Insurance and Real Estate Committee
JOINT FAVORABLE REPORT
AN ACT MAKING CONFORMING CHANGES TO THE INSURANCE STATUTES PURSUANT TO THE FEDERAL PATIENT PROTECTION AND AFFORDABLE CARE ACT, AND ESTABLISHING A STATE HEALTH PARTNERSHIP PROGRAM.
Joint Favorable Change of Reference to Government Administration and Elections
SPONSORS OF BILL:
Insurance and Real Estate Committee
REASONS FOR BILL:
CT's insurance statutes must be updated to reflect several consumer protections contained in the federal health reform law that have already gone into effect, including an expansion of coverage for dependents through age 26, prohibitions on pre-existing conditions for children, and prohibitions on unreasonable lifetime coverage limits. Once these statutory changes are made, the state Insurance Department will be able to enforce the new federal law. This bill also sets up a health insurance exchange to offer qualified health plans to small firms and individuals, as provided for under federal health reform.
RESPONSE FROM ADMINISTRATION/AGENCY:
The CT Insurance Department suggested that Section 6 be deleted. “This section modifies requirements solely for Connecticut's high-risk pool, the Health Reinsurance Association, and not the general insurance market, which may be the intent of the actual intent of the bill. The Health Reinsurance Association does not meet the federal definition of a health insurance issuer so is not subject to the requirements of the…(PPACAP). The changes of section 6 will increase the already high premiums for the existing high-risk pool plans. The individuals covered under these plans may have no other options should the premiums become unaffordable.”
The Department also noted that Section 10 “changes the definition of the Medical Loss Ratio (MLR) for purposes of the Managed Care Report Card and disclosure to individuals and groups at the time of application for an insurance policy. The federal definition of MLR is only for rebate purposes and is based on an insurance carrier's entire block of business for that market segment. It would be more accurate and appropriate for individuals and groups to know the MLR for their specific plan design rather than for the entire block of business.”
Finally, the Department stated that Section 11 “reflects some, but not all, of the PPACA conforming language the CT Insurance Department recommends be adopted…This could result in individuals losing existing protections where state law is more favorable than PPACA.” The Department offered alternative language to avoid loss of protection.
Victoria Veltri, Healthcare Advocate testified in support, but noting that “it is unclear whether the prohibitions against denying an individual age 18 or under an insurance policy because of pre-existing condition have been adequately addressed.” Other than that, she mainly addressed other bills, and the differences between HB 6323 and SB 921.
NATURE AND SOURCES OF SUPPORT:
Speaker Christopher G. Donovan spoke, mainly addressing other bills, but voiced his support.
Jill Zorn, Program Officer, Universal Health Care Foundation testified, comparing HB 6323 and SB 921. She voiced her support of the strong conflict of interest language contained in HB 6323, as opposed to SB 921. She also prefers HB 6323's Exchange staffing language over that of 921. She also mentioned that HB 6323 has “stronger language regarding standards that should be met by health plans preferred in the exchange. In addition, she explained how the language concerning adverse selection and transparency is stronger and more specific in HB 6323 than SB 921. She emphasized the importance of transparency and stakeholder input.
The American Cancer Society sent testimony, which stated, “Exchanges…if they are designed and function well, could provide consumers with a 'one-stop shop' to compare and purchase health insurance and enroll in public coverage programs, as well as use the power of a large risk pool to generate competition among health plans based on quality and cost…The new health insurance exchanges are critical to the success of health care reform. In order for cancer patients and their families to experience real changes in their ability to access, choose, and purchase comprehensive health insurance that meets their needs, policymakers…must tackle critical challenges related to the design, implementation, and governance of these new exchanges.”
Brian S. Dunchan wrote, stating that the passage of this bill would “result in a tremendous improvement in the public's health by allowing thousands of people to obtain basic medical coverage. Extension to 26 will help alleviate common void in insurance coverage.” He added that he thought that the dental benefits are too minimal, and that expanding them would be cost effective in the long run for the state.
AARP wrote, voicing its belief that the Exchange's governing body should “include strong consumer representation and also provide the opportunity for additional issue-specific working or advisory groups to be created and to give ongoing input into the process.” It also asked to have the language in Section 15 “make clear that assignments and user fees can be collected after January 1, 2015.”
