Task force studying high-deductible health plans struggles to find consensus
Health insurers and medical providers can’t seem to find much to agree on when it comes to alleviating the symptoms and root causes of “high-deductible health plans,” which have become common in Connecticut.
As the legislative session approaches Feb. 5, the High-Deductible Health Plan Task Force’s deadline to issue recommendations to lawmakers also looms, but it was unclear this week what might remain in the final report from the dozen-member body, which includes representatives of the insurance industry as well as hospitals, physicians, insurance brokers and others.
The task force, created by a state law passed last year, picked over a draft version report for several hours on Tuesday. There was disagreement over many of the proposals in the draft report, including one that called for a state-created public option health plan as a way to spur greater insurer participation in the Access Health CT exchange, which currently has two insurers (ConnectiCare and Anthem).
Two task force members -- Janice Perkins, ConnectiCare’s director of government relations, and Susan Halpin, chief lobbyist for the Connecticut Association of Health Plans -- urged that the final report not include support of a public option plan, arguing it was out of the task force’s scope and that the commercial and fully insured market bear the brunt of a resulting rise in costs, should a public option pass.
They had some agreement from providers, including Patrick McCabe, senior vice president of finance at Yale New Haven Health.
“The public option is of significant concern to me,” McCabe said. “The vast majority of our cost shift is because of the underpayments from governmental programs.”
“Having another option that’s overseen by some level of government, to me, is not a solution and is only a race to the bottom...and will only lead to some of the incremental cost shifts that we see today,” he added.
State Healthcare Advocate Ted Doolittle, who chairs the task force, said he wants to keep the public option in the final report, but said the matter would be subject to further discussion at a task force meeting next week.
“Certainly we’re on an unsustainable course at this point,” Doolittle said of rising healthcare prices.
Seth Powers, co-director of the Glastonbury-based Center for Children with Special Needs, said the task force should find another solution if its membership is too worried about a public option.
“Because without a solution, [a public option] is going to become more and more attractive over time,” he said.
Gov. Ned Lamont backed a public-option style bill last year, but pulled his support amid insurer opposition. Senate Democrats intend to try again this coming session, but Lamont -- who recently backed a new benchmarking system meant to hold rising healthcare costs in check each year -- won’t support that effort, WSHU reported last week.
Pro-rating deductibles for mid-year enrollees
High-deductible health plans have, as their name suggests, higher-than-average deductibles -- at least $2,800 for a family plan in 2020, under IRS rules.
One issue the task force has been debating is whether a state resident who switches jobs mid-year and enrolls in a new employer’s insurance plan, should have their annual deductible pro-rated.
“On its face, it does seem to be a reasonable thing,” said Dr. Greg Shangold, an emergency room physician and president elect of the Connecticut State Medical Society.
“It sort of just seems intuitive,” added Dr. Daniel Freess, past president of the Connecticut College of Emergency Physicians, who called the current situation “inherently unfair.”
Not so fast, say insurers.
“You’re mixing markets, you’re mixing employers, you’re mixing health plans, you’re mixing all different components of the way that premiums are determined and delivered in the rate-setting process health plans have to go through,” Halpin said. “I can see the appeal of this on its face. ”I don’t think it works from a practical standpoint.”
Doolittle supported a bill last year that would have pro-rated deductibles, which ultimately did not pass.
Word is not bond
If a health insurance customer service representative tells a customer that a particular service is covered by his plan, but then the patient patient later finds out the service was not covered, the matter is often decided on the wording of the specific insurance contract in question.
Some task force members want lawmakers to change state law to make the rep’s statements carry more weight than the contract.
Powers worried that such a change would force insurers to instruct their customer service reps, who are unlikely to be attorneys, to simply refer customers with questions to their contracts.
“I think what we would end up with then is a much worse customer experience,” Power said.
ConnectiCare’s Perkins said the Connecticut Insurance Department has a strict adjudication process in place and that insurers strive to provide accurate information over the phone to customers.
“We don’t want those kinds of conflicts to happen for the members at all,” she said. “That’s not good for anybody.”
Shangold said denials of coverage, or delays in approving care, are a problem.
A recent93-year old patient of his had been losing weight and her appetite in recent weeks. Shangold said she was awaiting insurer approval of a CT scan, but that he was able to get her one more quickly in the emergency room. He then had to deliver the news that she had metastatic lung cancer.
“As much as complexity is there, it’s affecting patient care,” he said.
Insurance Dept. weighs in
A number of the task force’s draft proposals would increase insurance premiums in the short-run, while others could run afoul of federal law, the Connecticut Insurance Department said in response to questions from its members.
Proposals that could increase premiums, or run into other problems, CID said, include:
- Mandating that high-deductible health plans here provide “first-dollar coverage” (meaning without deductible or copay) for 14 preventive care services recently approved by the IRS. As of now, covering those services without cost sharing is optional for carriers.
- Requiring high-deductible plans to provide first-dollar coverage of mental and behavioral health services. CID said that the IRS expansion of preventative services did not include mental and behavioral health, and that the IRS has indicated that substituting other services into the list of 14 is not allowed.
- Requiring insurers to pay doctors the full amount allowed for care provided to a patient, even if there is a deductible, and then requiring the insurers to collect any owed amounts from the patient themselves. Providers have complained that high-deductible plans have forced them to act as collection agents, which they say hurts the doctor-patient relationship. A UConn researcher presented findings to the task force in November that identified one Connecticut hospital had sued thousands of patients a year over medical bills.
CID said that making insurance carriers be the money collectors could affect the tax-qualified status of high-deductible plans and, to the extent insurers’ IT systems are not set up to collect the payments, could lead to higher premiums.
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