Free Daily Headlines :

  • COVID-19
  • Vaccine Info
  • Money
  • Politics
  • Education
  • Health
  • Justice
  • More
    • Environment
    • Economic Development
    • Gaming
    • Investigations
    • Social Services
    • TRANSPORTATION
  • Opinion
    • CT Viewpoints
    • CT Artpoints
DONATE
Reflecting Connecticut’s Reality.
    COVID-19
    Vaccine Info
    Money
    Politics
    Education
    Health
    Justice
    More
    Environment
    Economic Development
    Gaming
    Investigations
    Social Services
    TRANSPORTATION
    Opinion
    CT Viewpoints
    CT Artpoints

LET�S GET SOCIAL

Show your love for great stories and out standing journalism

Access Health CT faces growing challenges as insurers drop out

  • Health
  • by Kyle Constable
  • July 8, 2016
  • View as "Clean Read" "Exit Clean Read"
This is a photo of Pedro Lopez asking how long it will take to sign up for insurance at the Access Health CT store in New Britain.

Arielle Levin Becker :: The CT Mirror file photo

Customers wait in line at the Access Health CT store in New Britain.

In the wake of a state order halting new enrollment in Connecticut’s co-op health insurer, HealthyCT, the state’s health insurance exchange faces growing challenges as it prepares to lose two of its four carriers.

The exchange, Access Health CT, has been widely heralded as one of the strongest state health insurance exchanges in the country, but loss of the two insurers will limit the options available to customers in search of health insurance. Officials at the exchange remain optimistic, although they concede the next two years will be volatile.

UnitedHealthcare announced in April it plans to pull out of Access Health after this year – part of a strategic withdrawal from all state exchanges within the next two years. Then, on Tuesday, the state Insurance Department issued an order of supervision to block Connecticut’s nonprofit health insurance co-op, HealthyCT, from selling any new plans because of its “hazardous” financial standing. The order came despite reassurances from co-op officials they were on track to profitability.

On June 30, HealthyCT found out it would be required to pay $13.4 million in federal risk adjustment under the Affordable Care Act, a requirement meant to move profits from low-risk insurers to those taking higher risks. This prompted an evaluation by the state Insurance Department that found the co-op would become financially “unstable” after making the payment. Although HealthyCT cannot issue new policies, all existing policies will remain in effect until they expire.

UnitedHealthcare provides coverage for about 1,500 customers on Access Health’s individual marketplace and about 150 on its small business marketplace. HealthyCT provides coverage for nearly 11,300 customers on the exchange, and  40,000 in total in Connecticut.

The loss of HealthyCT from the exchange increases concerns in Connecticut about market concentration, a decrease in the diversity of health insurance options.

When President Barack Obama’s signature health care legislation took effect, federal officials hoped co-ops – consumer operated and owned plans promising to return a portion of their profits to members – would increase diversity on the state exchanges. Twenty-three new co-ops received federal funding, but since then, more than half have gone under. Those remaining continue to struggle financially.

Some experts believe the drop in carriers on Access Health could cause insurance premiums to rise both on and off the exchange.

“These changes will cause a further consolidation of the market,” said Matthew Katz, CEO of the Connecticut State Medical Society. “It appears that it could mean less choice (for consumers) and potentially higher premiums.”

Katz is not alone in that concern. Access Health CEO Jim Wadleigh said he is worried about potential rate increases as well, but did not know how much of a jump there might be. Insurance Commissioner Katharine L. Wade, whose office regulates the rates carriers charge on the exchange, said she cannot speculate about what the effect might be.

Wadleigh said more collaboration with the remaining insurers on the exchange – ConnectiCare and Anthem – will help to keep rates affordable by creating new, more innovative plans for consumers.

Connecticut’s exchange is still better positioned than most, Wadleigh said. While it is possible only two private carriers will remain, state-sponsored Medicaid plans also are available to customers through the Access Health portal as a result of a partnership with the state.

“There has been a very big collaborative effort between Access Health and the Department of Social Services on that front,” Wadleigh said. “There are really still three carriers, per se, because the HUSKY program is still a carrier for our Medicaid customers. I realize that’s mincing words there. Would I prefer to have more carriers? Yes.”

Market concentration challenges

Connecticut remains one of the most concentrated markets in the country for health insurance, the medical society’s Katz said, citing the Herfindahl–Hirschman Index, a statistic that measures how diverse a market is by looking at the number of providers and their market shares. Connecticut’s scores have consistently shown high concentration in recent years.

Katz said the loss of HealthyCT could jeopardize Access Health’s ability to attract new carriers to the marketplace. When it appears a market is controlled by one or two players – in this case, ConnectiCare and Anthem – it “creates a barrier” because the market appears too difficult to compete in, he said.

Access Health has courted other carriers to join the exchange in recent years, but has had little success, adding to the agency’s sense of urgency about maintaining competition on the marketplace.

