Pelto calls on Malloy Administration to reverse course on unfair health care policies

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Pelto calls on Malloy Administration to reverse course on unfair health care policies

As recently reported in the Connecticut media, the Malloy administration is developing a new “State innovation Model (SIM) that would negatively impact the availability of care for hundreds of thousands of Connecticut residents. Education and Democracy Party candidate for governor, Jonathan Pelto is calling on the Malloy Administration to halt their plans to implement this flawed healthcare payment and delivery model.

“Yet again, the Malloy administration is playing games with the healthcare of Connecticut residents” Pelto said. “Working behind closed doors and without proper public and legislative review, the Malloy administration is attempting to roll out a new, and untested, State Innovation Model (SIM) that could adversely impact thousands of unsuspecting Connecticut citizens and the healthcare providers who treat them. The Malloy Administration’s new plan is nothing short of a return to the failed ‘managed Medicaid system’ that was tried and rejected because it hurt some of Connecticut’s most vulnerable residents and cost the state more rather than saving taxpayers’ money.”

The SIM  plan seeks to cut costs by attempting to limit unnecessary tests and other forms of “over-treatment.”  Advocates for low-income residents have said that this type of extraneous testing and treatment might be a concern for people with private insurance, but people on Medicaid often struggle to receive even limited access to specialists and general care.

Healthcare advocacy organizations also have expressed also concerns about the fact that the proposed Medicaid changes were so rushed to meet the federal grant deadline that they have not been adequately were developed so recently that they haven’t been properly evaluated and have called for additional study before being used for 200,000 Connecticut residents.

“We are in an era of unprecedented changes in our health care system, instead of rushing to sneak in something that will clearly jeopardize access to the care people needs and deserve, the Malloy administration should stop playing games, put a halt to the new State innovation Model (SIM), and ensure that citizens, advocates and the legislature play a more active role in reviewing and modifying this plan before it is put into place,” Pelto concluded.

Paid for by Pelto 2014, Ted Strelez, Treasurer, Christine Ladd, Deputy Treasurer, Approved by Jonathan Pelto

WARNING: The assault on Connecticut’s Hospitals – Here come the for-profit hospital operators

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For decades, even centuries, Connecticut’s regional non-profit hospitals have been one of its greatest assets.  Emergency rooms, maternity programs, and access to local, high-quality hospital care have made our communities better, safer and healthier places to live and raise a family.

While improvements to the quality of care and the reduction of hospital medical errors have become a major concern across the nation, the notion of local, non-profit, comprehensive hospitals are the healthcare and economic backbone of many Connecticut communities.

But Governor Dannel “Dan” Malloy’s unprecedented cuts to Connecticut’s non-profit hospitals and his outrageous support for the for-profit hospital industry is already leading to the worst possible outcome.

The truth is that over the past two years, the Malloy administration has cut hospital funding by over $400 million and these cuts have led to layoffs and reduced services at numerous Connecticut hospitals.

The cuts have also left a number of smaller hospitals teetering on the edge of bankruptcy.

But worst of all, while undermining the funding of Connecticut’s non-profit hospitals, Malloy has also quietly opened the door and ushered in the for-profit hospital industry to our state.

Take the dire fiscal problems facing many hospitals, introduce the “profit motive,” and we’ll now be seeing the type of healthcare system that Malloy’s policies have created.

As recently reported by Connecticut media outlets, the for-profit Tenet Healthcare Corporation is already moving to purchase St. Mary’s Hospital in Waterbury, as well as, Waterbury’s other hospital.  Those of us in Eastern Connecticut know that Tenet is also making a play for hospitals east of the river.

For those who don’t know, Tenet Healthcare Corporation is the $12 billion national hospital operator that employs over 100,000 people and brags that they are, “a leading healthcare services company, through its subsidiaries operates 79 hospitals, 193 outpatient centers and Conifer Health Solutions, a leader in business process solutions for healthcare providers serving more than 700 hospital and other clients nationwide.”

As Tenant arrives in Connecticut, residents should be aware of the following information provided by Wikipedia,

  • In 2003, Tenet sold or closed 14 hospitals and closed more than 20 facilities in 2004 to achieve its financial performance goals.  Also in 2004, Tenet also moved its headquarters from Santa Barbara, CA to Dallas, TX.
  • In June 2006, Tenet agreed to pay $725 million in cash and give up $175 million in Medicare payments for a total of $900 million in fees to resolve claims it defrauded the federal government for over-billing Medicare claims.
  • In 2007, Tenet appointed former Florida governor Jeb Bush to its board of directors to improve its reputation.
  • In December 2011, the non-partisan organization Public Campaign criticized Tenet Healthcare for spending $3.43 million on lobbying and not paying any taxes during 2008-2010, instead getting $48 million in tax rebates, despite making a profit of $415 million, and increasing executive pay by 19% to $24 million in 2010 for its top 5 executives.
  • In April 2012, Tenet agreed to pay $42.75 million to resolve allegations that it improperly billed Medicare between 2005 and 2007.  

