Prescription drug costs are out of control

By Jill Zorn

pills-moneyPrescription drug costs are out of control and people are starting to notice.

  • The latest Kaiser Family Foundation tracking poll found that 77% of people believe that prescription drugs costs are “unreasonable” up from 72% a year ago
  • A Politico – Harvard poll found 70% of those surveyed blamed prescription drug companies for the high cost of health care
  • A survey conducted by the Physicians Foundation found that 59% of the public feel that the cost of prescription drugs is the main reason that health care costs are continuing to rise

Why is this issue rising to the top of the list of health care cost concerns?

One reason is likely the wave of publicity surrounding outrageous price hikes, like the EpiPen scandal.

Another reason is that drug prices are rising much faster than other health care costs.  As one example, the National Multiple Sclerosis Society reports that the average annual cost for MS medications was $16,000 in 2004 and today it is $78,000 – an increase of almost 400 percent.

But the most important reason is likely that more and more people find themselves with health insurance that requires them to pay a significant amount of money out-of-pocket for each service or prescription.  Most notably, coverage for medications, particularly for specialty drugs, is getting worse.  A typical insurance plan now only pays 50% of the cost of these more expensive medications.

The Physicians Foundation poll confirms that people are worried about affordability.  The survey found that 67% of people are concerned they will not be able to pay for medical treatment if they get sick or are injured.

According to the Kaiser Family Foundation survey, difficulty affording medications is much more common among people in fair or poor health (42%) than people in good health (20%).

Something is wrong with this picture.  Health insurance is supposed to protect us from financial ruin if we get sick.  Yet people who have health problems are worried that they can’t afford to be sick.

As a first step toward fighting back against high costs, Universal Health Care Foundation is gathering stories that illustrate how people in our state are struggling to afford care.  If you are having trouble affording your medicines, we want to hear from you.  Please email your story to us at

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Access Health CT hosts first annual Community Conference, open to feedback

By Rosana Garcia

Last week, Access Health CT (AHCT) hosted their first annual Community Conference, ahead of the fourth Open Enrollment period, which starts November 1.  The conference was geared towards the organizations and Certified Application Counselors who help enroll people in health plans or HUSKY (CT’s Medicaid) on the AHCT marketplace.  Workshops included ways to reach diverse communities and how to talk about options.  See some highlights here.

AHCT CEO Wadleigh and Board Chair Lt Gov Wyman at the conference - Image courtesy AHCT

AHCT CEO Wadleigh and Board Chair Lt Gov Wyman at the conference – Image courtesy AHCT

What I found most refreshing about the conference was how open all AHCT staff were to critique and feedback.  In fact, Jim Wadleigh, CEO of AHCT, was frank about AHCT’s mistakes and where they could do better.  For example:

  • Complaints about the call center led AHCT to contract with a new vendor for this Open Enrollment period, and going forward.
  • Wadleigh said that he is aware that AHCT needs to ensure that outreach and support is available year-round, and says that even though they aren’t quite sure how to accomplish that, they are looking for solutions (Wadleigh hinted that they may be opening two new storefronts in the future).
  • Admitting that past marketing materials were subpar, Wadleigh also spoke on how the organization is working to improve those materials.
  • AHCT was very public about needing to hear from everyone about problems they are having with the exchange, and encouraged those in the room to get in touch.

Access Health CT has had its ups and downs over the years.  Out of the gate, in the first ACA Open Enrollment period (2013), Connecticut was recognized as one of the best exchanges in the country.  Despite issues, it is important to remember what AHCT and the state has done well with the ACA, including:

  • Connecticut was one of the first states to embrace Medicaid expansion (under HUSKY D), making HUSKY available to low-income adults.
  • Connecticut is one of 13 states to have their own state-based marketplace.
  • Access Health CT requires all insurers to offer at least one health plan that is a Standardized Plan, which makes it easier for consumers to compare plans when enrolling.