But Chad Brooker, a senior manager at Avalere Health, a health care consulting firm, said the exchange has always been dominated by ConnectiCare and Anthem – even with the HealthyCT and UnitedHealthcare options. HealthyCT was just starting to become a competitor, Brooker said, when the Insurance Department barred it from issuing new policies. UnitedHealthcare only enrolled a small percentage of customers, he added, and its departure alone would not have had a significant impact.

Aetna headquarters in Hartford

Aetna

Aetna headquarters in Hartford

Brooker, who worked for about three years as a staff attorney for Access Health’s before joining Avalere Health in 2015, said Access Health was unsuccessful in courting two carriers – Aetna and Harvard Pilgrim – in the past.

Aetna, headquartered in Hartford, has not offered plans on Connecticut’s exchange. Brooker said it has a “substantial presence” in other states but has been “resistant to coming on the exchange since the very early days.” Aetna officials initially planned to join the exchange in its first year, but withdrew when they said requests from state regulators to modify their premiums would prove too costly.

Aside from “some negative connotations,” Brooker said, their decision not to join the exchange is consistent with the relatively small number of off-market individual plans they sell in Connecticut. He said the loss of HealthyCT probably will not affect their decision going forward one way or the other.

Aetna said Thursday it has not yet decided which state exchanges it will take part in next year.

The real loss, Brooker said, has been Harvard Pilgrim Health Care, which began selling policies in Connecticut in 2014. 

“(Officials) had put a lot of emphasis into Harvard Pilgrim,” Brooker said. “Their kind of reticence to come onto the exchange for the 2017 benefit year, when they had by all accounts stated they were prepared to launch on the exchange, I think is frankly a bigger issue than losing HealthyCT or United pulling out.”

Fairfield County residents probably will be hit the hardest by the loss of HealthyCT, Brooker said. The co-op had made significant inroads in the county, in part because it used an offshoot of the Trumbull-based Oxford Health Plans network in its enrollment efforts.

Wade maintains that competition off the exchange remains “robust” in the state but would not comment further on any concerns about market concentration.

The road ahead

While HealthyCT has been all but written off by some, it still has a lifeline with the state. Wade said if HealthyCT is able to raise enough capital from private sources and prove its financial viability, the Insurance Department will lift the order of supervision.

A similar situation is unfolding in Illinois, Brooker said, where the state’s health insurance co-op, Land of Lincoln Health, is also facing financial difficulties following its mandatory federal risk adjustment payment. State officials are intervening in an attempt to save it, Brooker said, but it is unclear whether they will succeed.

If Connecticut officials were willing to intervene, Katz said, it might be possible to save HealthyCT. But Wade said it is up to HealthyCT to raise the funds it needs.

Access Health CT Acting CEO Jim Wadleigh

The CT Mirror

Access Health CT CEO Jim Wadleigh

Despite the uncertainty in the near future for Access Health, Wadleigh said he does not believe losing HealthyCT and UnitedHealthcare will cause the exchange to lose its status as one of the best in the nation.

“The success that Connecticut has had nationally makes Connecticut a lightning rod for everything we do,” Wadleigh said in reference to the amount of media attention the exchange receives. “We’ll always be under a magnifying glass throughout this process.”

Wadleigh said there is frequent communication between the heads of the 16 other state exchanges, adding that he received a call from the head of the Colorado exchange shortly after the news about Connecticut’s co-op broke Tuesday. Colorado lost its co-op in 2015.

Keeping Connecticut’s two remaining carriers on the exchange remains a top priority for Wadleigh. He said ConnectiCare and Anthem have renewed their commitments to stay on the exchange. Wadleigh has kept in close contact with officials from both insurers, holding monthly and quarterly meetings with them.

He also said Access Health plans to redouble its efforts to recruit new carriers onto the exchange.

Officials are prepared for volatility for all state exchanges over the next two years, Wadleigh said, after which the “winners” will emerge.

Sign up for CT Mirror's free daily news summary.

Free to Read. Not Free to Produce.

The Connecticut Mirror is a nonprofit newsroom. 90% of our revenue comes from people like you. If you value our reporting please consider making a donation. You'll enjoy reading CT Mirror even more knowing you helped make it happen.

YES, I'LL DONATE TODAY

ABOUT THE AUTHOR

Kyle Constable Kyle was a general assignment reporter at the Connecticut Mirror. A former State Capitol beat writer for The Daily Campus, he graduated from UConn with a bachelor's degree in journalism in 2017. He previously worked for the Mirror as a freelance reporter and, before that, was the Mirror's 2016 summer reporting fellow and an intern during the 2016 legislative session.

SEE WHAT READERS SAID

RELATED STORIES
How does the public option bill differ from Gov. Ned Lamont’s health care plan? Here’s a look at the two proposals.
by Jenna Carlesso

With the rising cost of care a central issue this legislative session, lawmakers and Gov. Ned Lamont’s administration have each moved ahead with their own plans aimed at driving down prices.

