The Public Option: An Idea Whose Time Has (Finally) Come? 

By Jill Zorn 

clock-69184_960_720With competition shrinking and rates rising in many Affordable Care Act (ACA) marketplaces, the idea of a public option is being raised more and more frequently as a possible approach to stabilizing the marketplaces.  A public option is a government-based health insurance plan, similar to Medicare, that could compete in the health insurance marketplaces.

The announcement by Aetna in August that they are withdrawing from most of the exchanges where they currently compete started a new round of public discussion about the need for a public option.

Then, in mid-September, thirty-three U.S Senators, including Connecticut’s Richard Blumenthal and Chris Murphy, signed a Senate resolution calling for all Americans to have the choice of a public option, which would,

…lead to increased competition, reduced premiums, cut wasteful spending on administration, marketing, and executive pay, and ensure consumers have the affordable choices they deserve…and save American taxpayers billions of dollars.

And last week, California’s Insurance Commissioner announced his support for a state-level public option.  While it’s not clear that a state-based public option would have sufficient bargaining power when compared with a federal program, California is a big enough state that it might just be worth considering.

Richard Kirsch, one of the inventors of the public option, reminds us why it is such a popular policy solution.  In his recent blog post in The Hill, “Aetna’s Extortion Boosts Urgency for ObamaCare Public Option”, Kirsch writes,

Offering a national public option…would assure that there is a health insurance plan in every exchange. The plan would be modeled after Medicare, with negotiated rates accepted by almost every hospital and health care provider in the country. Those negotiated rates, like Medicare, will make it more successful at controlling healthcare costs than private insurance.

For all of the increase in expressions of support for a public option, any legislation would certainly face an uphill battle in Congress.  Some Democratic moderates are less keen on the idea than their colleagues who signed the Senate resolution.  And of course, the insurance industry is not thrilled with it either.

By going head-to-head with the powerful insurance lobby, the public option would clearly encounter stiff opposition, just as it did during the fight to pass the ACA.  As Yale University Professor Jacob Hacker, the other “father” of the public option, writes in Vox, “…the most consolidated parts of our private health industry aren’t going to let a strong countervailing power set up shop without a fight.”

But the public option is not going away any time soon.  That’s because, as Hacker writes in his piece entitled, “There’s a Simple Fix for Obamacare’s Current Woes: The Public Option,”

…the public option is one of those policy ideas that hits the trifecta: simultaneously simple, popular, and effective. It’s not the be-all and end-all of reform, but it would make a big positive difference. And its reemergence on the national stage suggests that so long as private plans and providers are consolidating and health insurance networks are contracting — and so long as there are lots of progressives who want to do more to make affordable universal health care a reality — it’s going to be a leading element of the national debate.

 

 

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Yale New Haven Health/L+M Hospital decision has been rendered… and now the work begins

By Stephanye R. Clarke

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The state gave the green light for the proposed affiliation between Yale New Haven Health (Yale), Connecticut’s largest health care system and Lawrence + Memorial (L+M) earlier this month.

As a reminder, back in February  of this year, the governor issued an executive order, in which he effectively halted decisions being rendered by the Office of Health Care Access (OHCA) on proposed consolidations until January 2017. No one saw that coming! Then in May, OHCA deemed the Yale/L+M application complete and scheduled a public hearing. This hearing was so lengthy that it was continued to a second hearing a couple weeks later, followed by a waiting game.

And then it happened: an announcement came September 7 that the governor issued an amended Executive Order, in which he granted the newly-formed Certificate of Need Task Force some additional time to make recommendations. This amended order also seemed to create a pathway for the Yale/L+M deal to proceed—and proceed it did. OHCA’s final decision was announced the next day, September 8.

As a member of the community served by L+M, I was happy to see that an Independent Monitor will be assigned to oversee the transition; and that quite a bit of reporting will need to be done, including public meetings with community residents.

However, there are still some areas of concern, including:

  • making sure that patients continue to receive quality, affordable care;
  • patients continue to have local access to services they need; and
  • that the overall health of the communities served by L+M improves by way of a meaningful investment in the implementation of the Community Health Improvement Plan.

I’ll still be watching. We all will.

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Highlights from Sept Access Health CT Board Meeting

By Rosana Garcia

ahct-twitter-cubeWith 39 days until Open Enrollment, the Access Health CT (AHCT) September Board meeting was chock full of guest presentations and information.