And the list goes on and on…

But as the CT Mirror reported earlier this week in an article entitled, St. Mary’s Hospital to be acquired by Tenet

St. Mary’s Hospital in Waterbury announced plans Tuesday to be acquired by Dallas-based Tenet Healthcare Corporation, a national for-profit hospital chain that’s already in the process of purchasing hospitals in Bristol, Vernon, Manchester and Waterbury.

St. Mary’s had been considering corporate suitors for several years. A previous deal to join forces with a different for-profit company and Waterbury Hospital fell apart two years ago over concerns about providing reproductive services and the rules St. Mary’s operates under as a Catholic hospital.

Although Tenet is also in the process of acquiring Waterbury Hospital, the deal announced Tuesday would leave each hospital in the city separate. Both would convert from nonprofit to for-profit.

[…]

Legislation passed this yearcrafted with Tenet’s other pending transactions in mind, changed state law to make it easier for non-profit hospitals to convert to for-profits.

So the when it comes to Connecticut’s hospitals, Malloy’s legacy is (1) record cuts and (2) making it easier for for-profit hospital chains to gobble up Connecticut’s hospitals.

Hardly the policies that Connecticut needs or deserves.

And why would Malloy push such detrimental policies on Connecticut?

One need only check out the Tenant Healthcare Corporation’s “corporate policies” which include the following:

We believe that it is important to participate in political, legislative and regulatory processes on issues that affect Tenet’s business and community interests, and are committed to doing so in a way that is consistent with our values, our legal obligations, and our Standards of Conduct…

Insurance Executives Win; Citizens and Mental Health Advocates Lose

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At the end of May, Governor Dannel “Dan” Malloy stunned healthcare advocates when he vetoed an important bill that would have required insurance companies to provide data about how much substance abuse coverage and related mental health care they are actually providing Connecticut residents.

The legislation was a product of a major study conducted the Connecticut General Assembly’s bi-partisan Program Review and Investigation Committee.  While insurance companies already report some utilization data, the Committee’s investigation determined that companies were not providing the information necessary for policymakers to determine whether patients were getting the substance abuse treatment and mental health services that they need and deserve.

Considering that the cost of appropriate substance abuse treatment and mental health services is far cheaper and more effective than dealing with the resulting emergency room visits, potential suicide attempts, violence and incarceration that can result from inadequate treatment, the bill was extremely appropriate.

With strong support from Democrats and Republicans, the legislation passed the Program Review and Investigation Committee 11 – 0, the Insurance Committee 15 – 2, the Connecticut State Senate 35 – 0 and the Connecticut House of Representatives by a vote of 143 – 0.

But then, in an apparent gift to insurance executives, who have been extremely generous to Malloy’s political fundraising efforts, the Governor reversed course and vetoed the bill.

Now, according to House Speaker Brendan Sharkey, the Democratic-controlled legislature will not override any of Gov. Dannel P. Malloy’s vetoes, including the important substance abuse and mental health bill.

The General Assembly’s decision to simply give in and give up the fight to ensure a better and fairer health insurance system for Connecticut is a sad one.

As the CT Mirror reported at the time Malloy vetoed the bill,

“Gov. Dannel P. Malloy has vetoed a bill opposed by the insurance industry that would have required carriers to report information about the substance abuse treatment they have covered and their networks of mental health and substance abuse treatment providers.

Malloy said he supported the objective of the measure, which was intended to increase the amount of information available about substance abuse treatment and coverage, but was concerned that it could lead to inaccurate information being gathered.

Malloy took issue with that last requirement, saying in his veto message that it’s unusual for state law to require private entities to “report on activities to achieve public policy objectives,” and that he worried about the precedent it could set.

In defense of his veto, Governor Malloy actually said that he is opposed to requiring private entities to “report on activities to achieve public policy objectives.”

Malloy’s statement is absolutely absurd considering that private businesses that are engaged in public purposes MUST regularly “report on activities to achieve public policy objectives.”  Just ask the electric companies, the water companies and all the other private entities that serve the public good.

Insurance companies that provide health insurance to Connecticut residents must be held accountable for their actions and the bill Malloy vetoed would have done exactly that.

