Exchange is soliciting public comment. But you have only a week to read and digest it, do the research to identify gaps and biases, and submit comments which are limited to three pages. There is no commitment or even a discussion of how (or whether) our hard work in commenting will be used or even read.

If this is what passes for public stakeholder input, the Exchange is out of touch.

Update – The comment period has been extended to just under two weeks.

Ellen Andrews

Advocates protest at last week’s Exchange Board meeting

2012-01-23T10:23:00.002-05:00

Last Thursday’s Board meeting was attended by dozens of consumer advocates protesting insurance domination of the Board’s membership and the absence of consumer voices. The advocates wore Band Aids over their mouths and stood with signs protesting the lack of even one voting consumer member; federal regulations say the majority of voting members should represent consumers and small businesses.

OP-ED: Health Insurance Exchange Needs a Passionate and Visionary CEO

2012-01-10T07:08:00.002-05:00

As Connecticut prepares to launch its Health Insurance Exchange (HIX) as part of health care reform, those of us that live and work here must work together to ensure our needs as consumers are met. It is concerning that the Board of the HIX is composed of several recent insurance company executives and almost no consumers. The Board is currently in the midst of hiring the CEO and the other key management positions. If as citizens and consumers, we fail to make our voices heard and advocate for a CEO that is consumer-oriented; the Board will most likely either hire a mid-level insurance company executive or a bureaucrat as the CEO. As consumers, we would then not have a reform oriented CEO that would be a passionate visionary in helping create an effective HIX that will make real health insurance plan choices available in Connecticut for Individuals and Small Businesses.

Since the HIX is a quasi-government start-up small business enterprise, basically a health insurance brokerage firm, it is extremely important that the person have experience in growing a small business from 5-to-50 employees in under a year; and that they are very familiar with the inner-workings of the State Capitol. If the CEO is not a passionate visionary that understands the significant positive impact the HIX will can have for Connecticut’s citizens, it is highly unlikely that the person will be willing to work the typical 60 plus hours a week that a small business owner works when growing a business; or, find ways to overcome governmental hurdles that will be an inherent part of launching the HIX. The CEO should be knowledgeable and experienced with Connecticut’s current health insurance marketplace for Individuals and Small Businesses; including the differences in mandates. For example, maternity, normal childbirth, is not a covered or mandated benefit in Individual health insurance plans; but small business health plans do mandate coverage for the benefit. A CEO that is consumer-oriented would most likely advocate for covering maternity in Individual health plans; instead of leaving Medicaid to cover all pregnancies in the Individual marketplace.

If the citizens of Connecticut do not advocate for a passionate consumer-oriented reform minded visionary as the CEO of the HIX, it is likely that we will be left behind, again. As an example of the need to advocate today; at a recent HIX Board meeting, a consultant with experience in launching the Massachusetts Health Exchange several years ago stated that Connecticut should look to their experience and avoid the mistakes they made in launching their exchange and significantly underestimating how many people would turn to the exchange for their health benefits. One of our HIX Board members stated that the consultant’s numbers of possible enrollees in Connecticut’s HIX were too optimistic at ~100,000; and that even 40,000 enrollees would be an overly optimistic number for January 1, 2014. The comment was that there is no significant cost savings to consumers; and that the Federal Premium Subsidies for Individuals and Federal Tax Credits for Small Businesses only available through the HIX would not be significant enough for consumers or Small Business owners to make the effort to purchase their health insurance plans through the exchange.

Tony Pinto

MA Connector speaker Monday talks about small businesses and the exchange

2012-01-06T16:39:00.000-05:00

Patrick Hollander, former CFO of the MA Health Connector will speak at the Speaker’s Working Group on Small Business Health Care Monday Jan. 9^th at 3pm in Room 1D of the LOB.

The next meeting of the CT Health Insurance Exchange Board is set for Jan. 19^th at 9am in Room 1A of the LOB.

