CT Health Insurance Exchange and other briefs posted

The CT Health Policy Project’s 2012 candidate briefing book on CT’s health is posted – including a brief on the CT Health Insurance Exchange. In addition, this year’s book includes briefs on twelve other timely issues including health care cost drivers, Accountable Care Organizations, and CT & national health reform. The briefing book is part of www.cthealthbook.org – our resource library on health care issues and solutions facing CT.

Insurance Company Shenanigans – Part 2

If you live in CT and are insured through Golden Rule, now also known as United Healthcare’s United HealthOne; you should read the State of Connecticut’s Insurance Department notice # 509542, dated 8/17/2012. They filed a rate increase of 9.9% which the State of Connecticut cannot deny; since they filed it saying they will reimburse policy owners if they don’t spend 80 cents of every dollar on medical expenses. Let me interpret for you; according to the State of Connecticut, they are charging 3.3% more than they should be charging. Basically, on average, they are charging and collecting $380 more per year next year than this year; or by the State’s estimate $125 more per year than they should be charging you! Doesn’t sound like much, but consider this: you are financing the operations of a company that paid its CEO over $50 million in salary and benefits just a couple of years ago! Is this fair? Consider that $125 is the average, and that people with family plans are overpaying by far more than $125 per year to finance this $100 billion dollar corporation. Tony Pinto

Insurance Company Shenanigans – Part 1

In case you’re wondering why you don’t hear insurance companies complaining about Obamacare; it’s because they are big winners and don’t want to rock the boat. Insurance companies are “limited” to either paying out 80% of every dollar collected in the Individual and Small Group business market or 85% of every dollar collected in the Large Group business market. What this means is that they can keep 20% or 15% of every dollar respectively for themselves to cover their operational costs and create profits for them. Think about that… In the Individual and Small Group markets, they can keep 20% for themselves to pay their expenses and fill their pockets. Doesn’t seem like a big number; but, this means that the more expensive in dollars the health plan is; the more they make in profit. For example; if you buy a health plan that costs $400 per month with high co-payments; they can make $80 per month at-most at 20%. However; if you buy a health plan that costs $600 per month with lower co-payments; they can make $120 per month at 20%. Interesting, isn’t it… The more a health plan costs; the more profitable it can be for the insurance company. Tony Pinto

When choosing a plan in the exchange, actuarial value just a starting place

A new real-world analysis by the Commonwealth Fund demonstrates devil in the details of the bronze/silver/gold/platinum health plan actuarial value levels designed to guide consumers and small businesses choosing plans in the new insurance exchanges. The metal categories were designed to organize and make sense of confusing choices and combat deceptive insurance industry marketing practices. The analysis describes the very different costs and coverage available to individuals under plans from the same metal category. In some cases a “better” plan based on actuarial value can end up costing consumers more depending on their costs during the year. Unfortunately it is very difficult for most consumers to predict their future health costs – isn’t that why we have insurance in the first place? The study concludes, “actuarial value is a useful starting point for selecting a plan, but it does not pinpoint which plan will produce the best overall value for a particular person.” So much for making things simple. As of January 2014, consumers will be required to secure health coverage under federal law. Individuals eligible for premium subsidies must purchase coverage in the new state insurance exchanges. Leadership of CT’s Health Insurance Exchange, now developing, has been criticized as dominated by insurers and lacking independent consumer representation.

CT health reform progress up to 15.2%

CT made impressive progress toward health reform in August. We moved from 13.7% of the way to 15.2% this month. Highlights include negotiation of a compromise Essential Health Benefit Package and CMS grant funding to the insurance exchange. The grant is very exciting – the state plans to use most of the funding for a new, comprehensive IT system. If we do this right, this could solve a lot of our systemic problems. Unfortunately we fell behind in limiting monopoly providers by approving the Yale-New Haven – St. Raphael’s merger raising serious concerns about access to care for New Haven area un and underinsured consumers, and about costs for all of us. But we are stepping up progress – it’s been a good month.

HHS approves CT application for more insurance exchange funding

Today Health and Human Services, the federal agency tasked with approving and funding state insurance exchanges under the Affordable Care Act, announced that CT’s Level II insurance exchange application has been approved for $107 million, along with new grants for seven other states. A large part of CT’s grant is meant to fund development of an IT system to coordinate “eligibility, enrollment, and information exchange among individuals, employers, insurance carriers, and state and federal government agencies”. This function is sorely needed, long overdue, and hopefully CT’s Health Insurance Exchange will do a good job of designing and procuring this system. Advocates have been critical of many decisions made by the insurance-dominated exchange Board, which includes no independent consumer representatives.

Last chance: Seeking nominations for CT thought leaders

We are refreshing our invitation list for the CT Health Thoughtleader Survey. The survey has been cited by policymakers as a tool in evaluating our state’s progress toward reform. It is part of our CT Health Reform Dashboard. To keep the list robust and ensure a broad reach, we are seeking nominations for the survey. Who do you rely on for information on health reform in CT? Help us improve the tools for our state’s health policymakers and give us your nominations.