The CT Conference of Municipalities wrote, voicing its support for multiple bills, including HB 6323, and stated, “It is imperative that local governments be afforded the discretion and flexibility to decide for themselves which tools apply best for their municipalities.”
Jennifer Jaff, Executive Director, Advocacy for Patients with Chronic Illness submitted testimony, expressing her belief that the “conflict of interest provisions of Raised Bill 6323 are superior to those of Raised Bill 921” because no Director can be a consultant to, or employee of an insurer, broker, health care provider, etc.
Matthew Katz, Executive Vice President, CT State Medical Society spoke, stating that “A state-level exchange would allow all stakeholders in Connecticut, such as a spectrum of physicians practicing in different specialties and care sites, to determine what is best for our state and the patients who need to access medical care.” He added however, “Essential for the effective and implementation of such an entity…it is imperative that at least one spot exists for a privately practicing physician with an understanding of insurance delivery and benefits at the practice level.”
Jody Wynn Rodiger recounted her story of her dealings with the current healthcare system, and simply said with regard to the bill, “The cost of services for all communities and all residents must be realigned and this is a good first step.”
Allen Hinden, Chairman, Department of Dentistry, United Cerebral Palsy Hudson Valley Community Services wrote, expressing his concern that medical coverage is denied for certain dental infections, while other infections are covered. He explained the significance of oral infections, and argued that they should be required to be covered by insurance.
Delta Dental of New Jersey, Inc. wrote, stating that “the requirement that dental coverage offered on the Exchange be separately offered and priced would enable purchasers the freedom to choose the coverage which is best for them…Such competition and transparency would benefit all purchasers of dental coverage in this State.”
Peter J M. Peterson and Johnathan B. Knapp echoed the previous two testimonies, and urging the consideration of the Committee to include a broader array of dental health services.
Mark B. Drosiers also reiterated the above testimony and emphasized the extension of coverage to 26 years old, stating, “I realized the importance of this when my daughter recently graduated from college and started her job search.”
Jon Davis, President, Conn State Dental Assoc. also spoke in support of the age 26 extension, and mentioned that the Exchange would benefit small businesses, offering them a low cost alternative.
Stephen Karp, National Association of Social Workers / CT Chapter stated that “The importance of the health insurance exchanges is that they will offer valuable assistance and guidance to businesses, especially small employers…in evaluating and acquiring health insurance plans….The exchange furthermore will be an avenue for the uninsured to find suitable health insurance coverage.”
Ellen Andrews, CT Health Policy Project said that “CT's health insurance exchange must not only be independent of conflicting interests, it must be above even the perception of conflicts.” She voiced her appreciation for the strong conflict of interest provisions in establishing the governance of the exchange, which SB 921 lacks.
Sheldon Toubman of the New Haven Legal Assistance Association, Inc. voiced his favor, but mainly addressed other bills.
William C. Nash wrote, voicing his favor, especially for the provision extending coverage to the age of 26. He mainly addressed other bills.
Jane McNichol, Executive Director, Legal Assistance Resource Center of CT testified, applauding the movement of this bill due to its enabling of ensuring that health insurance coverage is united with access, affordability, and quality health care. She emphasized the importance of a health plan designed for low-income citizens.
The CT State Council, Service Employees International Union sent testimony which compared the Exchange's pool with the pools that unions benefit from. The premise of the testimony is that large pools provide quality health insurance at lower prices.
Tom Swan, Executive Director of the CT Citizen Action Group, former co-chair of the CT HealthFirst Authority and the Statewide Primary Care Access Authority testified in strong support of the bill. He stated his appreciation of the state's elected leadership in their efforts to bring forward this and other bills to enable Connecticut to lead on the implementation of the federal Affordable Care Act. The bill, “represents common sense steps to improve our healthcare system, while making it more affordable” he stated. He also testified, “Small business and municipalities do not have the same leverage that large employers and the state have to negotiate with insurers and providers. It is clear that health insurers' goals over the last decade have been to get purchasers in the small employer market to pay more for less coverage.” This is why it is important to give small employers a additional option and let them take advantage of the state's purchasing power.
NATURE AND SOURCES OF OPPOSITION:
Reported by: Paul Brunner