Time Will Reveal: Will We Be Able to Live Our Healthiest Lives?

By Stephanye R. Clarke

“To everything- turn, turn, turn; There is a season- turn, turn, turn…” -The Byrds

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To state the obvious, we are entering a new season and starting next month we will be glued to various news sources to see how President-elect Trump’s first 100 days on the job impact America. Those who’ve been selected for potential Cabinet positions have garnered tons of opinion pieces and generated lots of conversation over the past few weeks.

Like many, I am particularly interested in how the new political climate at the federal level, along with Connecticut budget woes and potentially serious cuts to social service programs. I am curious about how these issues will influence people’s ability to live in safe, affordable housing, receive quality public education, have access to jobs that allow them to care for their families and quality, affordable health care (to name a few).

I’ve written about the social determinants of health in the past. One of my first blogs from earlier this year was about the #FlintWaterCrisis; another blog was about racial and ethnic health disparities; and an older blog explored the intersection of poverty, housing and health.

Yale Professor Dr. Elizabeth H. Bradley, one of our Reform to Transform keynote speakers, shared findings that show maintaining health can be broken down into the following parts: 20% genetics; 20% health care; and 60% social, environmental and behavioral factors. A blog she co-authored in August states, “The United States spends more on health care than any other developed nation, yet a recent study suggests social services could have a greater impact on health outcomes.”

Providers have increasingly conveyed the importance of an investment in improving health by way of care that reaches beyond the more traditional clinical care. Given the number of challenges at both the federal and state levels, it is my hope that as we enter a new year, accompanied by a new administration, new challenges and new expectations, it is my hope that people will continue to talk, strategize, mobilize and take action to assure the rights of all to thrive and live their healthiest possible lives.

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Update on the Health Insurance Merger Trials

By Jill Zorn

wooden judge gavelThe Department of Justice filed law suits in July to stop the Anthem-Cigna and Aetna-Humana mergers and both trials are now underway in Washington, D.C.

Anthem-Cigna

The Anthem-Cigna trial started on November 21.

The first phase of the trial is focused on the “national accounts” market for large employers that have multiple work sites across the country.  The second phase of the trial will focus on 35 specific geographical insurance markets.

During the trial, documents showing tensions between the two merger partners were unsealed.  “At several points Anthem attempted to press on with the merger process unilaterally, without cooperation from Cigna. Adversarial notes were sent between the CEOs.”  As the Hartford Courant reports, “The deal, called ‘a shotgun marriage’ by one business professor, may be remembered more for this soap opera than for how it changed the health insurance industry.”

The presiding judge, Amy Berman Jackson, is expected to rule on the case by early next year.

Aetna-Humana

The Aetna-Humana trial began this week on December 5.

This case is focused on the market for Medicare Advantage, Medicare health plans that are sold by private insurers.  One of the key questions of the case is whether having a choice of “traditional Medicare” will provide enough competition and consumer choice, if there is one less competitor in the Medicare Advantage market.

The case is being heard by Judge John Bates.

Impact on Connecticut

Connecticut, along with nine other states and the District of Columbia, joined the Department of Justice suit against the Anthem-Cigna merger because the merger would “have a negative impact on both the availability of competitively priced healthcare and the quality of care in the state of Connecticut.”  According to Attorney General Jepsen’s statement, “this merger would eliminate significant competition, leaving employers and individual consumers vulnerable to increased costs and providers subject to decreased rates, with few, if any, options to find better alternatives.”

In addition, as we wrote in a previous blog, hundreds if not thousands of Connecticut jobs are threatened by both mergers.  With Anthem, headquartered in Indianapolis, being the acquiring company, Cigna jobs in Connecticut are certainly vulnerable. As this recent Hartford Courant article points out, “When it comes to which jobs are eliminated after mergers, buyers tend to keep more of their own workers.”

Ironically, this may not hold true for the Aetna-Humana merger.  Even though Aetna is acquiring Humana, they have already promised to not cut jobs in Kentucky, where Humana is based.  Meanwhile, as this CT Mirror article points out, no commitment has been made to keeping Aetna’s headquarters in Connecticut if the merger goes through.

What’s Next

Universal Health Care Foundation opposed both mergers, working in coalition with several other organizations in Connecticut and across the country.  We anxiously await the results of these two trials, and hope the verdict in each case will be a resounding “NO.”

If you want to dig in deeper on the merger trials, you may want to check out the blog of the Coalition to Protect Patient Choice.  The Hartford Courant and CT Mirror are also writing periodically about the trials.

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The doors are still open: Access Health CT enrollment continues

By Rosana Garcia

open doors

If you are one of the 100,000 Connecticut residents who use Access Health CT to get coverage, you might be wondering about all the proposed changes you’ve been hearing about in the news, after the election.

