A task force that spent the last seven months studying the impact of high-deductible health plans on Connecticut residents did not ultimately support the creation of a state-subsidized public option plan.
That was no surprise, as plenty of opposition was evident from providers and insurers as the 12-member task force debated its draft recommendations in late January.
Regardless of the lack of endorsement from the task force, a public option bill advanced out of committee this week.
It’s unclear how much impact the task force’s final report will have on the current legislative session. The report was released Feb. 24, with legislative committee bill deadlines either expired or looming. If that weren’t enough, mounting concerns over the spread of coronavirus is threatening to further shorten the session.
High-deductible health plans, which have become commonplace in Connecticut and other states, are policies under which consumers pay lower monthly premiums in exchange for higher financial risks if they get sick or injured. That trade-off can lead to bankruptcies and impede medically necessary care when patients avoid or delay care for financial reasons, the task force’s research found.
In an interview earlier this week, task force chairman Ted Doolittle, Connecticut’s Healthcare Advocate, described the recommendations to state lawmakers as mostly “common sense” proposals, including measures such as improving consumer insurance literacy and providing additional access to “navigators” who help consumers select health plans.
Tackling the problem is a major challenge, and no simple shifting around of deductibles and premiums is going to do the trick, Doolittle said.
“There’s no free lunch there and there’s no substitute for attacking the actual high cost and the high price of health care,” he said.
In addition to a number of modest changes — “low hanging fruit,” Doolittle termed them — the final report also contains several recommendations, passed by majority vote, that received plenty of pushback from the task force’s insurance industry members.
Perhaps the most hotly contested was one that would mandate that insurers be responsible for paying their members’ deductibles to healthcare providers, and then collect those payments from their plan members.
That would be a major change for doctors and hospitals, which are mostly on the hook for collecting medical bills from their patients. Some doctors have complained they are forced to act as collection agents, damaging their patient relationships.
Some task force members were concerned that shifting the collections burden to insurers would increase premiums, and the report said it‘s unclear to what extent the shift would translate into healthcare price reductions. There was also concern about such a shift potentially destroying the IRS-conferred tax benefits of Health Savings Accounts, for which certain high-deductible plans are eligible. The task force sought legal advice from two law firms on the latter question, and received conflicting opinions.
“In order to resolve this conflict, a final opinion would be required by the IRS itself,” the report said.
While Doolittle is supporting several bills this session that align with the task force’s work, he hopes the report will be a guide in future sessions.
“To me, this is planning for the long term,” he said. ”This was a useful exercise just to get folks focused on high deductibles.”
Here are some of the bills Doolittle has supported in the ongoing legislative session:
- S.B. 1 and H.B 5175, which seek to spread the cost of insulin and other diabetes-related treatment across a broader pool of insureds.
- S.B. 337 would, among other things, require high-deductible plans to adhere to the same calendar year schedule, which would make it easier to pursue another of the task force’s recommendations — offering deductible credits to patients who switch plans mid-year, after paying some or all of their previous plan’s deductible.
- S.B. 340 would limit the amount that providers and collections agents could recover from uninsured or underinsured patients with unpaid medical bills. The task force, which reviewed data showing significant collections activity by one Connecticut hospital in particular, recommended that patients sued for unpaid bills have a right to itemized bills and other protections.
