Exchange update: HUSKY parents at risk, out of network standard plan costs alarming

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Public testimony before yesterday’s CT Health Insurance Exchange Board centered on the administration’s proposal to cut eligibility for HUSKY parents over 133% of the federal poverty level (currently $25,975 for family of three) saving the state $3 million in FY 14 and $30 million (net) the next year. The proposal assumes those families will purchase coverage in the exchange, but even with federal subsidies, premiums and out of pocket costs will be unaffordable to most. During public comment a woman spoke for her daughter-in-law who had to work. She gave a compelling description of the Hartford family of three making $45,000/yr, how tight their monthly budget is, and the likelihood that they will have to be uninsured if the cut passes. The Board also unanimously approved out of network costs for the standard plan. The costs will be double the already very high in-network out of pocket costs. Out of network co-insurance rates will vary from 50% to 80%, and maximum out of pocket costs are $12,500 for both the bronze and silver plans. This is particularly troubling as reports are surfacing that insurers are approaching providers to join “exchange-only” panels with payments at Medicaid rates. Out of network care may be a necessity if panels are very narrow. When asked if plans are only offering very low reimbursement rates, staff stated they would “have a conversation with the plan.” In other news at the Exchange Strategic Planning committee, staff described their very early plans to implement CT’s All Payer Claims Database. There were more questions than answers. The APCD will be controlled by the same Exchange Board with input from the APCD advisory committee of the Health Reform Cabinet – rather than set up independent governance as in all other states. Neither committee has an independent consumer member but do include insurers, providers, and state agencies. A bill has been raised to require providers to notify their patients that their information is to be shared in the APCD and give them the opportunity to opt-out of the database.