As Jeffrey Walter, the president of the Rushford Center and an expert on substance abuse treatment, explained in his testimony in favor of the legislation,

“The legislation might not be necessary were it not for the fact that behavioral health is treated differently by the insurance industry than virtually any other health care specialty….care for psychiatric and substance use disorders [are] denied at a rate that far surpasses my other part of the health care system.”

The Connecticut Psychological Association added,

“The provisions…increase transparency related to coverage decisions and complaints, which will facilitate evaluation of the review process, including compliance with federal parity law, which requires equal treatment of medical and behavioral health providers and conditions, as well as network adequacy.”

And Connecticut’s State Health Care Advocate, Victoria Veltri, explained,

“Expanding the data that insurers report to the Insurance Department concerning member utilization of services for the treatment of substance use, co-occurring and mental health disorders will provide additional needed clarity to the issues concerning consumer access to treatment for these conditions.”

Malloy was wrong to veto this bill and the Connecticut General Assembly is failing to do its job by refusing to even consider overriding Malloy’s veto.

You can read more about the bill in this CT Mirror story: http://ctmirror.org/malloy-vetos-substance-abuse-treatment-bill-opposed-by-insurance-industry/?hvid=4ILvLG

Paid for by Pelto 2014, Ted Strelez, Treasurer, Christine Ladd, Deputy Treasurer, Approved by Jonathan Pelto

Malloy must take responsibility for many of the these hospital layoffs

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When Governor Malloy proposed his bait and switch “provider tax” strategy he promised hospitals that they would be “held harmless.”  The goal he said was simply to maximize federal reimbursement rates.

But two years later, the impact of Malloy’s decision to renege on that promise is leading to massive layoffs and undermining many of Connecticut’s hospitals.

The news headlines have been shocking;

“The state’s 30 acute care hospitals have shed 1,400 jobs in the past year”

“Hartford HealthCare is eliminating 350 jobs”

“Nearly 70 positions at The William W. Backus and Windham hospitals will be eliminated”

“List shows 176 Connecticut layoff notices so far (Norwalk Hour)”

“116 positions will be eliminated as a result of state budget cuts (Danbury News-Times)”

St. Francis Hospital and Medical Center is reducing the staff at its pediatric and adolescent clinic

“The layoffs announced Monday are the second round in the last seven months.  In November, Hartford HealthCare laid off 179 employees, including 10 each at Backus and Windham.”

So why are people being thrown out of their jobs when access to quality healthcare is more important than ever?

Malloy’s “provider tax” budget gimmick is a major factor.

When Malloy proposed his $1.5 billion tax increase in 2011, the plan also included an additional $350 million “provider tax” on hospitals.  Malloy claimed it wasn’t really a tax because the hospitals would get all the money back and the federal government would reimburse the state for a portion of that money.

Of course, to the self-pay patient, it was a tax.

And to the health insurance company it was yet another cost to be passed on to the people who pay for health insurance.

But the General Assembly approved Malloy’s plan anyway.

As part of his state budget coverage, CT Mirror’s Keith Phaneuf wrote last year,

“And then there’s really bad news: Gov. Dannel P. Malloy would cut their state funding by one-fifth over the next two years.

Put it all together, hospitals say, and at best, they will cut jobs and services. At worst, some will shut their doors. And facilities in the state’s poor northeastern corner say they are particularly at risk.”

The fact is that while the Malloy administration did pay the hospitals back the first year, his budget REDUCED the amount Connecticut hospitals received by about $27 million in the second year, $134 million the third year and $269 million in this year’s budget.

Overall, as a result of Governor Malloy’s budget strategies, while hospitals are being paid for additional Medicaid services, the State of Connecticut has reduced funding for its 32 chronic care hospitals by about $400 million dollars in the last two years alone.

The massive number of layoffs are proof that the “chickens are coming home to roost.”

And, none of this is a surprise to Malloy and the legislature.

As the Vice President of the Connecticut Hospital Association said,

“In short, what started 18 months ago as a scheme to help balance the state budget … has been converted to an unadulterated tax on hospitals…It’s one thing not to help hospitals, it’s something completely different when you harm hospitals.  “Taking patient care revenue to balance the state budget is just plain wrong.”

The state cuts to hospitals garnered some notoriety last spring when Malloy lost his temper on the WNPR radio show, “Where We Live,”

The CT Mirror reported at the time,

When Malloy appeared on May 6 on WNPR’s public affairs show “Where We Live,” he responded quickly when host John Dankosky asked about the hospital funding reductions the governor’s own budget staff wrote about in his budget.

“Let me stop you right there,” Malloy told Dankosky about four minutes into the program. “There aren’t cuts to hospitals.”

The administration insists that while the hospitals lose $400 million in tax reimbursements, they will make it back. But to do so, hospitals will have to treat thousands more poor patients covered through Medicaid.