The Affordable Care Act (ACA) marketplaces have been in the news a lot, lately.  There are the national struggles of the ACA marketplaces.  Connecticut has its own specific challenges: United Healthcare left the exchange, Healthy CT is going out of business, ConnectiCare’s exit and re-entry into the exchange, and we’re seeing an average of double-digit rate increases in individual plans.

Some highlights from today’s meeting (see the agenda, check out the meeting presentation, or watch the meeting on CT-N):

  • New call center vendor: AHCT has contracted with Faneuil for call center services, amid complaints about Maximus. Faneuil started taking some of the calls September 12th, and will take over all call center calls on Monday, September 26, 2016.  AHCT detailed the intensive customer service training these new employees are receiving, in hopes of a better customer service experience.
  • Both Anthem & ConnectiCare presented on their on-exchange members, including trends they are seeing. Anthem focused on what is driving up costs.  They are seeing more use of the health plan in their on-exchange vs. off-exchange customers.  They suggested that some flexibility from the standard benefit design would help reduce costs.  ConnectiCare focused on three solutions to their cost problem: 1) Lessening the financial burden of seeing a primary care provider (with $5 co-pays to see primary care providers in their “Passage” plans); 2) Increasing health insurance literacy by opening 4 storefronts (flagship in Manchester, soon to follow in Newington, Bridgeport & Orange), and 3) Deterring emergency department usage by partnering with CliniSanitas, which will open 4 sites (same cities as the storefronts!) that are “one-stops” for health care services, and include bilingual services.
  • Paul Lombardo from the CT Insurance Department presented on rate review. He went into great detail about why the rate requests (and eventual rates approved) for 2017 health plans were so expensive.
  • Wakely presented their independent review of 2017 premium rates. Their presentation included a look at potential premium costs for certain customers.
  • Now that Vicki Veltri is the Chief Health Policy Advisor to Lt. Governor Wyman (rather than the State’s Health Care Advocate), she is still on the Board, but no longer the Vice-Chair. Robert Tessier was voted as the new Vice-Chair of the AHCT Board.  (Mr. Tessier is the Executive Director of the Connecticut Coalition of Taft-Hartley Health Funds and also serves on the state’s Health Care Cabinet)

Click here for a collection of tweets from the meeting!

 

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Health Care Cabinet dives deeper, considers input into health care proposal

By Rosana Garcia

stock-photo-14866230-golden-dome-of-the-state-capitol-building-hartford-connecticutLast week the Health Care Cabinet met on September 13 to dig deeper into a discussion of the health care cost containment and quality improvement reforms that they will recommend to the Connecticut General Assembly in a report due on December 1, 2016.  This effort, mandated by a 2015 omnibus health care bill, has been the major work of the Cabinet this year.

A team of consultants from Bailit Health has been guiding the Cabinet’s work.  The consultants presented their initial “straw model” proposal at the Cabinet’s July meeting.  You can see our blog that breaks down the proposal here.

At last week’s meeting Bailit Health presented a somewhat revised proposal, organized around clearly stated goals and listing some of the suggestions for changes that had already been received.  After hearing from several members of the public, the Cabinet dove into a systematic discussion of the proposal.

Now that there is an actual proposal on the table, stakeholders and consumer advocates are beginning to speak up, sharing their concerns and their suggestions for change.  The discussion is happening outside of the Cabinet meeting, too, as shown by this CT News Junkie article.

The official deadline for submitting public comment and alternative proposals is tomorrow, September 21, 2016.  Another option is to give public comment at the beginning of the next meeting of the Cabinet, scheduled to begin at 9:00 am on October 11th at the Legislative Office Building, Room 1D.

To submit: Email Victoria Veltri (at victoria.veltri@ct.gov), the new Chief Health Policy Advisor for Lt. Governor Wyman, and Megan Burns (at mburns@bailit-health.com), one of the Bailit consultants working on this project.

 

Resource Links

CT-N Recording of the September 13, 2016 Health Care Cabinet meeting

Health Care Cabinet webpage, with all the materials, presentations, agendas, meeting minutes, memos, briefs, comments and more related to the Cost Containment Study.  Comments received to-date have been posted under the September 13 meeting date.  Memos from the consultants clarifying some of the policy issues in the proposal and other resource materials are posted there, too.