The short answer: Enroll or re-enroll for coverage.

Despite the legitimate concerns about changes to health insurance with a new administration coming to the White House in January, nothing has changed yet.  The laws in effect prior to the election still stand—including the provisions of the Affordable Care Act that

  • Allow individuals to get insured via Access Health CT and receive financial help if they are eligible (see here for more on that)
  • Mandate all individuals have health insurance coverage, unless they qualify for an exemption

From an Access Health CT press release:

AHCT CEO James Wadleigh would like to also remind Connecticut residents that currently, there are no changes to the law. “If you have health insurance through the exchange, you are still covered. If you don’t, we encourage you to reach out and enroll now.

Changes in health care may well be coming, but for now, enrolling or re-enrolling in coverage is still available.  And since the future is unclear, using your coverage now and in 2017 may be a good bet in this uncertain time.

We have written about the challenges Access Health CT is facing.  We know that premiums may be unaffordable for those who qualify for very little financial help, or don’t qualify for help at all, on the exchange.

We also know, though, that roughly 75% of those who enrolled in coverage via Access Health CT receive some kind of financial help.  Access Health CT also has helped to enroll/re-enroll over 22,000 CT residents on HUSKY/Medicaid programs.

There is no doubt that changes to the Affordable Care Act will have deep impacts on Connecticut – and we will be watching out for CT residents as we move into a time of change.

Important dates you should know:

  • Enroll in coverage by December 15, 2016 so that you are covered started January 1, 2017.
  • The last day of Open Enrollment in January 31, 2017.

More info:

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We Can’t Afford to Go Backwards

By Jill Zorn

hhs-logoPresident-elect Donald Trump has selected Rep. Tom Price as his choice to lead the Department of Health and Human Services, a nominee with a radically conservative vision of health care that will “not just roll back five or 10 years of (health care) progress — but 50.”

The choice of Price is an indication that millions of Americans are at risk of losing their health coverage all together and millions more could find themselves paying more and getting less.

Plans for undermining the Affordable Care Act, Medicaid, Medicare and employer-based insurance

Described as a “One-Man Death Panel for Obamacare,” Price, a Congressman and physician from Georgia is committed to repealing the Affordable Care Act.  He crafted the budget reconciliation bill that President Obama vetoed last year that repealed key ACA funding sources, a piece of legislation that is expected to serve as the model for a similar repeal bill to be introduced in January.  Budget reconciliation bills only require 51 votes in the senate.

His extremist replacement plan, the Empowering Patients First Act, is by far the “least generous, especially to the sick, old and poor” of any of the Republican replacement proposals put forth so far, and will leave millions without coverage.

But Price is not only dedicated to repealing the ACA and barely replacing it, many other Republicans in Congress are also chomping at the bit to make huge cuts to Medicaid and Medicare, too.

If Price and his colleagues have their way, Medicaid, a shared federal-state program, will be turned into a block grant program.   This will mean caps on the amount of money that the federal government contributes to states and starving the program of needed revenue over time.  This backing away by the federal government would eventually leave millions uninsured or with far worse coverage and cut provider rates significantly.  The impact on Connecticut residents who rely on Medicaid — currently over 750,000 people — could be devastating, requiring, “dismantling a lot of what we currently do.”

Price is a strong advocate of Speaker Paul Ryan’s plan to privatize Medicare and turn it into a voucher program, capping what the federal government would pay for Medicare coverage for each individual.  He would also extend the Medicare age from 65 to 67.

Even employer-sponsored insurance would come under Price’s knife, as his plan would impose limits on how much employers can deduct from their taxes for paying for health insurance coverage for their workers.

In every case, the aim is to cut the federal government’s funding of health care and shift responsibility onto states, health care providers and individuals.

Views on women’s health and children’s health programs

Price has an extremist record on women’s health issues.  He opposes access to birth control without out-of-pocket costs, he is a staunch opponent of abortion rights and has voted to defund Planned Parenthood.  Given the power of the HHS Secretary to rescind and rewrite regulations, and make changes to grant programs run by the agency, he will have the opportunity to “take women back decades,” as Planned Parenthood President Cecile Richards has said.

He has even voted against the Children’s Health Insurance Program, which has always had strong bi-partisan support in Congress.

Reactions to Price’s nomination

Established groups like the American Medical Association (AMA), the Association of American Medical Colleges, and the American Hospital Association have all issued press statements supporting Price’s nomination and looking forward to working with him.

But many provider and health advocacy groups are pushing back against Trump’s nominee.  Thousands of signatures have been collected on this open letter declaring, “The AMA Does Not Speak for Us”.  New Twitter hashtags have appeared:  #NotMyAMA and #ShameOnYouAMA.  The National Physicians Alliance issued a statement opposing the nomination, citing “the harm his policies would inflict” on our patients.