“It is time for people to trim their sails, to find ways to deliver great service at less expense,” the governor said, adding that all hospital-related state spending should be $1.7 billion next fiscal year, just as it is this year. “We’re not cutting, we’re funding.”

What Malloy forgot was the evidence of the cuts was part of his own budget documents.

Again quoting the CT Mirror,

When the administration unveiled its latest budget plan in February, it initially referred to those changes in hospital reimbursements as spending cuts.

“The decision to reduce hospital funding was not an easy one,” the governor’s budget introduction states.

While the overall policy is rather complex, the impact has been pretty simple.  The way Malloy has handled the state budget is a primary factor behind the hospital layoffs that are taking place across the state.

The families that are being devastated by these hospital layoffs and the communities being impacted by reduced levels of services should tell Governor Malloy that at the very least, he must take responsibility for the actions he took that are now leading to many healthcare workers losing their jobs.

You can read the CT Mirror’s coverage of this issue here:  http://ctmirror.org/hospitals-warn-budget-cuts-will-cut-jobs-and-services-maybe-close-doors/ and here http://ctmirror.org/semantics-malloys-no-tax-pledge/

Define fiscally and morally irresponsible? Malloy’s plan for older, retired teachers.

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There are a lot of crazy, irresponsible and down-right mean things in Governor Malloy’s budget proposal, but his plan to totally eliminate Connecticut’s contribution to the retired teachers’ health insurance fund may very well take the cake.

For nearly sixty years, the State of Connecticut has been helping retired teachers acquire health insurance. 

Prior to 1986, active teachers did not pay into the Federal Medicare system, so when they retired, they didn’t qualify for Medicare, the primary health insurance system for older Americans. 

Furthermore, since teacher salaries were historically so low prior to the educational enhancement act of 1986, older teachers were retiring with very small pensions.  With no Medicare and limited incomes, few could afford the most basic level of health insurance coverage, without some type of subsidy.

For nearly 4 decades, the State of Connecticut utilized a variety of different mechanisms to help these older, retired teachers get some health insurance.  In 1991 it settled on the creation of the Retired Teachers Health Insurance Fund. 

To fund the program, active teachers contribute 1.2 percent of their income into the health fund.  This year that amounts to about $45 million.

The premiums that retired teachers pay for their insurance brings in about $37 million.

And state law required that the State of Connecticut contribute 33 percent of the cost of a Medicare supplement plan into the Insurance Fund.

Together these funds were used to help retired teachers get health insurance through the Teacher’s Retirement Board or through their last employing board of education.  The subsidy isn’t much, only $110 per month, and despite the massive increase in health insurance premium costs, the subsidy hasn’t been increased since 2000.  The Teachers Retirement Board has determined that the $110 subsidy “now covers “on average” only 14% of the monthly premium for the retiree, further eroding the value of the retiree’s pension.

But as bad as things have become, even the $110 helped a little as these retired teachers were forced to shell out of their own pockets an additional $500 to $900 a month to buy insurance through their former boards of education.

Meanwhile, some towns are engaging in a whole separate effort to change the rules and unfairly force teachers off their municipal plans, but I’ll cover that growing problem under a separate post.

In any case, for good or for bad, the present system has been functioning fairly well. 

And then to balance the state budget in Fiscal year 2010 and 2011, Governor Rell and the Democrats decided to insert language that allowed the state to forgo any contribution for two years.  The lack of funding created a situation that began to derail the financial stability of the Retired Teachers Health Insurance Fund. 

When Governor Malloy was sworn in, rather than recommit the state to the appropriate level of funding, he proposed shifting the burden onto the backs of the retired teachers.  The Legislature rightfully rejected the move, but “compromised” by agreeing to only allocate 25% of the value of a Medicare supplement plan rather than the 33% required by the law.

While the state did deposit $35 million in Fiscal Year 2012 and $18 million in Fiscal Year 2013, by refusing to deposit the appropriate amount the Fund was, yet again, undermined.

And then came this year…

Malloy went for broke and proposed simply making no payments what-so-ever into the fund.

Irresponsible
Outrageous
Inappropriate
Incredible
Breathtaking

This Governor, who ran on a platform of fiscal responsibility, proposing that the state simply forgo putting $70 million into the Retired Teachers Health Insurance Fund.

Here are the facts;

In 2012 the Teacher Retirement Board health plan was serving 18,804 retired teachers

In 2012, the Teacher Retirement Board was also paying the town subsidy on behalf of 16,725 retired teachers.

The average age of the retired teacher on the Teacher Retirement Board’s plan is 75 years old.

These teachers received a $0 cost of living adjustment in their pensions in 2010 and 2011.

The Governor’s plan is simply outrageous.

