Rate Shock Myth Debunked

Posted on April 26, 2013 by

A recent blog post from Community Catalyst, focuses on dispelling the “RATE SHOCK” myth.  As the post says,

“Lately, many insurance industry-funded studies and the resulting news coverage of them have focused on the potential for “rate shock” for the young and healthy, fear mongering young adults and others into thinking their rates will skyrocket come 2014.”

Instead, the truth is far different from the claims of the rate shock scare tactics.  As another advocacy group, the Young Invincibles, points out:

“The reality is that most uninsured young adults will qualify for subsidies or Medicaid, making coverage better and more affordable – a fact that the ‘rate shock’ crowd ignores.”

So, contrary to the rate shock scare tactics, the Affordable Care Act (ACA) will not be frightening young adults away from health insurance.  In fact, the ACA is already responsible for improvements in the rates of coverage of young people, as reported in a study released by the Commonwealth Fund today.

What the study also shows, unfortunately, is that while there are fewer uninsured young adults, the overall numbers of uninsured and underinsured adults has continued to grow.  The Commonwealth Fund reports that forty six percent of adults aged 19-64, or 84 million people, had no insurance or inadequate protection from health care costs in 2012.  In 2003 that number was 61 million and in 2010 it was 81 million.

“Thirty percent, or 55 million people, were uninsured at the time of the survey or were insured but had spent some time uninsured in the past year. An additional 16 percent, or 30 million people, were insured but had such high out-of-pocket medical costs relative to their income that they could be considered underinsured.”

The study shows that it is lower income people that make up a disproportionate share of the uninsured and underinsured.  It also provides information to show the burden of medical debt and the high cost of medical care that is placed on many Americans.  Over 40 percent of adults surveyed avoided getting needed care due to cost concerns.  A similar number reported problems paying medical bills.

In Connecticut, the expansion of Medicaid and the implementation of the new insurance marketplace, Access Health CT, is due to occur in January, 2014, with enrollment beginning this October.  The large majority of the uninsured and underinsured in our state will be eligible either for Medicaid or subsidized coverage, thanks to the ACA.  And this will be coverage that is more comprehensive and has better out-of-pocket protections than is generally provided to individuals in the current insurance market.  This is welcome news, not scary news for Connecticut.

Jill Zorn is the Senior Program Officer for Universal Health Care Foundation of Connecticut.

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Long-view on health reform

Posted on April 24, 2013 by

By Frances G. Padilla
President, Universal Health Care Foundation of Connecticut

Frances - use this oneWhen the Strategy Subcommittee of Access Health CT, the new health insurance marketplace, asks for provocative ideas, that’s an encouraging sign for the people of Connecticut. And it was a welcome challenge for a group of colleagues and me recently.

Last week, the co-chairs of two Work Groups of the Governor’s Health Care Cabinet met with the Subcommittee to discuss ways we can create fundamental change in the state’s health care system. Pat Baker, president of the Connecticut Health Foundation and Pat Rehmer, commissioner of the Department of Mental Health and Addiction Services represented the Delivery System Innovation Work Group. Nancy Yedlin, vice president of the Donaghue Foundation and I represented the Business Plan Development Work Group.

As changes under the Affordable Care Act (ACA), commonly called Obamacare, get underway, concerns about affordability are widespread.  The co-chairs of the two work groups had a great dialog with the Strategy Subcommittee members.  We talked about how the way we pay for care and the way we organize care can actually improve quality while reining in costs.

For example, right now doctors and facilities are paid based on how many patients they see – pure volume, like they are piece workers on an assembly line. A shift to a payment system that rewards quality and doesn’t reward errors and ineffective care could be a game changer.  It would allow providers to spend the time necessary to educate and empower patients to better control chronic health conditions like high blood pressure or diabetes.  Expensive complications requiring hospitalization would be avoided and patients’ quality of life would be improved.

We also discussed how the state could leverage the dollars it spends on health care to move delivery system change forward.  State government pays for two of the largest pools of insured individuals in Connecticut – state employees and Medicaid. Already those dollars are being used to promote an innovative model of care for both groups, known as the Patient Centered Medical Home.  This model of care is focused on primary care, prevention and patient education, again an approach that can keep people healthy and help them avoid expensive procedures down the road.  Because so many people in Connecticut are covered by these two large groups, more and more physician offices and community health centers are adopting this model of care, something that benefits all of the patients they serve.  This is just one example of several programs underway that are changing the face of health care in our state.  Still, as we pointed out, much more could be done to use our state health dollars to promote changes in the system from which all could benefit.

