Business Plan For Health Care

Group Suggests Reforms To Help Uninsured

January 7, 2007
By DIANE LEVICK, Courant Staff Writer

Heavyweights in insurance and business are weighing in on how Connecticut should help the uninsured and increase access to health care, offering ideas ranging from expanded government programs and new subsidies to financial incentives for consumers to shape up.

The Connecticut Health Insurance Policy Council Inc. will unveil its game plan Monday in a report that says the number of uninsured residents could be cut by half in three years through a public-private sector partnership.

The proposal combines many previous ideas, including controversial ones that are likely to draw fire again. They include allowing the sale of policies to the uninsured that omit some state-mandated insurance benefits as a way of lowering premiums. The council also advocates permitting policies with new coverage limits on certain services.

The council is the latest voice in a lively and growing legislative debate on how Connecticut should insure an estimated 298,000 to 407,000 residents without health coverage and how to improve access to care for people in Medicaid programs. The 6-month-old council is a coalition of health insurers, business groups and large employers, including United Technologies Corp.

Although ideas in their "Framework for Health Care Reform for Connecticut" look familiar, council leaders say what's new is an acknowledgement by employers and insurers that they need to do more.

The private sector is "pointing the gun at itself and saying `You're not doing the job well enough,'" said Robert Patricelli, co-chairman of the council and chief executive of Evolution Benefits and Women's Health USA in Avon. It's telling employers they've got to help low-wage and part-time employees and telling insurers they need to design health plans better, he said.

"We've got to stop pointing the finger at the government and we've got to say part of the problem is us," Patricelli said.

A key element of the council's plan is to improve Connecticut residents' health, a way of dramatically reducing the cost of health care and insurance and giving businesses a competitive advantage. The council endorses creation of a new state Commission on Healthy Lifestyles and says Connecticut should try to become the healthiest state by 2020.

An estimated 75 percent of health care expenses stem at least partly from unhealthy lifestyles, said Mickey Herbert, council co-chairman and chief executive of health insurer ConnectiCare.

More employers should provide financial incentives to workers to stop smoking, lose weight and take better care of themselves, council members say. For instance, Pitney Bowes gives employees a discount of up to $225 on the next year's premiums for not smoking, eating five servings of fruits and vegetables a day, exercising 30 minutes daily, always using seat belts and making progress toward a body mass index of 25 or less.

Many of the council's proposals would require government action and funding.

The council, for instance, says the state should create new subsidies, which could consist of tax credits and/or premium subsidies to lower the cost of insurance for certain groups and low-income individuals.

The state should further expand efforts to enroll people in Medicaid, especially children in the "HUSKY B" program, the council says.

It proposes reform of the structure and funding of Medicaid. The council says Medicaid should be expanded with federal money to cover single adults and childless couples who earn up to 100 percent of federal poverty level, replacing the state-funded State Administered General Assistance Program. Medicaid's HUSKY programs don't cover childless adults. The 2006 federal guidelines set the poverty level at $9,800 for a single adult and $20,000 for a family of four.

Medicaid should preserve its low co-payments but reduce benefits to be more in line with commercial health plans to stretch Medicaid funding further, the council suggests. That could result in consumers' spending more out-of-pocket to get care.

In addition, Medicaid reimbursement to doctors and hospitals must be increased because to achieve universal health care, access to care has to be improved, the council said. Long waits for appointments and some shortages of doctors and dentists willing to serve Medicaid patients have been reported.

"We have something of a hollow promise in Medicaid now," Patricelli said. "You've got coverage, but then you can't get to see a doctor. ... We can't pretend the emperor is fully clothed."

The council also thinks Medicaid funds should be used to help certain people buy employer-based insurance.

The council's consultant, the Lewin Group, priced one reform scenario and concluded that Connecticut could reduce the uninsured population by 157,440 for a $167.4 million increase in state spending and $59.2 million in additional federal funding per year.

The example assumes various Medicaid reforms, redesign of health plans and a requirement for all people earning above 500 percent of federal poverty level to have insurance.

Lewin estimated that 15.7 percent of Connecticut's uninsured are at the 500 percent level or above, meaning single people making about $50,000 a year, and for families of four, nearly $100,000.

The council, however, didn't reach a consensus on whether consumers should be legally required to get insurance.

Aetna, a member of the council, didn't endorse the final report partly because it lacked such a mandate, which the company has supported for more than 11/2 years. Aetna suggested the requirement could be phased in, starting with people above the 500 percent of poverty level and students, said Mark T. Bertolini, head of the company's regional businesses.

Council members also include the Connecticut Business and Industry Association, MetroHartford Alliance, Business Council of Fairfield County, Xerox Corp., Pitney Bowes Inc. and Eastern Bag and Paper Group. Insurance members include CIGNA HealthCare, UnitedHealthcare of New England, Anthem Blue Cross and Blue Shield in Connecticut, and Health Net of the Northeast Inc.

The council's report said employers should be pushed, with state assistance, to pay at least part of the premiums for part-time and temporary workers.

Also, more employers should adjust their premium contributions according to worker wages, paying a greater percentage of premiums for lower-income earners and the lowest percentage for higher-income employees, the council said. Some companies, including Xerox Corp. and Patricelli's companies, have already adopted the approach.

Critics may view the council's game plan as a way to boost insurers' membership and profits while putting the financial onus on the state, taxpayers, employers, workers and Medicaid members.

"I don't agree with that at all," said Herbert of ConnectiCare. "There needs to be an acknowledgement of the things we do well, or we do better than we think can be offered in any other way," he said, citing wellness and disease management programs.

Patricelli said insurers would shoulder costs of helping to increase data collection and sharing as the council proposes, to promote "best practices" among physicians and help them and their patients make better, more cost-effective decisions.

Patricelli acknowledged that the council could take heat for proposals such as reducing state-mandated benefits in some policies to make them more affordable for the uninsured. Legislators, he said, should consider whether everyone needs the full requirements for outpatient mental health therapy and infertility treatment.

The idea of designing more affordable policies with limits such as annual caps on hospitalization or other services has already raised objections. Aetna was sued recently over its "limited benefit" plans, aimed at part-time, hourly, and temporary workers.

"There are a lot of things that probably will be difficult politically," Patricelli said. "but I think one of our tasks is to say - and people know this - there is no free lunch."