Oh, and by the way, the General Assembly’s Appropriations Committee is holding a public hearing today on Malloy’s Teachers Retirement Health Care proposal.

Appropriations Committee Public Hearing

Thursday, February 21
Elementary & Secondary Education (Room 2D)
2:00- 2:30 PM Teachers’ Retirement Board
2:30- 3:00 State Library
3:00- 4:30 Department of Education
Public Budget Hearings (Room 2C) 6:00 PM

Wyman Says: SustiNet is dead… Dead I tell you… DEAD!

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Cross-posted from Pelto’s Point at the New Haven Advocate)

Think Charles Dickens’ The Christmas Carol;

“Marley was dead: to begin with. There is no doubt whatever about that. The register of his burial was signed by the clergyman, the clerk, the undertaker, and the chief mourner…You will therefore permit me to repeat, emphatically, that Marley was as dead as a door-nail…This must be distinctly understood…”

When Governor Malloy’s new Health Care Cabinet met earlier this week, Lt. Gov. Nancy Wyman, who had helped to lead the SustiNet effort and was once one of its greatest champions, took great pains to ensure that no one – no one – thought that SustiNet was anything but dead.

Wyman proclaimed that “SustiNets not around anymore, there is no SustiNet.”

In fact, Wyman and State Comptroller Kevin Lembo, who served as Connecticut’s Health Care Advocate at the time, were the co-chairs of the SustiNet Health Partnership Board of Directors that created SustiNet.

Their board worked for more than a year and a half developing what was recognized as a profound step forward in the battle to provide greater access to affordable, high quality health care in Connecticut.

When the SustiNet Plan was finalized last December, Lembo said that “this report provides the General Assembly with a roadmap for reform – and propels Connecticut to the forefront in addressing a nationwide health care and financial crisis.”

This extraordinary victory did not come easily.

The legislation creating the SustiNet Board of Directors and laying out the process for developing Connecticut’s healthcare reform plan was vetoed by Gov. M. Jodi Rell in 2009.

The Democratic Legislature took the unprecedented action of overriding that veto and setting in to motion the steps that would eventual lead to the SustiNet plan.

Last December, on the day the SustiNet Board was adopting its final report, a rally was held in Hartford.

Dan Malloy, then the Governor-Elect, spoke at the rally.  As he did during his campaign for Governor he credited his mother for his lasting commitment to universal health care.

Speaking to the crowd, Malloy said that “it was through her eyes and her advocacy that I think much of my commitment to making sure that all of our neighbors have access to quality health care really arouse.”

Surrounded by health care reform proponents and religious leaders, Malloy pointed out that SustiNet represented Connecticut’s move toward universal health care.  The Governor to be added “I’m not sure we’re at the top of the mountain, where we see the promise land but we know the promise land exists or at least a substantial portion of that which is necessary to provide the promise land is just around the corner,”

Speaker of the House Chris Donovan, another leading voice in the battle for SustiNet also spoke at the rally calling it “an impressive sight” and pointing out how much had changed over the last few years.

Pointing to the next governor, the next lieutenant governor and all the clergy and said “I remember a couple years ago when the clergy wanted to meet with the governor and the governor then refused,”

Now, 10 months later, SustiNet is dead….

Dead as a doornail.

At this week’s Health Care Cabinet Meeting, Dan Malloy’s special advisor on health reform, Jeannette DeJesús worked to put all that in the past saying “There’s a lot of new things happening that we need to consider, there are lots of new opportunities, and there are lots of people who want to play that have not participated in the past. Our goal is to really be inclusive at every turn.”

New things, new opportunities, lots of people who want to play a role?

But despite the thousands of hours spent developing the SustiNet plan, there was no discussion about what elements of the old plan were so terrible that the SustiNet plan needed to be trashed.

Was it the effort to leverage Connecticut’s tremendous buying power to lower healthcare premiums for people whose healthcare is funded by taxpayers?

Was it the effort to create a system in which municipalities, non-profit organizations and small businesses could buy healthcare at a lower cost?

Was it the focus on lowering costs for everyone by making greater use of electronic medical records, preventative treatment initiatives or promoting cutting edge care in patient homes?

Or was it the creation of a “public option”, which was scheduled to begin in 2014 and would have provided health care insurance for the tens of thousands of Connecticut’s uninsured residents- an option that would have be financed by premium payments and federal tax credits and would not have required significant state subsidies.

Everyone in the room knew, but few would say, that part of the problem was that the SustiNet plan had gotten caught up in the recent Malloy/SEBAC agreement when, as a result of poor communication by both the state unions and the Malloy Administration, opponents of the concession deal interpreted the proposed health care changes as part of a secret plan to use SustiNet to undermine the state employee’s
health care plan.

