Advocates see few consumer voices on health exchange

Its first meeting isn’t until Monday, and its membership was not officially confirmed until Wednesday night. But already the board overseeing the state’s health insurance exchange is under fire from consumer advocates, who see it as too heavily weighted toward the insurance industry.

The members of the new panel include three former insurance executives, the head of a coalition of health plans for unionized workers, the head of a green energy business, and a health policy scholar who is married to a state representative. It will be led by Lt. Gov. Nancy Wyman.

Gov. Dannel P. Malloy and legislative leaders selected most members of the board, which will oversee the quasi-public authority that governs the exchange, a marketplace for individuals and small businesses to buy health care coverage as part of federal health reform.

Jeannette DeJesus, Lt. Gov. Nancy Wyman

The administration says consumers will be heard.

Jeannette DeJesús, special adviser to the governor for health care reform, said consumers will have opportunities to participate in the process, but that building an exchange without people with expertise in insurance, data and technology “would not be the most effective way to approach this project.”

The criticism of the board’s composition could be an early glimpse at the sort of scrutiny the exchange will get as it attempts to implement elements of federal health reform, one of the most divisive laws in recent memory and a certain issue in President Obama’s re-election campaign next year.

Board members who worked in the insurance industry include: Mickey Herbert, former president and CEO of ConnectiCare; Mary Fox, a former senior vice president for Aetna Product Group;  and Dr. Robert Scalettar, who has served in top medical positions at Aetna Better Health, AmeriChoice by UnitedHealthcare, and Anthem Blue Cross and Blue Shield.

Malloy selected Fox, while Senate Minority Leader John McKinney, R-Fairfield, appointed Herbert and Senate Majority Leader Martin M. Looney, D-New Haven, picked Scalettar, whose wife, Ellen, is a former state representative and now serves on the Senate Democrats’ staff.

House Majority Leader J. Brendan Sharkey, D-Hamden, appointed Grant Ritter, a senior scientist and lecturer at the Schneider Institute for Health Policy at Brandeis University. Ritter’s wife, Betsy, a state representative, co-chairs the Public Health Committee.

House Speaker Christopher G. Donovan, D-Meriden, appointed Bob Tessier, the executive director of the Connecticut Coalition of Taft-Hartley Health Funds, which represents health plans for unionized workers. Tessier is a former union staffer who was a legislative liaison for Gov. Lowell P. Weicker Jr.

Cecilia Woods, Senate President Pro Tempore Donald E. Williams Jr.’s pick, was a longtime staffer for the state Senate Democrats whose positions included deputy chief of staff and research director. Michael Devine, selected by House Minority Leader Lawrence F. Cafero Jr., is CEO of Earth Energy Alliance in Westport.

The legislation that established the exchange, which passed this year, prohibits anyone from serving on the board who is affiliated with an insurer, insurance producer or broker, health care provider, or health care facility, or their trade associations.

Under the statute, several state agency heads will also be part of the board, as ex-officio members. Those with a vote are DeJesús, Secretary of Policy and Management Benjamin Barnes, and Social Services Commissioner Roderick L. Bremby.

Public Health Commissioner Dr. Jewel Mullen, State Healthcare Advocate Victoria Veltri, and Insurance Commissioner Thomas B. Leonardi will be non-voting members.

Consumer advocates, who had been anxiously awaiting word of the appointments, slammed the selections.

Jennifer Jaff, executive director of Advocacy for Patients with Chronic Illness, said she was disappointed that none of the state officials who made appointments selected a consumer representative.

She cited a line in proposed federal regulations for the exchanges that says that “exchanges are intended to support consumers, including small businesses, and as such, the majority of the voting members of governing boards should be individuals who represent their interests.”

“Although many thousands of consumers will be expected to purchase their insurance through the Exchange, they will not have a voice in the operations of the exchange,” Jaff said. “That is a huge and unfortunate oversight that is destined to affect consumers’ experience once the exchange is operational.”

Sheldon Toubman, an attorney with New Haven Legal Aid, said he was troubled that the only consumer representative was the healthcare advocate, and that there were three former insurance executives on a board that would likely be responsible for implementing a public insurance option–opposed in the past by insurers–if one was recommended by a separate board established as a compromise on the proposed state-run SustiNet health plan.

The board will make critical decisions about what health plans sold on the exchange will offer, will need to coordinate its activities closely with Medicaid and other state insurance programs, and will largely serve people who have struggled to get insurance coverage, said Alicia Woodsby, public policy director for the National Alliance on Mental Illness, Connecticut. “So you would think that there would be people who could represent them, or individuals themselves who’ve been uninsured or have had barriers to health care access, to sit on the board and share their perspective, so they can ensure that they’re adequately meeting their needs,” she said.

Woodsby said she and other advocates will continue to monitor the board’s activities. She, Toubman and Jaff were among a group of consumer advocates that wrote a letter to exchange board members earlier this month, offering assistance and outlining some issues the board will face.

Ellen Andrews, executive director of the Connecticut Health Policy Project, who also signed the letter, said including people who recently worked for the insurance industry violated the spirit of the conflict-of-interest provisions in the law.

“If they were so good at providing a decent marketplace that was fair and accountable and transparent and affordable, we wouldn’t be in this mess, we wouldn’t need reform,” she said. “This is worse than some of the states where they allow insurance companies to have a person” with industry ties on the board.

But Keith Stover, a lobbyist for the Connecticut Association of Health Plans, said there are reasons for having people with an insurance background on the board.

“I think that we would be making a mistake, just as a practical, technical matter, not to have people who are well-versed in how insurance works,” he said. “Because after all, what we’re about here is making sure that everybody in Connecticut gets insured.”

Stover praised the appointees as bright, capable and serious-minded. “With this kind of a group, I’m looking forward to a group that is about the business of what they have to do, rather than about the business of scoring political points,” he said.

DeJesús, a former president and CEO of the Hispanic Health Council, said she also had had concerns about having an equal number of people at the table “that can really represent the totality of the people in our state.” She said the conflict-of-interest provisions in the law, as well as the expertise needed to develop the exchange, made selecting board members a challenge.

But she said board members she spoke with expressed “real understanding and sensitivity to population issues and issues of access and availability to populations that are not traditionally represented on these boards.”

“I feel gratified that at least some of my concerns have been put to rest,” she said, adding that she thinks the board has the right representation. “It’s not perfect, of course, but I think that there are opportunities to level that off when we need it.”

DeJesús said other bodies are going to be formed that will contribute to decisions on health reform implementation, including an advisory group predominantly made up of consumers.

While the exchange is a significant part of health reform, she added, it’s not the only part. For reform to work she said, other work needs to be done, including addressing DSS eligibility systems and standards, people whose eligibility status changes frequently, access to technology and different levels of understanding about insurance, chronic disease management and preventing illness and obesity, and ways to maintain a robust insurance business in the state.

“As we move forward in building this exchange, I think it’s very important for people to keep in mind that it is a significant part of health care reform, but it is not health care reform,” she said. “We have to keep our eye on the big picture.”