As exchange board begins work, advocates still seeking change

The board developing the state’s health insurance exchange–a key piece of federal health reform–is already at work. But consumer advocates unhappy with the composition of the board are still trying to change its make-up, and Democratic lawmakers are open to the idea.

Some advocates have been urging lawmakers to amend law that governs the exchange to add board members who represent consumers. Others want three board members who have held leadership positions at insurance companies to be replaced, saying their appointments violate the state law that established the exchange, which prohibits board members from being affiliated with insurers or other health care industry groups.

“The biggest danger is that the board is set up to protect insurance companies instead of consumers, or to enrich insurance companies instead of protecting consumers,” said Tom Swan, executive director of Connecticut Citizen Action Group. He and other critics of the board are exploring administrative and legal options if the governor and legislators don’t replace the board members with insurance backgrounds.

But some involved in implementing health reform say it’s important to have people who understand insurance involved in developing the exchange, which will serve as a marketplace for individuals and small businesses to buy health care coverage beginning in 2014.

Lawmakers did not address the board’s composition during a special legislative session last week, but Democratic legislative leaders and Lt. Gov. Nancy Wyman, who chairs the exchange board, have expressed openness to considering changes during next year’s regular session. None said they had concerns about the board.

The board has eight members appointed by the governor or legislative leaders, and six members representing state agencies or government. The three members that have drawn the most scrutiny are Mickey Herbert, who retired last year as CEO of the insurer ConnectiCare;  Robert Scalettar, a physician who has held top medical positions at Aetna Better Health, AmeriChoice by UnitedHealthcare, and Anthem Blue Cross and Blue Shield; and Mary Fox, a former senior vice president for Aetna Product Group.

The other appointees include Wyman, small business founder Michael Devine, health economist Grant Ritter, former Senate Democrats staffer Cecilia Woods, and Robert Tessier, who leads a coalition of health plans for unionized workers.

Concerns from the left

Many states have been slow to embrace or even outright challenged federal health reform. In Connecticut, though, the most visible fight has taken place on the other side, with critics worried that the state won’t go far enough. Many of those seeking to change the exchange board’s composition were involved in the push for SustiNet, a proposed state-run insurance plan that failed to become law after Gov. Dannel P. Malloy expressed reservations. Malloy, a Democrat, has embraced federal health reform, but many advocates have criticized him for not supporting SustiNet and say he has been too deferential to the insurance industry.

At the most recent exchange board meeting, some critics held a silent protest, with bandages over their mouths.

The exchange board “is absolutely as far opposite as you could probably get to what the federal vision of that entity was supposed to be, which was very heavily weighed on the consumer side. And what we have is we have no consumers,” said Kevin Galvin, a small business owner who has been active in pushing for state-level health reforms and serves as chairman of Small Business for a Healthy Connecticut.

He noted that while state Healthcare Advocate Victoria Veltri is on the board, she is a non-voting member.

Ellen Andrews, executive director of the Connecticut Health Policy Project, said she was concerned that the board members did not appear to have experience working with low-income residents.

“They don’t know what they don’t know,” she said. “I’m more scared in terms of them being able to explain to people who are going to be forced to buy [insurance] why they should buy it, and why they should trust this group of people who, frankly, I don’t trust.”

Juan A. Figueroa, president of the Universal Health Care Foundation of Connecticut, which led the push for SustiNet, wants the exchange board dismantled and restarted. “I think there’s a real question as to the legitimacy of this board and I would just start all over again,” he said.

State Comptroller Kevin Lembo, the state’s previous healthcare advocate, isn’t seeking to have anyone removed from the board, but said it seems like a mistake that more consumers were not named on the board, and that it could be fixed efficiently through legislation or an executive order.

“I don’t assign bad motivation to anyone, I just think we are where we are, the question is, are we willing to fix it?” he said. “If it’s an easy thing to fix, then we should fix it and move on.”

Who is a consumer advocate?

Since the exchange was created through legislation, Wyman said she has suggested that advocates seek legislative changes if they want to expand the board by one or two people.