Medical providers are taking nature therapy seriously
by Jenifer Frank | C-HIT.ORG

In a time of social isolation and staying home, sometimes a walk in the park is the best medicine.

Have a case of a COVID variant? No one is going to tell you
by Christina Jewett and JoNel Aleccia | Kaiser Health News and Rachana Pradhan

Federal rules around who can be told about the variant cases are confusing, and tests have not been approved.

CT teachers are expected to get vaccinated for COVID at local clinics, but other options could cause problems
by Dave Altimari

School employees could end up on two lists, which means some vaccine might go to waste, officials said.

Grocery store workers ‘disgusted’ with Lamont’s new COVID-19 vaccine policy
by Keith M. Phaneuf

Grocery store workers are frustrated with Gov. Ned Lamont, who is no longer prioritizing them in the coronavirus vaccination schedule.

Support Our Work

Show your love for great stories and outstanding journalism.

$
Select One
  • Monthly
  • Yearly
  • Once
Artpoint painter
CT ViewpointsCT Artpoints
Opinion How do we show that we value teachers? By listening to them.
by Sana Shaikh

When I was graduating college, my friends’ futures were brimming with impressive labels: Google, Facebook, McKinsey, Bain, PhD, MD, Fulbrights – the list of professional excellence was seemingly never-ending. When I said that I was becoming a teacher, I got puzzled looks – “Why would you be a teacher?” “If you can’t do, teach,” I heard. The nonchalance about my professional trajectory was unsettling. What’s more? Nothing has changed in the last ten years.

Opinion Sports betting in Connecticut: Can’t all the brands just get along?
by Bill Field

When it comes to legalized sports betting in Connecticut, it’s time that all of the parties gathered in a room and hammered out an agreement that works for everyone. The adage of everyone benefiting from a rising tide hasn’t resonated in the past two and half years. 

Opinion COVID-19 will push nursing home design forward
by Myles R. Brown

Over 40 percent of American deaths attributed to COVID-19 have been nursing home residents. Outdated nursing home designs contributed to the scale of this tragedy in Connecticut. Many design changes that could have prevented the spread of COVID-19 were already needed to improve the well-being of nursing home residents. The pandemic has made these issues impossible to ignore.

Opinion Let gig economy workers pursue options
by Nicole Petruzzi

In response to your February 22 story, “In an evolving economy, lawmakers take roles once played by unions:” Like many Connecticut workers, I struggle to make ends meet for my family, even when working full time. This last year has been a particularly hard time. I started looking for a part-time job to supplement my income, but I was worried that even something part-time would take away precious and needed time with my family.

Artwork Grand guidance
by Anne:Gogh

In a world of systemic oppression aimed towards those of darker skintones – representation matters. We are more than our equity elusive environments, more than numbers in a prison and much more than victims of societal dispositions. This piece depicts a melanated young man draped in a cape ascending high above multiple forms of oppression. […]

Artwork Shea
by Anthony Valentine

Shea is a story about race and social inequalities that plague America. It is a narrative that prompts the question, “Do you know what it’s like to wake up in new skin?”

Artwork The Declaration of Human Rights
by Andres Chaparro

Through my artwork I strive to create an example of ideas that reflect my desire to raise social consciousness, and cultural awareness. Jazz music is the catalyst to all my work, and plays a major influence in each piece of work.”

Artwork ‘A thing of beauty. Destroy it forever’
by Richard DiCarlo | Derby

During times like these it’s often fun to revisit something familiar and approach things with a different slant. I have been taking some Pop culture and Art masterpieces and applying the vintage 1960’s and 70’s classic figures (Fisher Price, little people) to the make an amusing pieces. Here is my homage to Fisher -Price, Yellow […]

Twitter Feed
A Twitter List by CTMirror

Engage

  • Reflections Tickets & Sponsorships
  • Events
  • Donate
  • Newsletter Sign-Up
  • Submit to Viewpoints
  • Submit to ArtPoints
  • Economic Indicator Dashboard
  • Speaking Engagements
  • Commenting Guidelines
  • Legal Notices
  • Contact Us

About

  • About CT Mirror
  • Announcements
  • Board
  • Staff
  • Sponsors and Funders
  • Donors
  • Friends of CT Mirror
  • History
  • Financial
  • Policies
  • Strategic Plan

Opportunity

  • Advertising and Sponsorship
  • Speaking Engagements
  • Use of Photography
  • Work for Us

Go Deeper

  • Steady Habits Podcast
  • Economic Indicator Dashboard
  • Five Things

The Connecticut News Project, Inc. 1049 Asylum Avenue, Hartford, CT 06105. Phone: 860-218-6380

© Copyright 2021, The Connecticut News Project. All Rights Reserved. Website by Web Publisher PRO