But of course, that problem could have easily been resolved.

What could not be easily resolved was the strong opposition from Connecticut’s health care industry.

And since that opposition was very real and politically significant, the Governor’s new Health Care Cabinet did what it had to do and simply skipped over the true reason SustiNet was killed.

In the end the real problem was that here, in what was once the “Insurance Capital of the World”, if the SustiNet System worked as it was designed to do then health care premiums would drop and if health care premiums dropped, insurance company profits might drop as well.

In a year when Dan Malloy gave Cigna Insurance company almost $50 million in public funds to “move” its corporate headquarters back to Connecticut and create at least 250 jobs, whacking the insurance industry’s bottom line was hardly the message some wanted to send.

And equally important was the fact that SustiNet would allow a variety of entities to buy their health insurance through one of the state’s pools or plans.  Many chambers of commerce, especially the Connecticut Business and Industry Association, make their money by selling insurance to their members.

Giving small businesses another option for getting insurance, even if it mean cheaper insurance for businesses and their employees would have had a devastating impact on the ability of business groups to fund their activities.

So yes, SustiNet is Dead.  It was killed by some of the very people who helped create it in the first place.

Go to CTNewsJunkie’s archives for a great set of stories describing the rise and fall of SustiNet:   http://www.ctnewsjunkie.com/ctnj.php/archives/taglist/SustiNet

When Will Consumers Learn – It’s not all about them!

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Today’s leading Wait. What? story comes via CTNewsjunkie who cover the news that despite repeated requests from Connecticut healthcare advocates to make sure consumers are represented on the new and
powerful Health Insurance Exchange Board, neither the Governor nor legislative leaders saw fit to appoint even one consumer representative on the new 14 member board.

As required by federal health care reform (aka the Patient Protection and Affordable Care Act or ObamaCare) each state must set up a Health Insurance Exchange Board to coordinate the development of that state’s healthcare exchanges which are the mechanism to expand access to health care insurance starting in 2014.

As CTNewsjunkie explained “All of the 14 individuals are either members of Malloy’s administration, former insurance company executives, or individuals with political connections, none, aside from the non-voting state Healthcare Advocate, are consumer advocates.”

The fact that Connecticut’s elected officials included insurance industry executives but failed to put on a single voting healthcare advocate is particularly bizarre since the Patient Protection and Affordable Care Act expressly requires consumer representation and prohibits the appointment of exchange members who are affiliated with the insurance industry.

Governor Malloy had two appointments to the new exchange board and put on Lt. Gov. Nancy Wyman and Mary Fox (a retired Aetna executive).

Democratic Senate President Pro Tempore Donald Williams appointed Cece Woods, the former Deputy Chief of Staff and Research Director for the Senate Democrats.

Democratic Speaker of the House Chris Donovan appointed Bob Tessier, a former union organizer for SEIU-1199 and presently the director of the Connecticut Coalition of Taft-Hartley Funds which oversees health funds for unionized workers.

Senate Democratic Majority Leader Martin Looney appointed Dr. Robert Scalettar, who recently retired as medial director for Anthem Blue Cross Blue Shield and House Democratic Majority Leader Brendan Sharkey appointed Dr. Grant Ritter (an academic healthcare researcher who is also the spouse of State
Representative Betsy Ritter).

Republican Senate Leader John McKinney appointed Mickey Herbert, the retired president and CEO of ConnectiCare and Republican House Leader Larry Cafero appointed Michael Devine, CEO of Earth Energy Alliance (Perhaps Cafero thought it was the Energy Exchange Board he was making the appointment to and not the group responsible for developing a major piece of Connecticut’s healthcare reform effort).

Automatic members of the new board are Ben Barnes (OPM). Jewell Mullen (Commissioner of Public Health), Roderick Bremby (Commissioner of Social Services).

Non-voting members include Thomas Leonardi (Commissioner of Insurance), Vicky Veltri (Healthcare Advocate) and Jeannette DeJesus (Deputy Commissioner of Public Health and Malloy’s Healthcare reform Advisor).

While healthcare advocates expressed shock, anger and frustration the best quotes (or non-quotes) of the day came from those who made the appointments.

Jeannette DeJesus, Malloy’s point person on healthcare reform defended the governor saying that “he filled his positions based on the legislative requirements…He stuck to the letter of the law.”

In addition, according to the legislation, “McKinney was supposed to appoint an expert in health care access issues faced by self-employed individuals, and Cafero was to appoint an expert in barriers to individual health care coverage. Donovan was responsible for appointing a health care benefits plan administrations expert, while Looney was to appoint an expert in health care delivery systems. Sharkey was to appoint a health care economics expert and Williams was to appoint a health care finance expert.”