Health advocacy organizations, including Families USA, Community Catalyst and National Partnership for Women and Families, have all issued statements criticizing the nomination.

Locally, Connecticut elected officials have expressed strong opposition to Price’s nomination.

Price’s nomination is not business as usual.  It is a wake-up call that health policy in Washington DC is about to take a giant step backwards, aiming to destroy the hard-fought progress we have made toward guaranteeing quality, affordable health coverage for all Americans.

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You Should be Mad as Hell…and Join the Fight!

By Frances Padilla

gt1

I heard a story recently about a man in northeastern Connecticut who was air-lifted by helicopter to Hartford Hospital.  He had both a brain tumor causing head-splitting pain and he has an unrelated cancer.  As if these health challenges weren’t enough, he received a bill for $34,000 from the air ambulance company because his insurance didn’t cover the cost! What is wrong with this picture?

Another story I recently heard is of a family on Connecticut’s shoreline who pays $1,115 per month now for a health plan with a $6K deductible.   The new cost for the same plan in January 2017 will be $1,618 per month.  Shopping around revealed no better options for them.  They believe this increase is an outrage, reflecting the pricing power of our two major state health systems and large medical groups, and the monopolistic pricing power of patent-protected brand drug companies. And, insurers pass these increases along to us, of course with a markup to cover their own costs.

My brother recently spent several weeks working in Japan, a capitalist country where everyone is covered with high quality care, health care is not rationed and no one goes bankrupt because of medical debt. Yet in the U.S., medical debt is one of the most common reasons for personal bankruptcy. 

We can do better in the US, and in Connecticut.  Yes, even in these challenging times.

We need you. Your time, your money and your activism.  Together we can keep up the fight for better.  With your support, Universal Health Care Foundation of CT and our partners can continue to fight for better.  Better Care. Better Prices. Better Health. 

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Please give as generously as you can!

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CON Task Force Breaks Open Its Box

By Lynne Ide

opportunitysign

I’ve watched various commissions, task forces and government appointed bodies do their work over three decades now.  Rarely have I witnessed such bodies openly embrace mid-course corrections.

On November 21, the Certificate of Need (CON) Task Force decided to reconsider its course of action to-date and step out of its box.

And my response is: Bravo!

You may ask what this really means – and why should I care?

A bit of background is in order.  Earlier this year, Governor Malloy issued an executive order (Order 51, amended by Order 51A) that put a time-limited moratorium on the state’s approval of large hospital network acquisitions of additional hospitals.

It also created the CON Task Force, which was directed to assess the state’s regulatory approval process of hospital and health care provider systems (such as doctor practices, networks and related facilities) and make recommendations for changes in January 2017. In a nutshell, the CON process is run by the Office of Health Care Access (OHCA) and has oversight over things such as large equipment purchases (e.g. MRI machines), acquisitions, mergers, discontinuation of services and closures.

It’s no secret that there has been major consolidation in our state’s health care delivery system in the past decade.  In fact, Yale New Haven Health Systems and Hartford HealthCare now own multiple hospitals and medical practices controlling the lion share of state’s market.

View our 2015 explainer:

 

Fast forward to this week.

For several months, Universal Health Care Foundation of CT and other advocates have led the call for OHCA’s authority and oversight, as well as the rules of the road for hospital systems in the state, to be recalibrated with an emphasis on accountability and service to the state’s health care needs.

Thus far, health system consolidation in Connecticut has delivered higher costs and limited choices for care with no demonstrated increase in quality.

On November 21, during public comment, I implored the CON Task Force to hit the pause button and recalibrate its approach.  Since the state’s health care delivery landscape is barely recognizable from the landscape in which the CON process was created, it seems inadequate to approach the work of the Task Force from the box of “What should we keep and what should we get rid of?”  You may read my full comments here.

I challenged the Task Force to address the following questions:

  • What does the overall Connecticut health care delivery landscape look like right now – and what do we project it to look like in three, five or ten years?
  • What is the current and anticipated unmet need in this landscape?
  • What are the state’s residents experiencing in this landscape vis-a-vis cost, access and quality measures?
  • What are the state’s front line health care providers experiencing in this landscape?
  • How can we re-design the state’s oversight role to address the needs of our residents first and foremost – and support successful, responsive health care delivery systems into the foreseeable future?

And then it happened – one after another, Task Force members gave voice to the desire to get more out of their work together, rather than focusing on what we want to keep or get rid of in the CON process.

Lieutenant Governor Nancy Wyman stepped into the discussion and swung the door open for a more expansive exploration of what we really need from this process, stating that, “We need to get something done that we are proud of.”