Robert Scalettar, M.D. the co-chair of the Strategy subcommittee, discussed the work the state is undertaking to establish an All-Payer Claims Database.  In the current system, patients, as well as providers, are hard-pressed to find the prices of health care treatments and services in the state.  This project will allow consumers to compare the price that different health facilities charge for the same procedure. Price competition will lead to lower costs.  But it will also have an impact on quality. “If we got to a point where we had real price and cost transparency then it would move us to a place where competition was on actual outcomes,” said Nancy Yedlin, my co-chair from the Cabinet’s Business Plan Work Group.

Speaking of competition, I also talked about the importance of adding more competitors, particularly non-profits that focus on innovative care delivery, to the insurance market in Connecticut.  The recent licensure of HealthyCT, a non-profit, patient-centered, health insurance CO-OP, is welcome news for our state.

HealthyCT will be a new insurance choice as the insurance marketplace, Access Health CT, begins offering health coverage to the uninsured in our state on October 1, with the coverage kicking in on January 1.  Although subsidies will be available to help lower and middle income residents afford premiums, many are concerned that the cost of coverage, including co-pays and deductibles, will still be too high.  As a major purchaser of health care, Access Health CT has the opportunity to use its clout to push the system in the right direction.

I’m glad the leaders of Access Health CT are soliciting ideas for how they can use their purchasing power to ensure we all get the care we deserve at a price we can afford.

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Health Foundation Supports Continued HUSKY A Coverage

Posted on April 17, 2013 by

For Immediate Release

April 17, 2013

Contact: Alice Straight 203-639-0550 ext. 309;

PRESS RELEASE

 Universal Health Care Foundation of Connecticut announced today that it stands in support of those rallying to preserve HUSKY A at the Capitol.

“Taking away the security of decent health coverage from an estimated 7,500 to 11,000 people who already live on the economic edge is unfair to them and increases the cost of coverage for all of us,” said Frances G. Padilla, president of Universal Health Care Foundation of Connecticut. “We at the foundation urge the governor and the legislators to reconsider the proposal and to allow parents to continue to be covered by HUSKY.”

Under the governor’s budget proposal, HUSKY eligibility will be cut for parents with incomes between 133 and 185 percent of the federal poverty, or annual incomes of $25,975 to $36,131 for a family of three. These residents would instead be expected to purchase private health coverage through Access Health CT, the new health insurance exchange established by the state under the federal Affordable Care Act. The state is expected to save $2,400 per person in Medicaid spending, according to a recent report by the Connecticut Health Foundation, titled “Policy Analysis of Potential Impact of Governor’s Budget Proposal on HUSKY Parents,” which is based on research it commissioned by the University of Massachusetts Medical School’s Center for Health Law and Economics.

Universal Health Care Foundation of Connecticut is an independent, nonprofit philanthropy based in Meriden, Conn. It supports research-based policy, advocacy and public education that advances the achievement of quality, affordable health care for everyone in the state.

To learn more, visit the foundation’s website at www.universalhealthct.org. Follow the foundation on Facebook.

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Foundation’s legislative activities continue

Posted on April 11, 2013 by

By Frances G. Padilla
President, UHCF

This year, UHCF is focused on efforts that educate and engage people, and build public will forFrances - use this one health care reforms that increase affordability, improve quality and promote better health. While much of this work is focused outward in communities across the state, we are still keeping a watchful eye on the inner workings at the state Capitol. Between now and early June, the legislature will consider many proposed bills.

UHCF has submitted testimony on a few bills. The criteria we have used for our legislative advocacy this year include:

Promoting transparency and accountability – Will the proposed bill impede or improve accountability and openness in public or quasi-public bodies that make decisions regarding health care access, delivery, cost and quality?

Putting consumers first – Will the proposed bill make it easier or more difficult for consumers to have access to quality, affordable health care?  Does the proposed bill give undue influence to interests that benefit financially from the current health care system?

Increasing quality and affordability of the health care system – Will the proposed bill move our state forward with reforms that focus on improving health and delivering more value for our health care dollars?

In addition to following legislation, UHCF is closely monitoring the implementation of the state’s new health insurance exchange, called Access Health CT. A key part of the federal Affordable Care Act, this exchange will be an important tool for individuals and small businesses looking to purchase health coverage.  Stay tuned for more news as the exchange unfolds.

We are also watching the state budget process and paying particular attention to the impact of the Malloy administration’s planned move of some of the parents currently covered by the HUSKY A program into Access Health CT, where they would have to purchase more expensive coverage with more limited benefits.