But when CTNewsjunkie looked for an explanation of how appointments could have been made that were so different from what was required “neither lawmakers or the administration were willing to comment.”

Meanwhile, one of Connecticut’s leading consumer healthcare advocates, Jennifer Jaff,  was quoted as saying “I am appalled that nobody thought to appoint someone who would represent consumers’ interests, especially in light of the express language in the federal regulations” adding that it is “Another example of Connecticut consumers getting the shaft when it comes to health insurance issues.”

Well said Jennifer.

Hooray for Transparency… Oh wait, not that kind of transparency….

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(Cross-posted from Pelto’s Point at the New Haven Advocate)

Yesterday Democratic Legislative Leaders quietly announced that they had reached an “agreement” with the Malloy Administration on the bill that was once known as An Act Concerning The Rate Approval Process For Certain Health Insurance Policies.

Originally known as Senate Bill #11, the legislation passed the Connecticut State Senate 36-0 and the House of Representatives 131-14.

The bill established a public hearing process for when individual and small employer group health insurance companies and HMOs sought rate increases of 10 percent or more.

It required that Connecticut’s Healthcare Advocate and Attorney General be parties to any insurance rate increases hearings, increased the amount of time required before a new rate can take effect, mandated the Insurance Department post rate filings on its website and provided the public with a 30-day comment
period.

Supporters of the initiative included all the major Democratic Legislative leaders, Connecticut’s Healthcare Advocate, ConnPIRG, Citizens for Economic Opportunity, the Connecticut Citizens Action Group, the Connecticut Working Families Party, the CT AFL-CIO and the Connecticut’s leading advocate for those facing serious illnesses, a group called Advocacy for Patients with Chronic Illness.

Opponents included all the major insurance associations including the America’s Health Insurance Plans, the Insurance Association of Connecticut, the Connecticut Association of Health Plans, the American Council of Life Insurers and Anthem Blue Cross-Blue Shield (the entity that had sparked the need for the law when they had requested and almost got last year’s record-breaking premium increases).

But despite heavy lobbying, in the end, the Democrats (and Republicans) supported the transparency and consumer protection legislation.

And then Governor Malloy, who had strongly opposed the huge Anthem increase last year stunned the proponents and advocates by vetoing the bill.

At the time Malloy said, “The Connecticut Department of Insurance already conducts an objective actuarial analysis of each and every rate increase request… The current process fully protects Connecticut’s residents from excessive and discriminatory rate increases.”

For an earlier post on the topic see my blog on Malloy’s veto: http://jonpelto.wordpress.com/2011/07/05/the-power-of-vengeance%e2%80%a6malloy-strikes-back-at-the-unions-at-progressives-at-the-public/

Yesterday a press release from the Democratic leaders announced that rather than attempt to override the Governor’s veto, “the legislature and executive branch are working together to achieve a common goal – greater transparency and public input in the rate increase approval process for health insurance.

The agreement does allow the Healthcare Advocate (OHA) to request that the Insurance Commissioner hold a hearing on rate increases, but only if the increase is at least 15 percent or higher rather than the 10 percent threshold that was included in the legislation.

The agreement also appears to limit the number of hearings to no more than 4 a year.

While the press release is a bit short on details, the agreement appears to relieve the Insurance Commissioner from having to adopt any rules or regulations concerning the definition of when a rate increase is considered excessive or discriminatory.

Some other aspects of the legislation also seem to have disappeared.

The Governor’s website makes no mention of the agreement; however, the press release put out by the Senate Democrats does include the traditional array of self-congratulatory quotes.

Senate President Don Williams said “The General Assembly overwhelming approved Senate Bill 11 because its members believe in the importance of changing the way rate hikes are approved…The Governor shares our concerns and is working with us to immediately improve the process.”

House Speaker Chris Donovan said, “We passed this bill after hearing from thousands of residents facing unconscionable increases in their insurance premiums-small businesses, self-employed individuals and those looking for work-folks who have no leverage to negotiate with the big insurance companies. That is why I am pleased that Governor Malloy and Commissioner Leonardi have agreed to a compromise that will allow public hearings and the participation of the Healthcare Advocate in the rate approval process.”

And Governor Malloy concluded that “This compromise will ensure that consumers have a voice in proposed insurance rate increases without compromising the health and competitiveness of the state’s insurance industry.”

And with that, the drive for transparency takes another step forward followed by another step backwards.

The Power of Vengeance…Malloy Strikes Back (at the unions, at progressives, at the public?)

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Governor Dan Malloy vetoes one of the more important Health Care Consumer Laws of the last decade.