Exchange Board Consultant & Members View of a “Meaningful” Tax Credit

2011-12-18T16:42:00.002-05:00

At the CT Health Insurance Exchange meeting on Dec 15, both the consultant and some Board members stated that the current federal Tax Credit available to Small Businesses from 2010 through 2015 is not meaningful enough for employers to motivate employers to enter the Exchange in 2014 for the tax credit. Simply explained, they are implying that an employer will not bother to purchase their employee benefits through the Exchange, because the tax credit isn’t worth their time. This also assumes that small employers also have no interest in letting their low income employees get federal tax subsidies to offset their share of the premium payments.

Therefore, this author decided to run some scenarios using available online tax calculators. I am not a tax advisor, so these examples are for reference. In having attended a seminar by an IRS representative recently, it makes one question what assumptions the consultant made in their calculations. Important items to note that were pointed out during the seminar; 1) owners and family members, including extended family, are not included in the tax credit calculation; and 2) the numbers are based of FTE’s, meaning part-time employee hours worked are combined to create full-time equivalent employees. As any small business owner knows, excluding family; and including lower wage part-time employees in this type of calculation actually increases the ability to qualify for the tax credit and the amount of the tax credit.

The tax credit has been available since 2010 and allows a for-profit business the option of a five-year carryback, but the credit can only offset actual earnings. For Non-Profits, the tax credit is reduced, but it is also refundable. The tax credit is available to employers with up-to 25 FTE’s, so we are primarily discussing the small locally owned and operated business in our own communities. The following examples assume full time employees with average employee wage of $15/hour, working 40 hours/week, 52 weeks/year and that the average cost of the health insurance premium to the employer is $8,000/employee. The $8,000/employee is based on a 2/3 to 1/3 ratio of employee only plans to family coverage plans with annual premiums of $6,000 and $12,000, respectively; and that the employer pays 50% of the premium cost of the health insurance. Based on many years of working with these size employers, these are very realistic numbers.

For a for-profit employer:

3 FT Employees; Estimated Annual Tax Credit 2010-2013 = $3,192, and for 2014/2015 = $4,560.

9 FT Employees; Estimated Annual Tax Credit 2010-2013 = $9,576 and for 2014/2015 = $13,680.

18 FT Employees; Estimated Annual Tax Credit 2010-2013 = $5,712, and for 2014/2015 = $8,160.

For a non-profit employer:

3 FT Employees; Estimated Annual Tax Credit 2010-2013 = $2,160, and for 2014/2015 = $3,024.

9 FT Employees; Estimated Annual Tax Credit 2010-2013 = $6,840, and for 2014/2015 = $9,576.

18 FT Employees; Estimated Annual Tax Credit 2010-2013 = $4,080, and for 2014/2015 = $5,712.

The above numbers are estimates and an accountant would have to verify the actual numbers on a case-by-case basis. However, if you are a small employer, I am certain that you can relate to the above numbers. Therefore, if reasonable health insurance plans, similar to today’s plans, are actually available on the Exchange; I believe all employers that qualify for the credit will try and purchase their benefits through the Exchange. Simply put, I don’t know too many small business owners that have $1,000’s to burn! It is absolute proof that the consultant and some board members are completely disconnected from the struggles of a small business owner!!! Do they not understand that $500 to $1,000 per month, as estimated above, is the difference between making payroll or not; or, keeping the electricity on or not; or, paying this month’s rent or not! Seriously, do they really understand small business? And, can we trust them to do what’s in the best interest of small businesses???

Tony Pinto

Mercer finishes report to Exchange Board

2011-12-16T10:07:00.003-05:00

Mercer’s analysis predicts that exercising the Basic Health Plan Option would save CT between $145 and $30 per member per month. The Basic Health Option was created in the Affordable Care Act; Mercer estimates that 74,000 people in CT would be eligible. The option allows states to enroll residents just above Medicaid eligibility levels to 200% of the federal poverty level (now $21,780/year for an individual, $45,700 for a family of four) into a state-sponsored plan similar to Medicaid in 2014. The feds will reimburse the state 95% of the cost of subsidies those consumers would have received in the insurance exchange. Up to this report, there has been some disagreement on the potential savings/costs of CT choosing the option. Advocates are concerned that without the Basic Health Plan, low-income consumers, some now in Medicaid, would be forced into lower-value, unaffordable options in the exchange. As incomes fluctuate more at lower incomes, choosing the Basic Health Option will improve continuity of care for more people in CT.

