Print

Supporters Rally To Save State's Independent Health Care Watchdog

ARIELLE LEVIN BECKER

February 12, 2009

Once the shock of her diagnosis faded, Sharon Hines thought her experience as an oncology nurse might give her some advantage as she battled stage 4 lung cancer.

Then Hines' insurance company denied her request for a cancer drug her doctor approved, and fighting cancer meant fighting her insurance company, too.

"The anguish and the despair and anger I and my family felt was crushing," she said.

Hines, of Middletown, turned to the state Office of the Healthcare Advocate, an independent agency that advocates for consumers on health coverage issues. Staff members helped her request an external review, and within days, the reviewer ruled in Hines' favor.

Now Healthcare Advocate Kevin P. Lembo and his office are facing elimination under Gov. M. Jodi Rell's proposed budget, and Hines, whose cancer has stabilized, is among the people fighting for them. "The Office of the Healthcare Advocate is there when people are most vulnerable and in some cases it may be a matter of life and death," she said.

Rell's administration has said the cut was part of an effort to reduce the size of government and that other agencies also monitor health insurance.

But critics of the move, including House Speaker Christopher G. Donovan and other lawmakers, say the cut makes little sense since the office's roughly $1 million budget comes from a fund paid into by insurance companies, not taxpayers. Eliminating the office, they say, won't help the state's budget woes.

Some are also wondering if the elimination of Lembo's office is strictly a budgetary move or a political one. Lembo had been outspoken in his criticism of Rell's Charter Oak Health Plan, a key initiative designed to provide coverage for uninsured adults.

Lembo and other advocates took issue with the state's requirement that doctors who participate in the HUSKY insurance program for children and families also participate in Charter Oak, warning that it would cause doctors to leave HUSKY. That requirement was later revoked, but the dispute over it was bitter.

Lembo also took issue with Rell's calling Charter Oak an insurance plan since it did not include certain provisions — like mental health parity — that the state requires of insurance plans.

Lembo argued that calling Charter Oak insurance could mislead people into believing they had more protections than they did, but state Insurance Commissioner Thomas R. Sullivan disagreed with Lembo's concerns and declined to take action.

While shying away from direct criticism of Rell's motives, several lawmakers and Lembo said the elimination of the office left them mystified.

"I can tell you that it gives advocates pause," Lembo said. "It may be more convenient and easier to push through policy ideas when there are no voices of dissent and no questions raised, but that's a government you need to be afraid of."

Asked if he believes the cut was retaliation for his criticism, Lembo said, "I have a hard time believing it because it would be just so far below the dignity of the office of governor. I just can't imagine that our governor would be that petty or that small."

State Rep. John C. Geragosian, the co-chairman of the appropriations committee, noted that Rell proposed cutting both Lembo's office and the Office of Consumer Counsel.

"It's tough to have somebody looking over your shoulder. Sometimes it creates another level of accountability that makes life easier without having it around, I guess, if you're the administration," said Geragosian, a Democrat from New Britain. "But I think this particular agency does a great job for consumers."

Rell's office, in a written statement, said the decision to eliminate the office was solely about the state budget deficit.

"Kevin is a dedicated public servant and has done a fine job. However, we are in a recession. Everyone is hurting. The governor has said that Connecticut families are making do with less and so can state government," the statement said.

Although the cut does not save the state money directly, the cost of funding the office is passed on to ratepayers by insurance companies, said Jeffrey R. Beckham, a spokesman for the state Office of Policy and Management.

Beckham said many services the office provides are available from the Insurance Department and nonprofit groups — something several legislators disputed.

The office has served about 7,500 patients since 2005 and advocates for policy changes to address systemic health insurance issues.

Lembo and others warn that the need for advocacy will become even more intense as more people lose jobs, face cuts in their health benefits or see more claims rejected.

Advocates say the office is effective, saving consumers $5.2 million last year by getting improperly denied claims overturned.

Ellen Andrews, executive director of the Connecticut Health Policy Project and a member of the healthcare advocate's advisory committee, said the office was created because the Insurance Department was not doing the full job that was needed. About half of Connecticut residents are covered by insurance plans that are not subject to state regulations, and the insurance department does not address their issues.

She said organizations like her own, which runs a consumer help line, would not be able to absorb the need created by losing the healthcare advocate. "It would be a disaster for us and for our clients if they went away," she said.

State Sen. Jonathan A. Harris, D- West Hartford, co-chairman of the public health committee, also disputed the idea that the healthcare advocate's office duplicated work of other state agencies. "That's almost like saying you don't need to have that attorney represent you because there are other attorneys out there," he said.