Senate Majority Leader Martin M. Looney, D-New Haven, would support making the healthcare advocate a voting member and would consider other changes, but couldn’t commit to them yet, spokesman Lawrence Cook said.

And House Speaker Christopher G. Donovan, D-Meriden, is open to discussing adding consumer representation to the board, according to spokesman Doug Whiting.

“I think he feels that the composition of the board is representative, but clearly there are a number of folks and advocates who don’t believe that,” Whiting said. “He’s willing to listen to that argument, and if the argument’s persuasive, at least to consider making changes.”

But House Minority Leader Lawrence F. Cafero, Jr., R-Norwalk, said he would be loath to change the make-up of the board, “unless they’ve got a pretty damn good reason.” Cafero said it’s one thing to ask an appointing authority to make a new selection if members are not knowledgeable about the subject or aren’t showing up to meetings.

“But to change the legislation as to who comprises the board, that’s another thing,” Cafero said. “They’d have to really demonstrate to me and others as to why that’s necessary. And if it comes down to just ’cause they’re not getting what they want to get, that’s life.”

Besides, Cafero noted, “Your definition of consumer-friendly might be different than mine.”

And Wyman, who said she thinks the board achieves the appropriate balance, challenged the idea that board members, herself included, won’t stand up for consumers.

“I really believe that most people on that board do believe they’re consumer advocates,” she said.

Moving fast

Herbert, too, took issue with the idea that he and other board members are not consumers. He noted that he has experience purchasing insurance for a small business–the Bridgeport Bluefish baseball team, which he owned and operated for eight seasons, and which has about a dozen full-time employees. He has also been involved in private and state efforts to figure out how to cover all Connecticut residents.

“It’s something that I’m very, very committed to, and I know quite a bit about,” Herbert said. “I don’t feel like I was chosen for any other reason but for the fact that I have a lot to offer through this process.”

Herbert said it would be “folly” to remove him, Fox and Scalettar from the board.

“We’re not conflicted currently, and I would argue that it’s imperative to have some folks on that board that have health insurance backgrounds and experience, because that’s what this is all about,” he said.

Fox and Scalettar did not respond to requests for comment, but others spoke on their behalf.

Cook called Scalettar, Looney’s appointee, “eminently qualified” to serve on the exchange board because of his expertise in health delivery systems.

“Among his other qualifications, he has practiced pediatrics at a community health center, he built and ran a student health center, and he was chief medical officer for Anthem Blue Cross-Blue Shield,” Cook said. “That is why Bob Scalettar is on the Health Insurance Exchange–because of his decades of commitment and to people who need good health care.”

Wyman, who like Fox was named to the board by Malloy, said Fox had not worked at Aetna in some time, and brings a different perspective to the board. Fox “believes that she is an advocate,” Wyman said.

Jeannette DeJesús, special advisor to the governor for health reform and vice chairwoman of the exchange board, said it’s been made clear that the administration would support action by the legislature to add board members. But she suggested that advocates might be better off focusing on other areas.

The board is moving at a fast pace to build and implement a new insurance marketplace in two years. One task, hiring a CEO to run the quasi-public agency, is moving quickly, with board members expected to select the top candidates–to be narrowed by the governor–next month.

Having one person on the board won’t be nearly as effective as making sure that a wide range of communities affected by health reform get heard in the process, DeJesús said.

Through DeJesús’ office, the state was recently accepted into a program that will give training in health equity issues to members of the exchange board and other boards involved in health reform. She said it’s important to have diverse communities represented on the board, but that to assume that the people chosen don’t have sensitivity or knowledge about those areas might not be correct.

Herbert said he’s trying to stay above the fray and largely ignore the dispute over the board composition.

“We have a lot of work to do and in a very short period of time, so it might be a little bit too strong to say we’re ignoring all the noise around us, but the reality is we’re just focusing on our job, which is trying to get this exchange up and running in really a pretty short period of time,” he said.