Print

Putting Kids' Benefits At Risk

Susan Campbell

August 27, 2008

Beverly Lawrence, a Middletown single mother of three, is poised for a coming storm.

Today, her children are covered by the state's Husky plan (Healthcare for UninSured Kids and Youth) — more specifically, by Anthem's Blue Care Family Plan, for which she pays nothing. She says that's worked well, even when the family needed referrals.

But that's about to change. Despite recommendations to do otherwise, Gov. M. Jodi Rell has changed the Husky program — insurance for the state's children and youths — and linked it with her new Charter Oak Health Care, which is supposed to provide insurance for all. People like Lawrence must move to another insurance plan.

But two of Husky's new plans don't even include her county's one hospital in their network, says Betsy Morgan, director of Middlesex Coalition for Children. Wouldn't getting the local hospital on board seem important?

And one of the Husky plans — Aetna Better Health — offers only three pediatricians for its Middlesex County clients. That's bad, but United Healthcare/AmeriChoice offers none. Where do these children go if they need care?

Without some answers, last week a group of legislators, health care providers, advocates and representatives of state agencies — all members of the regulatory Connecticut Medicaid Managed Care Council — asked that Charter Oak and any changes in Husky be delayed until next July.

They took that rare step after one of the weirdest meetings ever held at the Legislative Office Building — which is saying something. No representative from the Department of Social Services, which administers both Charter Oak and Husky, attended, so Sen. Toni Harp (D- New Haven) and others asked tough questions that just floated out there.

Representatives from the health care field said their members — doctors and hospitals — are worried about reimbursement, among other things. They have unanswered questions, too, and so they're hesitant to sign on.

With a delay, more providers might join the program. Without it, the health care of hundreds of thousands of state residents who need it most is jeopardized. Nevertheless, it's full speed ahead in Middlesex County, where the state intends to start the switch on a voluntary basis beginning next week, even though federal law says provider networks within a program such as this have to offer services comparable to what's available to the general public.

Obviously, they're far, far short.

The governor insists she's pressing on. She says opposition comes from people who want universal health care no matter the cost, but that's not even partly true. Opposition comes from people who can see this for the train wreck it is.

Instead, why not look at primary care case management, where patients enter treatment through one portal, a primary care provider who administers their health care from then on — from making appointments with specialists to maintaining electronic medical records. The focus is prevention, and in the 30 states where the program is used, both providers and consumers are happy.

Legislators approved $2.5 million for a pilot that was supposed to start in April, says Ellen Andrews, executive director of Connecticut Health Policy Project. But it hasn't. Instead, families like the Lawrences are left with iffy coverage. When this rolls out statewide, things could get ugly.