Exchange chat draws questions, chiding, on health insurance reform

New Haven — Some came with questions about insurance costs and seeing doctors. Some wondered if they’d lose their government coverage and have to start paying for a private plan. And some wanted to discuss their disappointment in how health reform is being handled in Connecticut.

The audience at Thursday night’s panel discussion on the state’s health insurance exchange included those with questions about the basics of federal health reform and those with arguments about the nuances of policy decisions being made.

The discussion was one of seven “Healthy Chats” being held around the state, part of an effort to raise awareness and answer questions about the exchange, which will be a virtual store for selling insurance coverage.

Exchange CEO Kevin Counihan

Exchange CEO Kevin Counihan began the meeting by offering a description of the exchange and, later, used charts to illustrate how federal subsidies for buying insurance would cap the premiums people with incomes below certain levels would pay.

One woman, who said she is on Medicare and Medicaid, said she was scared because the charts distributed to the audience indicated that, based on her income, she’d have to pay more than $1,300 for health insurance, even though she pays nothing now.

“Is that true?” she asked. “If it’s true, I’m very upset.”

It wasn’t, said Jill Zorn, senior program officer at the Universal Health Care Foundation of Connecticut and a panelist.

“If you have Medicare, you’re going to keep your Medicare,” she said, adding that the woman would not participate in the exchange.

“And I won’t be forced to?” the woman asked.

“This is for people that don’t have coverage at all,” Zorn said. The exchange will be open to people who would otherwise be buying coverage on the state’s individual or small group markets.

One man asked about challenges to accessing health care, since having insurance doesn’t necessarily mean it’s easy to get a doctor’s appointment.

Counihan, who worked at the exchange Massachusetts established as part of its health reform law, said that in that state, doctors began to rely more heavily on nurses, which freed them to do more sophisticated work. In addition, he said, the introduction of Minute Clinics at pharmacies provided another way for people to get care without going to a primary care doctor or emergency room.

He said that wait times to see primary care physicians rose from 38 days to 44 days after the state’s health reform law went into effect — an increase, but not as dramatic as what some critics say, he said.

Rate negotiations, board composition, public option

Steve Jennings wore a red “healthcare4every1” T-shirt, the symbol of the movement for a public insurance plan known as SustiNet, which failed to win adoption last year. He expressed disappointment that the state doesn’t have a public option, and that the exchange’s board had chosen not to negotiate over rates with insurance carriers that want to sell policies in its market.

He also raised concern that even with the exchange, hundreds of thousands of people won’t be able to afford coverage.

“What we’re trying to do in Connecticut is to make something that’s unaffordable more affordable,” Counihan said. “Does that make it perfectly affordable? No. Is it as low as it ought to be? No. But it’s trying to make some progress in that direction.”

He added that the exchange was part of an attempt to make insurance a right of citizenship, not a privilege of employment.

Several other people also took issue with the exchange board’s decision not to negotiate over rates with insurance carriers. Counihan and the exchange’s staff had opposed negotiating with insurers over rates because of concerns that the exchange would have little leverage to bargain in the first year and that doing so could make it difficult to attract insurance carriers to sell their products in the exchange.

Counihan said he’s not aware of any states planning to negotiate rates with insurers in the exchange, and said the concept is “a little bit of an urban myth,” rooted in Massachusetts, where one part of its exchange negotiated rates. That part was only for subsidized customers and isn’t a parallel situation to the one other state-based exchanges are in, he said.

Liz Keenan, a leader of the group Congregations Organized for a New Connecticut, pressed Counihan on the decision.

“It seems like we have a bit of a chicken-egg syndrome here,” she said.

If you don’t know who will enroll in the exchange, there might be reluctance to negotiate rates because of concerns about getting insurance companies to sell their products in the exchange. But if consumers aren’t confident that the exchange’s plans will be affordable, they might not want to join either, she said.

“We could do all the marketing in the world. People won’t sign up and we won’t expand the pool … enough to be able to drive costs down,” Keenan said.

In response, Counihan said there’s little for the exchange to negotiate over in the first year if it has no market share and no idea of who is enrolling, how many people will enroll and what their health status is, and what health plans will be offered.

Making insurance affordable is a national issue, he said, and lowering costs could involve delivery system reforms, payment reforms, and addressing structural issues in the state.

“That’s way above our pay grade,” he said. The exchange is tasked with getting a market up and running by October, he added, and he hopes it’s a way to start addressing those bigger picture issues.

Zorn noted that the Connecticut Insurance Department will have to approve the rates of all plans sold in the exchange, and said consumer advocates should watch that process closely. “They need to have very sharp pencils,” she said.

Beyond insurance price, she added, the cost of health care has a lot to do with how care is delivered, and she said she hopes the exchange will help push for improvements to reduce expenses.

Mary Elia, a retired teacher from West Haven, said she spent years negotiating teachers’ contracts with the insurance company that is now Anthem Blue Cross and Blue Shield, when it was nonprofit and later, when it became a for-profit company. When the company’s status changed, the tenor of the negotiations did too, she said. And she said the exchange board reminds her more of the representatives of the for-profit company she bargained against.

She was sounding a theme that’s dogged the exchange board since its members were appointed: Criticism that consumers aren’t adequately represented, and that there are three members who are former insurance executives.

Counihan said he knows there’s a perception that the board is a shill for the insurance industry. “That perception has not been my experience,” he said, adding that the former insurance executives “are among the most aggressive consumer supporters on that board.”

But Counihan’s experience didn’t convince the Rev. Gary Witte, pastor of Woodmont United Church of Christ in Milford.

“You have a transparency gap,” he told Counihan.

The next Healthy Chats will be held in:

• New Britain: Tuesday, Dec. 11, Central Connecticut State University, 1615 Stanley St., Memorial Hall, Constitution Room
• Stamford: Thursday, Dec. 13, University of Connecticut Stamford, 1 University Place, Gen Re Auditorium
• Bridgeport: Tuesday, Dec. 18, Bridgeport Holiday Inn Hotel & Conference Center, 1070 Main St., Harbor Ballroom

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