This is not to say that this year’s Open Enrollment won’t be without its challenges.  There are quite a few wrenches in the works this year, many out of AHCT’s control, including:

It is very encouraging that Access Health CT is willing to admit to its problems, actively seek solutions, encourage critique and feedback, and promise to be responsive.  In the end, Access Health CT’s success at overcoming its challenges will be critical for those who rely on them for access to health insurance.  We’re rooting for AHCT to continue to improve and looking forward to next year’s conference.

Related Links

To see a collection of tweets from the conference, check out this Storify.

The presentations from the conference can be found here on the AHCT Community Partners page.

There, you can also find other resources such as printable flyers and past webinars. AHCT also has a monthly newsletter you can sign up to receive.

For any questions regarding AHCT’s community outreach initiatives, you can contact

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Health Care Cabinet will be seeking public input on recommendations

hcc-10-11-2016-pic-1By Rosana Garcia

The Health Care Cabinet met again yesterday, moving closer and closer to finalizing the recommendations they will send to the legislature in their report.

The meeting (materials here) focused on addressing two of the original six strategies proposed by Bailit Health consultants, continuing the conversation from the September 13th meeting.

The Cabinet also discussed alternative proposals that had been submitted by Cabinet members and others.  The Foundation’s response and recommendations are here.

So what’s next?  At yesterday’s meeting, the following timeline was laid out.

  • The Cabinet will meet again on November 1st to vote on a preliminary set of recommendations to be included in their report to the legislature
  • Public input on these preliminary recommendations will be the focus of a meeting on November 15th
  • After public input has been given, and any other suggestions put forward, the final recommendations and report will be voted on at the December 13th meeting

A lot was discussed yesterday; here are some highlights:

  • Ben Barnes (Secretary of the Office of Policy and Management) expressed concerns about pharmaceutical prices, as those prices are rising fast and strain the state budget
  • Pat Baker (President of the Connecticut Health Foundation) emphasized that is important to focus on health care quality and outcomes, not just cost, and to keep in mind health disparities – a sentiment that was echoed by others
  • The ability for the state to have capacity to access and analyze data on health care prices, quality and outcomes seems to be an important aspect of making evidence-based decisions moving forward
  • The Cabinet has been considering what the State Innovation Model (SIM) is working on in changing the way we pay and deliver health care, and how to build on that (SIM’s latest Work Stream Update is here)

There are a lot of issues and elements to the Cabinet’s impending report.  Interested in hearing the whole conversation?  Go to the October 11, 2016 Health Care Cabinet Meeting recording on CT-N.

Our previous blogs on the Health Care Cabinet’s work:

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Fixing the ACA Marketplaces: Carrots and Sticks

By Jill Zorn 

PrintThis is the fourth in a series of blogs on possible solutions to problems faced by Affordable Care Act (ACA) marketplaces.

Previous blogs in the series put recent doom and gloom pronouncements about the marketplaces in context, addressed the political challenges all possible ACA fixes face, and discussed the revival of the public option as one possible solution.

Other possible ideas for improving the functioning of the marketplaces can be broken down into either carrot or stick approaches that generally fall into two categories:

  • Carrots or sticks to get more young and healthy people to buy coverage
  • Carrots or sticks to keep insurers competing in the marketplaces

In either case, marketplaces will be larger, so there are sufficient premium dollars available to cover the costs of people when they get sick.  And the marketplaces, at least in most parts of the country, will have a sufficient number of competitors to help keep the cost of premiums down.

Get more people, particularly young and healthy people, to enroll


  • Make it easier to enroll, particularly for millennials, by conducting better outreach, developing on-line tools, recruiting colleges and other partners to become more involved
  • Raise income limits so more people qualify for subsidies
  • Raise eligibility limits for Cost Sharing Reductions (CSR), the extra financial help lower income marketplace users receive above and beyond premium subsidies, that helps with out-of-pocket costs like co-pays and deductibles.