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On and off exchange insurance rates going up for 2017

By Rosana Garcia

novekedesFriday afternoon before the Labor Day weekend, the Connecticut Insurance Department (CID) released its decisions on 2017 health insurance rate requests for individual and small group plans, on and off the exchange (Access Health CT).  Some Anthem & ConnectiCare rates needed to be recalculated, but now that the dust has settled, CID updated it’s 2017 rate request and decisions chart.

CID’s decisions around ConnectiCare rates prompted ConnectiCare to sue the state, threaten to leave the exchange, and then finally resolved when ConnectiCare agreed to stay on the state exchange (Access Health CT) with the rates CID approved, and withdrawing the lawsuit.  We wrote about the hubbub yesterday.

But despite the drama and controversy, what do the 2017 rates mean for consumers?

It’s important to remember that the rates approved by the Connecticut Insurance Department are for individual and small group plans, both off and on the state exchange.

On the state health insurance exchange for individuals, there are two insurers offering plans—Anthem and ConnectiCare.  Anthem’s final approved average rate increase was 22.4%.  ConnectiCare’s final approved average rate increase is 17.4%.  While both of these rate increases are less than what insurers asked for, it is still a significant increase.

If you had a plan that cost, before subsidies/tax credits, $400, that would be an average increase of $90 per month for Anthem plans, and average increase of $70 per month for ConnectiCare plans.  Now, many people qualify for subsidies on the exchange, so for some, your monthly bill shouldn’t increase this much.

But if your income is higher than 400% of the federal poverty level (that is an annual income of $47, 520 for an individual, or $97,200 for a family of four), you are not eligible for subsidies and pay full price for insurance.

If you aren’t eligible for subsidies, you can purchase insurance off the exchange, as there is a separate set of individual plans sold off the exchange.  There are currently four companies (Aetna, Cigna, ConnectiCare and Golden Rule) who sell plans off the exchange—and it’s worth a look to see if they offer lower-cost plans for you and your family.

Off the exchange, average increases are also pretty high.  Aetna has an average rate increase of 27.9%, and ConnectiCare has two plans, one with an average increase of 48.1%, and another of 38%.  Cigna plans have an average increase of 6.6%, and Golden Rule’s average increase is 2% (even though they originally requested an average 32% increase).

What’s obvious is that health insurance rates need to take affordability into consideration.  Connecticut consumers’ wallets can’t keep up.  We need to fight for better care, at better prices, for better health.

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ConnectiCare’s decision is a win for consumers – or is it? 

By Lynne Ide 

loselosediceIn case you missed it in this past week’s news, ConnectiCare was peeved that the state’s Insurance Department decided to approve an average premium increase of only 17.4% for individual health plans in 2017.  ConnectiCare wanted an average increase of 27.1%.

ConnectiCare responded on two fronts:

What followed was a high profile game of chicken between the insurer and the state.

Somewhere in the middle of all that drama, the 47,597 people who purchased ConnectiCare health plans via AHCT – and the thousands of people who were HealthyCT or United Healthcare customers via AHCT – were at risk.

Why? If ConnectiCare pulled out of the health insurance exchange, national insurance behemoth Anthem would be the sole company selling health plans on AHCT in 2017.  (Anthem has 56,700 customers via AHCT right now.)  That’s because United Healthcare decided to pull out of the all the state exchanges earlier this year – and HealthyCT, a CT-based nonprofit co-op, was forced out of business.

In the end, the state Insurance Department stood its ground on the rates and our state health insurance exchange, AHCT, kept the window open for ConnectiCare to back off its threat.  So after a lot of back and forth, ConnectiCare will remain on the exchange for 2017.

See “ConnectiCare will stay on CT health exchange in 2017” (CT Mirror) and ConnectiCare Agrees To Stay In Exchange, Withdraws Lawsuit & Appeal” (CT News Junkie)

Connecticut will have two insurers offering health plans in AHCT in 2017, rather than four.  Some choice is better than no choice.

But in the end, how good are unaffordable choices for people who must purchase their health plans via AHCT?  ConnectiCare is getting an average rate increase of 17.4% for individual plans — and Anthem’s average rate request of 26.8% has been reduced, though not by much, to an average increase of 22.4%.