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Getting what you pay for

Posted on April 5, 2013 by

“Throw out the rules and start from scratch…,” that’s what Dr. Rashika Fernandopulle told Connecticut radio listeners last week in a provocative interview about the cost and quality crisis we’re facing in health care today.

On their weekly radio show “Conversations on Health Care,” Community Health Center Inc. leaders Mark Masselli and Margaret Flinter interview and spotlight innovators in the field. On March 24, they interviewed Fernandopulle, who runs Cambridge-based Iora Health, an organization focused on transforming the delivery of health care. He doesn’t mince words about our current broken system:

“We spend an obscene amount of money on health care…. It’s bankrupting individuals, it’s bankrupting companies who can’t compete internationally and it’s bankrupting the country….. We are spending so much yet the quality we get is awful. Anyone who is trying to get health care knows it’s depersonalized, it’s fragmented, it’s reactive and the outcomes are embarrassingly poor”

In health care, it’s clear that there is a huge gap between what we pay for and what we get. Universal Health Care Foundation of Connecticut is working to ensure state residents understand what they should expect from the changing health care system and how they can help create a better system of care. In a few weeks, we’ll be unveiling a large public education campaign to provide residents with the information they need to make informed decisions for their families and communities. Efforts like Dr. Fernandopulle’s are worth noting.

He is pioneering a new model of primary care that relies on team-based care with strong community supports. This new approach has been shown to achieve improvement in key measures of health status and patient satisfaction as well as net spending reductions of 20 percent. If you’re interested in seeing how he’s doing it check out this Atul Gawande 2011 New Yorker “Hot Spotters” article.

The Affordable Care Act expands access to care, and bans the worst insurance practices. Federal health reform is now in full implementation mode, with tens of thousands of uninsured residents expected to get coverage starting in January. But these gains could become nearly irrelevant if we can’t halt out-of-control cost increases and make great leaps forward in improving quality. The status quo is simply not acceptable; as Fernadopulle says, we really need to “start from scratch.”

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Affordability tops list of five big questions

Posted on March 29, 2013 by

In her latest Exchange Watch story on Columbia Journalism Review Trudy Lieberman poses the five big questions that every healthcare reporter should be asking.  At the top of her list is the question advocates in Connecticut have been focused on, “Will policies be affordable?” While there will be subsidies to help many individuals and families pay for premiums, insurance policies sold by Access Health CT will also have deductibles and co-pays.  As Lieberman points out, Connecticut’s exchange board recently, “increased the annual deductible from $2,500 to $3,000 for the ‘silver’ plan, which is designed to cover 70 percent of medical costs.”  And the most recent draft of the standard plan had a proposed $400 prescription drug deductible and $30 and $45 office visit co-pays.

For those who currently buy their own insurance, these deductibles and co-pays in the model plan are big improvements over their current policies.  Even for young people who are uninsured now, the large majority will receive premium subsidies and will not suffer from “rate shock,” like America’s Health Insurance Plans (AHIP) would like them to believe.

Even though this higher deductible comes into play only with hospital admissions, outpatient surgery and skilled nursing admissions and there are caps for total out-of-pocket costs, this plan still leaves the sickest as potentially the most vulnerable to having their costs spiral out of control.  And for the HUSKY parents between 133 percent and 185 percent of Federal Poverty Level (annual income between $25,975 and $35,317 for a family of 3) who may lose their HUSKY coverage, even with extra out-of-pocket protections, copays and deductibles will be too high and many are projected to become uninsured.

On Monday the board will hold a special meeting to finalize their recommendations for the standard plan.  Meetings are open to the public and may also be accessed by phone.  There is also an opportunity for public comment at the beginning of the meeting.

Jill Zorn is the senior program officer at Universal Health Care Foundation of Connecticut.

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Celebrating 3 years of change

Posted on March 23, 2013 by

By Frances G. Padilla
President, Universal Health Care Foundation of Connecticut

As the country marks the third anniversary of President Barack Obama signing into law the Affordable Care Act (ACA), top tier states like Connecticut are leading the way in its imFrances - use this oneplementation.  In 2014 our state will open and operate the ACA’s health insurance marketplace known as the exchange and residents have already benefited from the closing of the Medicare donut hole, premium rebates and expanded coverage for young adults.

A number of state-based initiatives are underway that show great promise in helping to change the way we do health care in our state for the better.  Still, Connecticut has a long way to go to fully realize a sustainable system of health care delivery that puts patients first, improves quality and controls costs.  The next 18 months will be critical in determining the fate of our state’s effort to make sure its 3.5 million residents have access to quality, affordable care.