Mercer also estimates that 40,000 people will join the small business exchange and 185,000 will join as individuals. This is substantially lower than a CT estimate by RAND for the Council of State Governments using a different model. Mercer estimates that only 5% of small businesses not eligible for subsidies will purchase coverage in the exchange and that many will drop coverage entirely, leaving their workers in the individual market. Board members noted that employers in MA did not drop coverage during their health reforms five years ago. Mercer acknowledged that these are estimates and a great deal depends on effective outreach and public education campaigns. Again, Board members are focused on low numbers of small businesses in MA’s exchange and asking “how can we avoid mistakes made in MA.” They are missing the larger point -- since their reforms and creation of their exchange, the percent of MA small businesses offering health benefits is up, while it dropped significantly in CT during those same years.

Mercer also found little impact of incorporating CT’s high risk pools into the exchange. They estimate that merging the small group and individual markets would lower individual premiums by 2% but raise small groups’ by 4%. Again this is different than what MA experienced – individual premiums averaged 33% less after reform. Mercer also found that the individual mandate penalty makes very little difference in the number of uninsured, even if the penalty was tripled from current law. (Is this where advocates say – I told you so?)

Another Hartford Courant editorial calls on insurance exchange to add consumer voices

2011-12-14T07:51:00.002-05:00

For the second time, the Hartford Courant’s Editorial Board has called on the health insurance exchange to add voting consumer members. “Giving consumer advocates a voice, and a vote, will almost surely further the stated goals of the exchange: to provide more health care choices, to enhance the quality of health care, to hold insurance companies more accountable and to lower health care costs.” The editorial points out that Lt. Gov. Wyman, Chair of the Exchange, believes that legislators need to change the law but “she also made the curious statement that adding consumer voices to the board ‘would do nothing less than undermine the progress Connecticut has made in becoming one of the states in the forefront of implementing this historic and much-needed reform.’" Frankly, the law is fine, a national model in conflict of interest protection, excluding any members “affiliated” with insurers. Federal regulations also state that a majority of members should represent consumers. Currently, three Board members have deep ties to the insurance industry and no voting members represent consumers. One in ten CT residents is expected to buy their coverage from the exchange. The Board is responsible for deciding which insurers will be able to sell plans in the exchange, what standards they will have to meet, what benefits they have to offer, and what they can charge.

Former CEO of ConnectiCare believes he is a consumer advocate

2011-12-08T07:17:00.002-05:00

In a Hartford Courant article Mickey Hebert, a controversial former insurance executive nominated to the CT insurance exchange board, maintains that he is fully capable of understanding the needs of consumers. Advocates dispute that claim, outlining important qualifications that only people who have assisted consumers meet the standard. Advocates are also skeptical that a former insurance executive can put aside his former occupation, looking out for the interests of a for-profit insurance company, and act in consumers’ best interests, especially when the two are at odds. The state law that created the exchange includes strong conflict of interest language excluding membership on the Board by anyone “affiliated” with an insurance company. Federal regulations state that a majority of voting Board members should be consumer representatives.

More MA small businesses offer health benefits after reform, lessons for CT exchange

2011-12-07T11:37:00.003-05:00

Massachusetts implemented sweeping health reforms in 2006, including creating a health insurance exchange – the MA Health Connector. The reforms were very successful in increasing health coverage in the state; less than 2 percent of residents are now uninsured. The percentage of Massachusetts’s smallest businesses (under 10 workers) offering health benefits to their employees rose by 2 percent from 2005 to 2010 while the US average fell 4% and Connecticut’s rate dropped 7%. For more, read the first CT Health Insurance Exchange Watch Brief. In recent discussions at the CT Health Insurance Exchange Board meetings, much has been made of low small business enrollment in the MA Health Connector. Board members and presenters have focused on how to make Connecticut’s exchange attractive to small businesses. But the point isn’t to build enrollment in the exchange, it is to get people and small businesses covered. It is very possible that the MA Health Connector’s ability to offer quality products at more affordable prices placed competitive pressure on the market outside the exchange to improve options. Building a functional exchange in Connecticut can have positive effects on the rest of the market. We urge the CT Health Exchange Board to refocus on providing affordable, quality insurance options to everyone. Let the market do its work.

