Insurance exchange committee updates

The first meetings of the four CT health insurance exchange advisory committees were largely uneventful and had a lot in common. They were mainly led by consultants, lacked diversity, emphasized principles (already drafted by the consultants), timelines and goals. In three committees, access to outside information was limited and discouraged. In contrast, the Consumer committee appears to be developing a formal process to collect it. In every committee, the consultants emphasized the need to be cost conscious. The Qualified Health Plan committee did not address a very important policy decision, whether the exchange will be an active purchaser of health plans – negotiating on behalf of members as one large entity for better prices and to enhance quality. The Massachusetts connector is an active purchaser and has kept price increase well below the level of plans in the rest of the market. The Navigator committee spent most of its time talking about the role of brokers, agents and other stakeholders, navigator training and certification, and the need for good research on the exchange’s consumers. The latest federal regulations preclude brokers who are paid by insurance companies to sell their products from being paid as navigators inside the exchange. The Consumer committee talked about the Basic Health Program Option and making sure plans are affordable for consumers. Advocates at that meeting also pushed back at consultants’ suggestion that cost cutting had to come at the expense of outreach – using existing resources. (They acknowledged that outreach is often the first to be cut, with an expectation that nonprofits and community groups will do the work within their available resources.) At the Small Business committee the consultants announced that they expect to go out to bid for plans in that exchange later this summer.

Insurance exchange Board meeting update

The CT Health Insurance Exchange Board chose their three CEO candidates to send on to the Governor at last week’s meeting. The decision was made without a voting consumer representative and after another hour-long closed-door meeting. Names of the three chosen were not released; hopefully they do not have close ties to the insurance industry. A bill to add one consumer and one small business representative is making its way slowly through the General Assembly. In an interesting irony, the Board has determined that the general perception of CT stakeholders is that they have not accomplished much. Rather than consider whether the crowd is wise and improve performance, they have chosen to engage their communications consultants to fix their image with a media campaign including postcards, emails, webinars, and a website. Thankfully they have heard from CMS about the need to keep costs under some control and are looking to coordinate with state agencies, especially DSS, and with the federally funded New England IT exchange collaboration. RI, the first state to receive Level 2 exchange funding, did not receive their full request as CMS asked them to reuse available resources. CT’s exchange is reportedly also seeking to borrow a large sum from the General Fund until more federal money is granted and plan to hire nine more staff. The Board was asked to trust their leader and staff and authorize the exchange to enter into an undisclosed $3 million contract. Board member requests for information on the contract, the services to be delivered, the contractor, or the process used to choose them were denied. In good news, they will be engaging a research consultant to develop a better analysis of who likely exchange customers are, where they live, etc.

Connecticut’s insurance exchange gets a C

This month Connecticut health care thought leaders give our state’s insurance exchange a C grade, unchanged from the March survey. Overall reform efforts did somewhat better at a C+,  and a B-/C+ for effort. Medicaid is again the bright spot, earning a B. Health Insurance Market Reform and Data-based Policymaking joined Engaging Consumers in Policymaking in earning D grades this month. Forty percent more respondents answered Don’t Know on one or more issue areas this month, emphasizing the need for better communication and coordination in health policymaking. Asked for suggestions to improve Connecticut’s progress toward reform, several themes emerged including engage consumers in policymaking, smarter policymaking, urgency -- move more quickly, and implement a public option through the SustiNet plan. For more on how CT is progressing toward reform, visit the CT Health Reform Dashboard.

April CT Health Reform Dashboard -- 10.8% progress to date

This month again CT is making progress toward health reform. This month we are 10.8% of the way toward health reform. Unfortunately we are only up from 10.7% last month. At this rate, it will take 48 years to fully implement reform. Track CT’s progress on the CT Health Reform Dashboard at www.cthealthreform.org

Exchange advisory committees begin work

Last week the four CT Health Insurance Exchange advisory committees held their first meeting jointly. The meeting included a very good presentation on the basics of the exchange and a list of the decision points for each committee. The next advisory committee meetings, all public and all tentatively in Room 310 of the Capitol, will be:

Consumer Experience and Outreach

April 10^th  9 to 11am

Brokers, Agents and Navigators

April 10th  12:30 to 2:30pm

Health Plan Benefits and Qualifications

April 11^th   9 to 11am

Small Business Health Plan Options Program (SHOP)

TBD

Experience to inform health insurance exchange outreach

CT has a long and varied history of outreach programs; some worked very well and some were less successful. There is a great deal of experience available to the CT Health Insurance Exchange and their consultants to design a robust program that meets the needs of individuals and small businesses likely to enroll. As individuals will be required under federal law to purchase coverage, and 140,000 state residents will have to buy it on the exchange to access subsidies, it is vital that we learn from experience and not repeat mistakes. We’ve collected some of that experience in a new brief. We offer this experience to the Exchange to help ensure a viable, trusted Exchange is developed that makes serving its customers their first priority.

Insurance Exchange meeting allows limited public comment

Partially responding to widespread calls to respect consumer voices, the CT Health Insurance Exchange Board allowed 12 minutes of public comment at the beginning of today’s meeting. Speakers were limited to two minutes each – there was only time for five. They heard from a struggling consumer, a small business owner, advocates and a representative of the faith community that, while we are grateful for this effort, the process needs to be far more open. Several Board members seemed moved by the testimony and understood that they are missing important perspectives critical if the exchange is going to work. The Board is currently hiring senior staff, developing a budget, beginning to develop a mission statement and guiding principles, and choosing an administrator for the exchange, all without voting consumer input. Mintz and Hoke, the advertising agency hired for consumer input, was criticized by speakers and Board members for soliciting limited input and not reaching out to CT’s well-organized consumer advocacy networks. Their scope is limited to message-testing for the eventual exchange products, not listening to customers about how those products should be designed to meet the demands of the market. They emphasized mass media, which has not historically been successful in outreach in CT, social media and texting. While texting and social media are commonly used between young invincibles in personal communications, it is unclear whether they are effective vehicles to sell health insurance. They are still researching other states’ consumer research efforts and populations eligible for the exchange; unfortunately, it is unclear if there is time for a learning curve. The speaker helping the Board with governance put consumers at the end of the chain of stakeholders (never mentioned small businesses) and equated consumers with providers and health plans in importance. It was clear that Board members have not seen consulting contracts, RFPs or other solicitations before they are finalized. The administrative RFP will be “fast tracked” concerning many consumers and small businesses.  Mike Devine, the only small business owner on the Board, asked whether KPMG, hired for business operations, had investigated overlap with other agencies in CT, and other states. There is likely a great deal of overlap with other states, particularly the New England collaborative, and federal and very well-resourced privately funded programs that are developing innovative enrollment, operations and outreach programs. After an hour and a half of public meeting, the Board went into secret executive session for an hour and twenty minutes. After which they reconvened for less than a minute to adjourn, without voting or reporting on what was discussed in executive session.

Ellen Andrews