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 implementation. 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.