Madelyn Colon: The ACA could lead to more savvy consumers

Moving 37,500 adults who are currently insured out of the state Medicaid HUSKY A Program and requiring them to buy their own health insurance on Access Health CT, the new Connecticut health insurance exchange marketplace, isn’t such a bad idea.

The Office of Policy and Management (OPM) says the annual savings to the state now providing health care to those on the program who would migrate to the state Exchange, will be $180 million a year.

In addition to the potential savings, a new generation of savvy health care consumers could also be an outcome.

The legislature’s Appropriations Committee has not acted on the proposal since it was first proposed by Governor Malloy in the FY 2014-2015 biennium budget. Husky advocates are concerned that paying cash for insurance premiums will be an additional burden to families trying to make ends meet, and they question whether the change will mean more limited benefits, co-payments, and deductibles and less access to dental, vision and medical transportation services. They worry HUSKY participants will opt out of insurance protection completely.

The Connecticut Health Foundation has estimated that a family of three with an annual income from $25,975 to $36,131 would pay $1,800 dollars annually in premiums for health insurance plans purchased on the state Exchange.

Under the Patient Protection and Affordable Care Act (ACA), federal subsidies will be available for the premium payments for the plans, including tax credits applied in advance to lower premiums. The credit will be sent directly to the insurance company and applied to the premium. These “affordability” stipends will be determined by family income. OPM is also looking at options to supplement the federal tax credits and help pay premiums through the savings realized through the Husky change.

Access Health CT is open to private insurance carriers and is attracting new models in health care delivery. HealthyCT is one, the first health insurer to file on the Exchange with a co-op style nonprofit health plan that features a patient-centered model of care not offered under any of the state Medicaid programs.

Consumers “shopping” for health insurance on Access Health CT will also be able to tailor plans to their own unique health care needs.  The criteria for “benchmark plans” and “minimum essential benefits” required under the ACA must be met in the plans offered in the Exchange, and the insurance rates proposed by health insurers have to be approved by the state health insurance department. Plans will cover many preventive services, including domestic violence and BRCS genetic testing and counseling and 26 covered preventive services for children, including special autism care, adolescent depression screening and obesity screening. Many are at no cost.

Access Health CT is working with state health advocates like the Universal Health Care Foundation to ensure that the CT Exchange is responsive, and public outreach and advocacy through “navigators” and “assisters” is now available to guide consumers.

The ACA is now law and guarantees health insurance protections, enabling almost anyone to secure lifetime health insurance coverage. To work, it requires realignment of how both health care and health insurance is delivered.

Juan A. Figueroa, former state representative and gubernatorial candidate who is a leading health care advocate, thinks that safeguards are key. “The ACA is the law of the land and whether we like it or not, it is shaping the debate on health care delivery from this point on. Having said that, a basic premise of the Law is the availability of health insurance products that are of decent quality and affordable to those that historically could not afford them. The Exchange is one place where the safeguards need to exist and be meaningful to ensure meaningful access.”

Instead of just stopping all conversation on change to how Medicaid Husky Part A functions as part of the conversation, let’s look at this as a way to develop more informed health care consumers.

 

A Hartford native, Madelyn Colon writes on political and public policy issues that impact the state Latino community. She has worked in local government and politics for more than 30 years, and holds a B.A. from Wesleyan University and an MPA and MBA from the University of Hartford. 

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