🔒Q&A: Health advocate takes over in uncertain times

Q&A talks with Ted Doolittle, Connecticut's healthcare advocate.

[Editor's note: This Q&A went to press shortly before Congressional Republicans announced Friday that their legislation to replace Obamacare didn't have enough votes to pass. Doolittle's answered the Greater Hartford Health's questions prior to Friday's announcement.]

Doolittle was nominated as the state's healthcare advocate in January by Gov. Dannel P. Malloy. He's experienced health care from many angles — as a fraud investigator for the state Attorney General and the federal Medicare/Medicaid programs, as an in-house attorney for UnitedHealthcare, and as a law partner at a private firm. Now he's in charge of an agency whose responsibility is to provide prompt, free assistance to Connecticut individuals and families who are having issues accessing health care.

Q: You're starting your new job during a tumultuous time in health care, with President Trump and Republicans pledging to repeal and replace Obamacare. What impacts could that have on consumers and what role, if any, can your office play?

A: Repeal without replace would devastate insurance carriers and consumers. The uncertainty would cause untenable financial risks for the insurance carriers. Most carriers would pull out of at least the individual markets until they could assess the new landscape. Based on the complex annual business and actuarial cycle of health insurance, carriers that exit will be out of the market for at least a year. If the ACA is not responsibly replaced, the only way a carrier could re-enter such an uncertain market is with astronomical premiums, skimpy benefits, or both.

If repeal includes a sufficient transition period — instead of a catastrophic “repeal now” approach — then my office will play an active role advising policymakers in both Hartford and Washington to ensure that the short- and long-term interests of Connecticut consumers are protected. Any replacement should include a long-term national plan for a partnership with government, insurance carriers, providers, and drug manufacturers to drive medical costs down.

Q: In your January confirmation hearing, you said healthcare premiums are rising because providers are charging more for services. Do you believe insurance companies, which you will have to interact with regularly, share some of the blame for rising costs?

A: Medical costs in the U.S. are by far the highest in the world. Insurance is just a mechanism to pay for health care; the carriers move money in an organized way from the consumer/taxpayer to healthcare providers. All of the powerful stakeholders — providers, carriers, drug makers, medical device manufacturers, large employers, government, trade groups and consumer advocacy groups — have an opportunity, and a responsibility, to contribute to cost improvements. These stakeholders must view cost issues from a global perspective, in addition to their own parochial perspective.

For example, insurance carriers often center their marketing on premium rates, but if premiums are kept low by, for instance, making deduc tibles higher, you have not cut costs — you have just shifted responsibility to pay the same high costs from one entity (the insurer) onto another entity, in this case the consumer.

And, among all the healthcare market players, the lone consumer is generally the least well-positioned to impact cost. If the goal is to harness market forces and drive America's and Connecticut's healthcare costs down to internationally competitive levels, it makes more sense to load price risk away from the consumer and onto any of the more powerful, sophisticated market players who — unlike sick or infirmed individuals — have expertise, market power, and the financial and emotional wherewithal to make rational economic choices.

Q: What is one way carriers can help solve the core societal issue of high medical costs?

A: If insurance carriers that currently go to market based largely on premium costs instead went to market based on a broader measure of the all-in costs to policyholders (premiums plus patient responsibility), they would deliver a more meaningful price metric to employers and individuals shopping for insurance — a metric based on not the price of health insurance, but rather on the price of health care.