  • Assess penalties if people enroll late, providing an incentive for them to enroll as soon as they are eligible

Change insurance regulations to keep carriers in the marketplaces


Note:  these policy ideas are designed to protect insurers from the risk of having too many sick customers and not enough healthy customers

  • Tighten special enrollment periods – these are the times when people are allowed to enroll outside of the annual open enrollment periods – to make sure that people don’t wait to enroll until they are sick
  • Shore up the special programs in the ACA that are designed to protect insurers if they end up serving a far sicker population than they anticipated.  Collectively, these programs, known as “the three Rs”, have generally not worked as well as planned and some are also in the process of phasing out.
  • Allow insurers to offer narrower networks of only lower cost, but supposedly high quality providers. (Note:  these narrow network plans can be controversial.  One reason insurers may like them is that they can scare away sicker patients who need a wider choice of providers.)


  • Make the individual market bigger, and therefore more protected from risk, by requiring all individual insurance policies to be offered only through the marketplace, as is done in the District of Columbia and Vermont.
  • Allow government to use its negotiating power to require participation in the exchanges if the insurer is:
    • Doing business in the state
    • Contracting for Medicaid or Medicare

This last idea is related to the public option, in that it allows government to use the full force of its negotiating power, and uses that power to promote competition.  Here’s how Michael Hiltzik, a columnist for the LA Times, wrote about it, just after Aetna had announced they were pulling out of most marketplaces across the country:

We’ve mentioned before that the government isn’t entirely powerless to goad big insurers like Aetna into greater participation in the ACA exchanges. Among other things, the companies make money hand over fist by serving Medicaid expansions in many states and in Medicare managed-care plans. Why not tie their access to those lucrative markets to sticking with the exchanges until they’re finally stabilized?

To learn more:

Stabilizing the Affordable Care Act Marketplaces: Lessons from Medicare

Sabrina Corlette & Jack Hoadley, Georgetown University’s Center on Health Insurance Reforms blog  August 16, 2016.  To read the full report, go here

How Do You Fix A Marketplace That Is ‘Too Big To Fail’?

Katherine Hempstead, Huffington Post, August 18, 2016

ACA Marketplaces: Stressed but Fixable

Sara R. Collins & David Blumenthal, Commonwealth Fund, August 24, 2016

The Affordable Care Act Is Not In Crisis – But it Could Be Better

Ezekiel Emanuel & Topher Spiro, Washington Post, August 22, 2016

Obamacare Marketplaces are in Trouble. What Can Be Done?

Reed Abelson & Margot Sanger-Katz, The Upshot / New York Times, August 29, 2016

It’s Time for the Government to Play Hardball with Those Whining Obamacare Insurers, Michael Hiltzik, LA Times, August 9, 2016

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Watching re-runs: People as pawns in Anthem, Yale Medicine dispute

By Rosana Garciachess-pawn-social-mobility

Update: Yale Medicine and Anthem Blue Cross Blue Shield have resolved their dispute.

Like watching reruns of old sitcoms on television, here we are again, with a major insurer and health provider arguing over their contract.  Unlike a well-loved sitcom, though, this is no laughing matter.

Anthem will no longer cover health services provided by Yale Medicine as of October 7, unless the two can resolve a contract dispute.

This is a rerun, with slightly different actors, of other public contract disputes between insurance carriers and providers.

  • In April 2015, UnitedHealthcare and two Hartford Healthcare hospitals went down to the wire in their contract negotiations.
  • In October 2014, Hartford HealthCare and Anthem made up quickly, though Hartford HealthCare was briefly out of Anthem’s network.
  • And in June 2012, CT’s Children’s Medical Center was out of Anthem’s network for two months before resolving their contract..

These disputes often get resolved, but not without alarming consumers and sending those in treatment scrambling for a Plan B.  Patients could end up paying higher out-of-network charges for staying with their providers.

In fact, Senate President Martin Looney blasted Anthem and Yale Medicine for putting patients in a bind.  Senator Looney’s press release likens patients to “pawns in [Anthem & Yale Medicine’s] battle to increase profits.”

In the end, whether the contract is resolved or not, it is always people who get the short end of the stick.  It’s people who get the stress, have to find new providers if the dispute isn’t resolved, and have to navigate an ever-more-complex system that is supposed to care for them.

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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

Traffic light over white background

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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