This is at a time when everyday people are bearing more and more of the cost of their care through rising deductibles, increasing premiums, and higher co-pays or prescription drug costs.

Something in the health insurance marketplace has got to give.  Right now, for too many middle class people, it feels like health care is getting more and more broken.

For now, our state has won a small battle.  For consumers, the war for better care and better prices is still on.

 

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Are the ACA Marketplaces Fixable?

By Jill Zorn

dreamstime_xs_9893879.jpgAs discussed in a previous blog, the Affordable Care Act (ACA) marketplaces are struggling with lower than expected enrollment, sicker than expected customers, dwindling insurer competition and rising premiums in some regions of the country, including Connecticut.

Amidst this doom and gloom, it’s important to remember that there are still many competitive ACA marketplaces out there.  Also, a significant achievement was announced this week:  the percentage of uninsured people in the United States fell below 9% for the first time.

But there is no doubt that there are problems with the ACA marketplaces, that are likely to get worse.  So, as the title of this blog asks, ‘Are the ACA marketplaces fixable’?

It turns out that there are a range of suggestions out there.  They generally fall into two categories:

  • More carrots or sticks to get younger and healthier people to buy into the marketplaces
  • More carrots or sticks to entice insurers to compete in the marketplaces

Most of these fixes involve federal action, and almost all of them require Congressional approval.

This brings up an even more fundamental question than the query posed in the title.  The question is, ‘Do we WANT to fix them’?

When it comes to the Republican-controlled Congress, the answer to that question is clearly “no”.  As President Obama pointed out in his recent article in the Journal of the American Medical Association,

“While I have always been interested in improving the law…my administration has spent considerable time in the last several years opposing more than 60 attempts to repeal parts or all of the ACA.”

At the state level, it is clear that some of the most troubled ACA marketplaces are in states that refused to expand Medicaid and actively fought the ACA in other ways.  Here is how national health care policy reporter Noam Levey, of the LA Times opens his article, The States with the Biggest Obamacare Struggles Spent Years Undermining the Law:

“…Critics of the Affordable Care Act have redoubled claims that the health law isn’t working. 

Yet these same critics, many of them Republican politicians in red states, took steps over the last several years to undermine the 2010 law and fuel the current turmoil in their insurance markets. 

Among other things, they blocked expansion of Medicaid coverage for the poor, erected barriers to enrollment and refused to move health plans into the Obamacare marketplaces, a key step to bringing in healthier consumers.

Those decisions left the marketplaces in many red states with poorer, sicker customers than they otherwise might have had.”

In summary, one of the favorite sports of opponents of the ACA is do everything they can to damage it, and then say, “we told you so”, when things go wrong.

Then there are the people at the opposite end of the political spectrum that can’t keep from saying, “we told you so”, either.  They never believed a competitive marketplace composed mainly of private, for-profit insurers was the way to ensure access to health care.  They’re ready to throw the whole thing out and start fresh with a single-payer approach or, as Bernie Sanders calls it, Medicare for All.

As Robert Reich recently wrote in his Huffington Post piece, Why a Single-Payer Health Care System is Inevitable, “The problem lies…in the structure of private markets for health insurance which creates powerful incentives to avoid sick people and attract healthy ones.”  Any attempts to fix the ACA are just “band aids”.  Sooner or later we must choose, “a government run single-payer system – such as is in place in almost every other advanced economy – dedicated to lower premiums and better care for everyone.”

During the effort to pass the ACA, many supporters of single payer decided to bow to political realities, hold their noses, and fight for the ACA.  But even if the Democrats win the presidency and both houses of Congress in November, it’s not clear that this important part of their base will be willing to fight for incremental changes to a system they don’t believe is morally or practically the answer.

This leaves people purchasing insurance on the ACA exchanges in an untenable position.  With the right continuing to try to kill the ACA marketplaces and the left, even if they had sufficient political power, lacking the enthusiasm to go all out to save them, it’s unclear where those relying on the ACA for health coverage will be able to turn.

The next blog in this series will dig into some of the proposed fixes to the ACA and whether any of them could possibly move forward, particularly at the state level.

To learn more

For an interesting discussion of the politics of fixing the ACA, listen to this episode of Vox’s The Weeds podcast, particularly the part of the discussion that starts around minute 29 and goes to about minute 46.

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