Small businesses ask HHS for help with CT insurance exchange

2011-12-07T11:36:00.005-05:00

Small Business for a Healthy CT, a coalition of small companies, sent a letter yesterday asking HHS Secretary Sebelius to intervene with CT policymakers and reverse insurance industry domination of the CT Health Insurance Exchange Board. SBHCT is among at least a dozen advocacy groups that have voiced concerns about the Board membership which includes three insurance industry representatives but no voting consumer representatives and only one small business owner. The exchange is being created under national health reform with federal funding and is meant to be a consumer-friendly marketplace for coverage. It is expected that one in ten CT residents will get their coverage through the exchange. State law excludes anyone “affiliated” with insurance companies from Board membership and federal regulations state that consumer representatives should be a majority of voting members. The Board will decide which insurance plans are allowed to offer plans in the exchange, what benefits they have to offer, what standards they have to meet and how much they can charge consumers. Press reports include radio reports, CT News Junkie, the New Haven Register, Hartford Business Journal, Public News Service, CT Mirror, and The Hill.

Advocates file ethics complaint over health insurance exchange insurance reps

2011-12-07T11:36:00.002-05:00

A group of eight organizations, led by Citizens for Economic Opportunity and including the CT Health Policy Project, have requested an inquiry into the appointment of three members of the CT Health Insurance Exchange. The letter asserts that the appointments violate the law that created the Exchange which excludes membership by anyone “affiliated with or otherwise a representative of” insurance companies. The three members outlined in the letters have long work histories with insurers and little evidence of significant or recent experience outside the insurance industry.

Advocate and small business concerns about CT insurance exchange

2011-12-07T11:35:00.002-05:00

Together with Small Businesses for a Healthy CT, the CT Health Policy Project has been meeting with CT Health Insurance Exchange Board members. The Board has been criticized for lacking consumer representation. Our concerns center on rebuilding public trust, effective outreach and public education, active purchasing to use the collective power of the exchange to get the best value for members, maintaining an even playing field inside and outside the exchange, a grownup conversation on mandates, and coordination with Medicaid. We are finding a lot of overlap and some of our best support is coming from unlikely sources. The Board is currently seeking a CEO.

Small businesses know health insurance exchange is a jobs issue

2011-12-07T11:33:00.005-05:00

In a CT News Junkie opinion piece, Kevin Galvin of Small Business for a Healthy CT, wrote -- When asked to identify their biggest challenges, small business owners in Connecticut and across the country have said that one of the greatest is the prohibitively high cost of providing health insurance. CT cannot become a business-friendly state without addressing the difficulty of insuring workers. He also notes that the insurer-dominated CT Health Insurance Exchange Board does not inspire confidence. He calls for the addition of consumer and small business representatives to that Board, as does proposed federal regulation. He calls on the Governor and General Assembly to include those representatives in the upcoming jobs bill and special session.

Editorials support consumer representation on CT health insurance exchange

2011-12-07T11:33:00.002-05:00

The Hartford Courant and the New Haven Register have both run editorials calling on policymakers to add consumer and small business representatives to the CT Health Insurance Exchange Board. Advocates have raised concerns about insurance industry dominance in the Board membership and the lack of consumer and small business representation. One in ten state residents are expected to rely on the exchange to purchase coverage in 2014 when the federal individual mandate becomes effective. An estimated 140,000 state residents will have no choice but to purchase coverage in the exchange to access affordability subsidies. The Board will make important decisions about which plans are included in the exchange, how much they can charge, and what services they will cover. Consumer voices must be at the table, with a vote.

