Official: State leads in healthcare compliance

Donald Eng

The federal Affordable Care Act (ACA) is far from perfect, but the kinks are gradually being ironed out and Connecticut is better off than many states in implementing its requirements.

That was the message recently delivered to Valley Council for Health and Human Services members by the man in charge of implementing the state’s health insurance exchange.

“I fundamentally believe that this is a free-market, pro-competition measure to make it easier for small businesses and individuals to buy healthcare,” said Kevin Counihan, CEO of Access Health CT, the state’s health insurance exchange.

Counihan said the current system was unsustainable, with costs spiraling to the point where getting a cut stitched could cost thousands of dollars, and the average family health insurance payment cost more than the average family mortgage.

The ACA, often called Obamacare, has brought much criticism as well. Opponents have bounced on problems with implementing the law in recent months.

 

Fewer uninsured in Connecticut

The state’s exchange is considered a model for the country because of its ease of use, Counihan said. As a result, about 9% of state residents are uninsured, compared to about 17% nationally and as many as 30% or more in states like Texas, Florida and California.

The Connecticut exchange is simple, Counihan said. Users may log on to accesshealthct.com and, after confirming their eligibility, select from gold, silver and bronze plans offered by four health insurance providers.

Counihan said the web data shows that it takes about 40 minutes for a person to sign up, better than the national average of more than an hour. “If it sounds simple, it is,” he said.

 

More than 130,000 have signed up

By working with the four insurance companies, with the possibility that two more will sign on by the end of the year, Counihan said, the prices for consumers will be relatively low.

“The more companies involved, the better the prices get,” he said. About 130,000 state residents have purchased plans so far, and the state is in the process of making purchases easier, opening two storefront locations for customers to walk in and buy insurance. The two current retail locations in New Britain and New Haven sell a combined 100 policies a day, he said.

 

Change in approach by employers

Demand for the health exchange could also increase because of what Counihan calls the “401(k)-ing” of health insurance. Rather than providing health insurance policies as an employment benefit, employers have begun giving employees a defined amount of money with which to purchase their own plans.

This is similar to the decline of company pensions, replaced with defined contribution plans like 401(k)s, he said.

A number of obstacles still remain, including several legal challenges and the inherent difficulty in changing a large healthcare system. These challenges, though, are no different from what large programs like Social Security and Medicare faced when they were implemented, Counihan said.

“It needs work, like any law, and it is ideologically polarizing,” Counihan said. “But we need to decide as a country whether access to comprehensive care is a right of citizenship or a benefit of employment.”

 

Questions on implementation

Questions from the council members focused on the problems the ACA has faced in implementation, including the reports of people losing their health insurance if it does not measure up to the law’s standards. Counihan said that has been a problem in a small percentage of cases, but the impact in Connecticut has been minimal.

“Some of the plans that have very high deductibles have been voided, and that is a legitimate source of discussion,” he said.

Hospital costs are another problem, one that Counihan called the 800-pound gorilla in the room. In Massachusetts, where he previously worked, Counihan said, the state’s insurance law has resulted in the transferring of routine care to nurses and walk-in clinics.

Rather than having a doctor treat sprained ankles and sore throats, that is increasingly being done in clinics rather than emergency rooms, and at a substantially reduced cost, he said.

“The marketplace will accommodate what we are trying to do,” Counihan said.

 

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