Dr. Tekisha Everette, of Health Equity Solutions, summed up the discussion saying, “Let’s spend the rest of our time, even if it is in the express lane, getting to what we need.”

So, here we go!  This Task Force may be on its way to laying new groundwork for robust, impactful oversight of a health care delivery system that will address the needs our state’s residents and support successful, responsive health care systems into the foreseeable future.

That is one New Year’s wish that I’d like to see realized.

 

Resource Links

CON Task Force page

Universal Health Care Foundation’s October/November testimony to the CON Task Force

Video of Nov 21, 2016 CON Task Force Meeting (Recorded by CT-N)

 

 

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Repealing the ACA: Millions of Lives on the Line

By Jill Zorn

Female Doctor Treating Patient Suffering With Depression

This is a very real possibility: Congress repeals the Affordable Care Act (ACA) in January and never quite gets around to replacing it.

Repeal

With majorities in both the Senate and the House, Congressional Republicans are chomping at the bit to repeal major provisions of the Affordable Care Act (ACA). They are expected to use a process known as budget reconciliation, which allows them to repeal key ACA revenues and expenses. Using this process, they won’t need 60 votes in the Senate to avoid a filibuster, they will just need 51 votes in the Senate to pass a bill and a President who will sign it.

They have already done a “test drive” of an ACA budget reconciliation bill, HR 3762, which was vetoed by President Obama last year. Given that they are ready to go, most observers feel that Congress won’t waste any time and will pass something very similar in January.

Here are a few highlights from that bill, which the Congressional Budget Office says could lead to 22 million people losing their coverage:

  • Eliminates the tax credits that subsidize the purchase of health insurance in the marketplaces
  • Eliminates the Medicaid expansion that covers low income adults
  • Eliminates the individual mandate penalty, a fee imposed on people who do not get covered
  • Eliminates other fees and taxes that fund the ACA

Reflecting a hostile environment in Congress toward family planning, the budget reconciliation bill also eliminated federal funding for Planned Parenthood.

Impact on Connecticut

In Connecticut, 200,000 low income adults are covered through the Medicaid expansion. Just over 100,000 people buy health insurance through Access Health CT, Connecticut’s health insurance marketplace, and 75% of them rely on tax credit subsidies so they can afford their coverage. Facing an almost $1.5 billion budget deficit next year, it is not clear how or if the state could find the resources to keep these people covered.

Delay?

Without a replacement plan in place, last year’s budget reconciliation bill, Congress delayed the Medicaid and tax credit cuts for two years, to allow time for a “smooth transition” to whatever programs would ultimately replace the ACA. Following this idea, a repeal bill passed in January 2017 is expected to include a delay until the end of 2019, after the midterm Congressional elections have passed.

But there is no guarantee that a replacement plan can be passed, as it will require 60 votes in the Senate, can be passed. Getting that kind of bipartisan consensus could take years – or could actually be impossible to achieve.

Also, as the Center for American Progress (CAP) points out, once the individual mandate penalty is gone, insurers aren’t likely to want to continue to offer insurance policies in the marketplaces. CAP explains that delay is “a fallacy”.

Even with a delayed effective date, the reconciliation bill approach would cause massive disruption and chaos in the individual market for health insurance. The complete unraveling of the market would occur by the end of 2017.

Replace?

An article by Sarah Kliff of Vox, lays out some of the possible plans for replacement. As she summarizes,

If we can say one thing about most Republican plans, it is this: They are better for younger, healthy people and worse for older, sicker people. In general, conservative replacement plans offer less financial help to those who would use a lot of insurance.

Most of these plans offer far less help to lower income people, too. In other words, in this ‘through the looking glass” ACA replacement world, the people who need insurance the most, or who have lesser means to afford it, will have far more likely to become uninsured.

Another recent blog post by Georgetown’s Sabrina Corlette, points out the “insanity” contained in several of the replacement plans. Proposals like re-establishing high risk pools or promoting the purchase of insurance across state lines, touted as “the answer”, simply do not work.

Other Ways to Unravel the ACA

Finally, outside of the legislative process, the Trump administration has many other ways to unravel the ACA, including rewriting regulations, not enforcing regulations, and not appealing court decisions. Tim Jost and Nicholas Bagley two attorneys with health policy expertise, have both written about this possibility.

Fight Back

With millions of lives on the line, health advocacy organizations across the country, including Universal Health Care Foundation, are gearing up to fight back against the unconscionable actions of “Repeal and Replace”. Please join us by signing up on our website or sending us an email at info@universalhealthct.org.


Note: It’s not just the Affordable Care Act that is at risk. A future blog will explain how Medicare and Medicaid as we know them are also very much on the firing line.

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