Insurance Exchange Board members dominated by insurance interests, no consumer representatives

2011-12-07T11:31:00.002-05:00

Members of CT Health Insurance Exchange Board were announced in August. Despite federal law calling for a majority of members to represent consumers, there are no consumer advocate voting members. (Thankfully Vicki Veltri, State Health Care Advocate, will sit at the table but cannot vote.) In addition, three members have long ties to insurance companies as recent employees. This is despite CT law barring members affiliated with insurers, among others, in strong conflict of interest language that has been a beacon among states. Advocates are concerned that representatives of the insurance industry lobbied hard to stop passage of health reform in Washington but are now placed in charge of implementing it here in CT. One in ten state residents are expected to rely on the exchange to purchase coverage in 2014 when the individual mandate becomes effective. It is critical that consumers eligible for Medicaid who apply through the exchange are appropriately referred to that program rather than diverted into insurance plans in the exchange. Advocates sent a letter to members urging them to set aside insurance ties and make consumers their top priority. For press reports, click here, here, here, here, here and here.

Advocates urge CT Health Insurance Exchange Board members to consider consumers’ needs

2011-12-07T11:29:00.002-05:00

In an August letter to the newly appointed members of the CT Health Insurance Exchange Board, eleven consumer advocacy organizations offered to help in their important work and urged the members to keep the needs of consumers in mind in all decisions. The insurance exchange was created in response to national health reform; most states are taking the option to create their own exchange with federal start up funding. The exchange was designed to provide CT consumers and small businesses with a rational, fair marketplace to purchase health insurance. It is critical that this market be a trusted credible source for consumers who will be required to purchase health insurance in 2014. It is estimated that one in ten state residents will secure coverage through the exchange by 2016 including 140,000 eligible for federal premium subsidies who will be required to purchase coverage through the exchange. The Board will have a number of difficult and controversial decisions to make including whether to allow any willing insurer to participate, as Utah has chosen, or actively purchase coverage to get the best deal for consumers, the Massachusetts model. The Board will have to decide which state mandates, if any, beyond the federal essential benefit package (EBP) to require of exchange plans, with the state likely paying the cost for those benefits. The proposed EBP is expected to be announced this fall. The Board will have to decide whether to create separate exchanges for individuals and for small businesses, whether to merge the small group and individual markets, and hire staff to run the exchange. CT’s law creating the exchange included very strong conflict of interest language supported by advocates, excluding people currently affiliated with the insurance industry among others. We expect that all members will honor the spirit of the law, regardless of background.

CT Health Insurance Exchange Watch

CT Health Reform Dashboard -- 10.7% progress to date

Bill adding consumer and small business voices to Exchange Board passes Insurance Committee unanimously

Advocates speak up in Exchange Board meeting

New press on insurance exchange’s problems

Insurance public hearing to add consumers and small businesses to insurance exchange board

CT Health Reform Dashboard -- 10.4% progress to date

Exchange Board seeking nominations for advisory groups

CT Insurance Exchange seeks comment – sort of

Advocates protest at last week’s Exchange Board meeting

OP-ED: Health Insurance Exchange Needs a Passionate and Visionary CEO

MA Connector speaker Monday talks about small businesses and the exchange

Exchange Board Consultant & Members View of a “Meaningful” Tax Credit

Mercer finishes report to Exchange Board

Another Hartford Courant editorial calls on insurance exchange to add consumer voices

More questions raised about insurance company rep.s on exchange board

Former CEO of ConnectiCare believes he is a consumer advocate

More MA small businesses offer health benefits after reform, lessons for CT exchange

Small businesses ask HHS for help with CT insurance exchange

Advocates file ethics complaint over health insurance exchange insurance reps

Advocate and small business concerns about CT insurance exchange

Small businesses know health insurance exchange is a jobs issue

Editorials support consumer representation on CT health insurance exchange

Insurance Exchange Board members dominated by insurance interests, no consumer representatives

Advocates urge CT Health Insurance Exchange Board members to consider consumers’ needs