Foley health plan: From welless programs to scrapping mandates

NEW BRITAIN – Republican gubernatorial candidate Tom Foley on Thursday outlined a plan that he said would lower the cost of health care and improve its quality, calling for policies ranging from promoting wellness to allowing some employers to offer “bare bones” health insurance plans that don’t provide all benefits state law requires.

Tom Foley 9/23

Tom Foley talks health care

His proposals include moving seniors from nursing homes to community-based care, wellness programs, changing the malpractice system and eliminating the cost-shift that occurs when public insurance programs pay less than the cost of care, raising costs for commercial insurers – concepts Foley has discussed before.

On Thursday, he also called for moving all Medicaid recipients into managed care, pushing health care providers away from fee-for-service models and toward evidence-based medicine, and putting a moratorium on new benefit mandates for private insurance coverage.

“We simply must find ways to provide quality health care services for less here in Connecticut,” Foley said during a press conference at the Hospital for Special Care in New Britain.

As governor, Foley said, he would set three broad goals for Connecticut: Become the healthiest state by 2020, lower the cost of delivering health care by 10 percent – adjusted for inflation – in 5 years, and improve the quality of care.

As a way to insure more people, Foley said small companies should be allowed an alternative to “state-mandated Cadillac plans.” State laws require insurance plans to cover close to 60 specific services, including screening and treatment for autistic children and wigs for patients who lose their hair from chemotherapy.

Foley proposed allowing companies that do not cover workers or have health insurance costs above a certain percent of payroll to offer “core needs” plans that are exempt from state benefit mandates. He described them as “bare bones” plans that would include coverage for catastrophic events.

“Too many people in this state are not covered by health insurance,” he said. “We need to make sure that everyone we can find a home for in insurance coverage has one.”

Foley noted that many large employers are exempt from state mandates because they are self-insured and not subject to state regulation.

Business and insurance groups have opposed some benefit mandates, although studies suggest that some of them add little expense to insurance costs. A study of six proposed coverage mandates found that, altogether, they would add about 72 cents to each insurance plan member’s monthly costs.

Another study estimated that a mandate added earlier this year, requiring insurers to cover oral chemotherapy in the same way they treat the intravenous version, would add less than 50 cents to the monthly cost of each member. The study, completed for the drug maker GlaxoSmithKline, noted that only a small portion of people with commercial health insurance would use the mandated services in a given year.

Foley acknowledged that some of the savings he identified would not be immediate. Wellness programs, which he wants to promote in the public and private sector, take time, with the impact taking place “over a lifetime,” he said.

Faster savings could come from providing more long-term care outside nursing homes, which Foley said could happen “as soon as we can build up the ability to care for those people in community-based and home-care programs.” Research has suggested that caring for 75 percent of the long-term care patients covered by Medicaid through home and community-based care by 2025 – up from just over 50 percent now – could save up to $900 million a year.

Reorienting the health care system from its fee-for-service model to models that involve more management and coordination of care could save money and improve quality, Foley said.

Foley said the state can also require a transition to electronic record-keeping – something the federal government is promoting – and encourage health care providers to use evidence-based medicine to improve quality.

“We can improve care while saving money for families and to our government,” Foley said.

Democratic gubernatorial candidate Dan Malloy, who issued a health care plan earlier this year, blasted Foley’s proposals. The mandates the legislature created identified what the minimum insurance coverage in the state should be, he said, and insurance plans should not be encouraged to go below it.

Instead of allowing employers to offer bare bones health plans, Malloy said the state could make health insurance more accessible and lower costs by opening the state employee insurance pool to outside groups and offering multiple plans, including options for employers who could not afford the plans state employees receive.

“We all want to drive down the costs,” Malloy said. “You don’t drive down the costs by adding to the unreimbursed health care expenses of hospitals.”

In a statement released by his campaign, Malloy described Foley’s plan as “a lifeline to the insurance companies and HMOs that got us into this mess in the first place.”

Independent Party candidate Tom Marsh said Foley’s health care plan shares many similarities with his own, particularly the focus on wellness and lifestyle choices and shifting how long-term care is delivered.

“While we have differing paths on how to meet those objectives I don’t see great difference in the general tenor of our positions,” said Marsh, the first selectman of Chester.

The Hospital for Special Care, a long-term acute care hospital, has invited all the gubernatorial candidates to meet its staff, tour the facility and discuss health care. Malloy is expected to visit next week.