SB 11: AN ACT CONCERNING THE RATE APPROVAL PROCESS FOR CERTAIN HEALTH INSURANCE POLICIES.

It was a powerful tool put forward last year by then Healthcare Advocate Kevin Lembo as a way to make sure the public interest was heard when insurance companies asked for rate increases of greater than 10 percent.

It required a series of public hearing when insurance companies sought approval for gigantic rate increases.

This year it passed the House 131 to 14.

It passed the Senate 36 – 0.

It passed the Appropriations Committee – with the Republicans voting no.

It passed the Insurance Committee – with the Republicans voting no.

It was sponsored by such notables as Senate President Williams and Senators Looney, Slossberg, Prague, Meyer and LeBeau, (some of the most moderate members of the Senate).

Other co-sponsors included Representatives Willis, Grogins and Nardello.

This year’s version had the strong support of Victoria Veltri, the Acting Healthcare Advocate, who took over when Kevin Lembo became State Comptroller.

State Senator Martin supported the bill saying “I believe that our state would benefit most if Connecticut’s rate review system met the federal requirements such that Connecticut would be permitted to perform its own rate review rather than having the reviews done by HHS.”

Other supporters included ConnPIRG, Citizens for Economic Opportunity, the Connecticut Citizens Action Group, the Connecticut Working Families Party, the CT AFL-CIO and the Advocacy for Patients with Chronic Illness – Connecticut’s leading advocate for those facing serious illness.

On the other hand, big business came out with all guns blazing.  The regional director of America’s Health Insurance Plans spoke against the bill (the nation’s primary lobbying entity for the insurance industry).

Other industry organizations against the bill included the IAC (Insurance Association of Connecticut), the Connecticut Association of Health Plans, the American Council of Life Insurers and Anthem Blue Cross-Blue Shield (who had requested and almost got last year’s record-breaking premium increases).

And then last Friday – hours before the long weekend was to begin – when media coverage was sure to be limited – Governor Dan Malloy came to the rescue of the insurance industry.  He took out his veto pen – for the first time – and used it to veto this important legislation ensuring his commitment to greater transparency was – once again – nothing but empty rhetoric.

Malloy’s rationale; “The Connecticut Department of Insurance already conducts an objective actuarial analysis of each and every rate increase request… The current process fully protects Connecticut’s residents from excessive and discriminatory rate increases.”

mmmm… I vaguely remember candidate Malloy trying to make a campaign issue of Anthem’s outrageous rate increase request last year…

More to come…

Yet Again – Connecticut Is Working Toward Its New Motto: Penny Wise and Pound Foolish

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Arielle Levin Becker of the CTMirror had a “must read” story last Friday about the end of the State Medical Assistance Program for Noncitizens.

As she reports, two years ago the Connecticut State Legislature eliminated the program that provides health care coverage for newer non-citizen state residents who are over age of 21.

A subsequent lawsuit led to a court order stopping the State from implementing the new law but earlier this year the State Supreme Court reversed the lower court’s ruling and Connecticut’s Department of Social Services is now ending health care coverage for almost 5,000 Connecticut residents.

You can almost hear some people saying “That will teach those non-citizens a lesson.”

But before people breakout the champagne, remember that ending basic low-cost health insurance for 5,000 people will lead to two things.  First, since emergency rooms must legally treat anyone who walks in, some of these newly uninsured will end up going to emergency rooms where what would be a $25 clinic visit becomes a $500 ER visit.  Secondly, since many of these people will end up postponing treatment, some will not only end up in the emergency room but will then have to be admitted meaning thousands or even tens of thousands of dollars in additional costs.

So, as a result of the state’s uncompensated care payments to hospitals and the cost shift that takes place for non-state compensated care, proposals like these often cost society as much, if not more, than it would have if the government simply allowed people to get the community based clinic care they need.

The Malloy Administration points out that anyone losing their health care insurance can attempt to get coverage under the Charter Oak Health Plan, which former Governor Rell championed, but the premiums as so high that it is hard to believe that many of these 5,000 people will be able to get coverage.

And to those who say, “Hey, times are tough, budget cuts are needed, we simply can’t afford to spend money on  providing some type of health care to non-documented immigrants (aka non-citizen state residents) and Connecticut is not alone in cutting off care for these types of people, well, it is true that Massachusetts is now looking to follow Connecticut’s lead on this issue, but Vermont went in exactly the other direction and included non-citizen residents in their landmark health care reform law because they were convinced that not only was it the right thing to do but it was the economically correct thing to do as well.

But here in Connecticut, where pennywise and pound foolish is becoming the norm, we can feel like we really showed those immigrants a thing or two, even if we end up having to pay more for our vengeance.

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