Starting Oct. 1, the exchange known as Access Health CT will begin taking applications during open enrollment. The insurance offered through the marketplace will be effective on Jan. 1, 2014.  Ensuring that people the exchange was created to serve are enrolled and have access to affordable coverage will be imperative.  The exchange, and the expansion of health coverage it is expected to provide, only represents one piece of the health care puzzle, albeit a major one.  To move from the current illness treatment system based on perverse financial incentives toward a system that promotes prevention and healing, Connecticut must continue to innovate with an eye toward systemic change.

A good example of how a system which places greater emphasis on good health outcomes and affordability, rather than how many patients a doctor sees is the state’s employee health plan.  Building in incentives to encourage state employees to have yearly preventative care screenings and encouraging doctors to act as patient centered medical homes has resulted in a 23 percent drop in emergency room visits by state employees. Overuse and misuse of emergency room care are among the factors contributing to rising health costs.  Another promising initiative is the HealthyCT CO-OP, a nonprofit health plan seeking licensing approval from the Department of Insurance.  The CO-OP is based on the patient-centered model of care and would be offered as an option in the exchange.

Health reform in Connecticut has not escaped some disappointing blows.  Plans to implement the patient-centered medical home model of care under the state’s Medicaid program have been slowed by cuts to Community Health Center reimbursements.  The governor’s proposed budget, with its plans to cut the HUSKY eligibility of parents with incomes between 133 and 185 percent of the federal poverty level under the assumption they can afford coverage in the new exchange, has many residents worried.

Between 7,500 to 11,000 parents covered through HUSKY would go without coverage because of their inability to afford the co-payments and premiums in the new exchange, according to recent research commissioned by the Connecticut Health Foundation and conducted by the University of Massachusetts.  Such decisions fall short of the spirit and intent of the ACA.  At the same time, they serve as sobering reminders that the road to health reform is bumpy.  As new public  policies and laws are rolled out, they need careful monitoring, evaluating and adjusting.  This requires the attention of an informed and vigilant populace, ready to intervene, advocate and take appropriate action when necessary.

As we reflect on the many benefits, as well as the challenges, of the ACA and state-based health care reform, let us recommit ourselves to ensuring quality, affordable health care for everyone in Connecticut.

Frances Padilla is the president of Universal Health Care Foundation of Connecticut.

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Some good reading for a snowy weekend

Posted on February 22, 2013 by

As Connecticut readies for another snowy weekend we looked for some reading materials and found that the state, and its residents, were featured heavily in multiple stories on healthcare this week.

Here are some snippets from the reporting we’ve found:

Columbia Journalism Review
Exchange Watch: Growing pains in Connecticut
by Trudy Lieberman

“Right before Christmas, the governing board of Connecticut’s new health insurance exchange—named Access Health CT— turned to the question perhaps most crucial to the success of Obamacare: Can the public afford the policies that insurers will sell through these new state exchanges that the law requires?

“In designing the policies that carriers can sell, states were to supposed to pick from a menu of options a “benchmark” plan—outlining essential benefits that all other plans must include. In late September, after contentious discussions, Connecticut chose as its benchmark one of the state’s most popular plans sold to small employers. It had been sold by ConnectiCare, an insurer that once operated as a nonprofit but now is part of EmblemHealth, a New York City regional for-profit conglomerate. This plan was similar to others the exchange considered though it offered somewhat richer benefits.

“But: the biggest news of the December meeting came when board chairman Kevin Counihan announced: “We have a benchmark plan that is uncompetitive. When we adopted it, it was [competitive]. It isn’t now, because it’s too expensive.”

Click here to read more

LA Times
States worry about rate shock during shift to new health law
By Noam Levey

“WASHINGTON — Less than a year before Americans will be required to have insurance under President Obama’s healthcare law, many of its backers are growing increasingly anxious that premiums could jump, driven up by the legislation itself.

“Higher premiums could undermine a core promise of the Affordable Care Act: to make basic health protections available to all Americans for the first time. Major rate increases also threaten to cause a backlash just as the law is supposed to deliver many key benefits Obama promised when he signed it in 2010.

“’The single biggest issue we face now is affordability,’ said Jill Zorn, senior program officer at the Universal Health Care Foundation of Connecticut, a consumer advocacy group that championed the new law.”

Click here to read more

And this last one is probably one of the most impressive pieces of journalism passed around our offices in a while. Steven Brill drills into the cost side of healthcare. It’s 24,000 words, so it makes for a good excuse to put off that shoveling (at least for a little while).

Time Magazine
Bitter Pill: Why medical bills are killing us
Steven Brill

Time Editor Richard Stengel writes about Brill’s piece:

“Why, Brill asks, does America spend more on health care than the next 10 highest spending countries combined?

“One answer is that health care is a seller’s market and we’re all buyers–buyers with little knowledge and no ability to negotiate. It’s a $2.8 trillion market, but it’s not a free one. Hospitals and health care providers offer services at prices that very often bear little relationship to costs. They charge what they want to, and mostly–because it’s a life-and-death issue–we have to pay. Have you actually looked at your hospital bill? It’s largely indecipherable, but Brill meticulously dissects bills and calculates the true costs. He employs a classic journalistic practice: he follows the money, and he does it right down to the 10,000% markup that hospitals put on acetaminophen. He explains why about one-fourth of our bloated health care spending is overpayment and strips the veneer from of a vital American industry that is not always what it seems to be.”

Brill’s piece can be found here.

If you don’t have time to read the entire piece, Brill appeared on the Daily Show with Jon Stewart

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Film Sparked Important Health Reform Conversation

Posted on November 30, 2012 by

Posting by: Frances G. Padilla, President

Both  screenings this week of the award-winning film Escape Fire: The Fight to Rescue American Healthcare were a resounding success.   Many thanks to all of you who came out on Monday in Hartford, and Wednesday night in New Haven for the screenings.

As the movie so aptly points out, our healthcare system requires major transformation. Central to this transformation is the need to stay focused on addressing the root causes of the problems rather than the symptoms.  That begins with improving the health of the people, all the people,  in our state. To realize a better system of health care and delivery that serves us more efficiently, CT must continue to find ways to work together.  That, of course, means we need to keep the conversation going.

A special thank you to our panel of experts for leading the audience in a thoughtful interactive and informative discussions following each show. Our panelists were:  Kathi Traugh from the Yale School of Public Health, Office of Community Health;  Dr. Douglas Olsen, a member of the National Health Service Corps  and medical director of three federally qualified health centers in Hartford County and an instructor at the UConn School of Medicine; and Jill Zorn, senior program officer at the Foundation. Teresa Younger, executive director of the CT Permanent Commission on the Status of Women and Cornell Wright, president of The Parker Wright Group, both of whom are members of our board, moderated the conversation.

We plan to make the film available for more showings after Jan 1st. Please call the office for more details. Meanwhile,  you can share your reflections and comments on the film with us below. We look forward to hearing from you.

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Health Care Foundation Publication Released in Gratitude for Strong Community Partnerships

Posted on November 21, 2012 by

Universal Health Care Foundation of Connecticut, Inc. is pleased to announce the release of “The Power of Movement Building: The Story of the Universal Health Care Foundation of Connecticut,” a narrative chronicling the first decade of its work at the forefront of the health care reform movement in Connecticut.

“This week, when families and communities around the nation observe the Thanksgiving tradition, is an especially fitting time for the foundation to share this story with our friends and partners and the broader public,” said Frances G. Padilla, the foundation’s president. “Because our story is really about what can be accomplished, when people from different backgrounds come together to work for the greater good of the community.”

The 23-page publication was unveiled Nov. 19 at a celebration held by the foundation’s board of directors and the board of its parent organization the Connecticut Health Advancement Research Trust in Hartford to thank the foundation’s past president, Juan A. Figueroa, for his leadership. The boards also recognized the foundation’s broad base of supporters for their contributions to the effort to achieve health care reform in the state. Many of the defining moments in the health care reform movement, including legislative victories, chronicled in the publication were also highlighted by speakers at the event, attended by nearly 200 people from the medical, faith, labor, small business, advocacy and philanthropic communities. Sen. Richard Blumenthal, Lt. Gov. Nancy Wyman and House Speaker Chris Donovan were among the dignitaries and public officials that attended.

“We wanted to acknowledge the contributions of our partners and supporters in this historic body of work while at the same time share insights into the many dilemmas and contradictions that shaped our decisions and then, ultimately, our strategic direction,” Padilla said. “We hope that our experience as a contemporary, activist foundation with high ideals, political savvy and a commitment to progressive values will be instructive to other foundations and organizations.”

The narrative takes readers behind the scenes of the coalition building work that was concurrent with the policy and research work. The foundation has been at the forefront of health care reform in Connecticut from the passage of the landmark SustiNet law in 2009 to the building block legislation passed in 2011, which shapes the direction of today’s Connecticut Health Insurance Exchange and the SustiNet Health Care Cabinet.

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