Audacity is sometimes laudable. The bold action that propels a business forward, the unusual tack that takes a company into uncharted waters are often the stuff of legend.
And yet, there is another form of audacity. That’s the action that flies in the face of common sense, the act that’s more taunting than daring, that’s brazen, not bold.
The health care insurers who have grabbed hold of some $625 million in Connecticut taxpayer money, but who claim that they have no obligation to explain what they’re doing with all that loot, are in-your-face audacious. While they pull a cloak of secrecy around them, they are also busy trying to do an end-run in the legislature against the public’s right to know.
They need to be stopped from getting away with their shameless ploy.
Connecticut effectively outsources the management of its Medicaid program to a handful of managed care organizations, arms of various insurance companies. The MCOs contract with the state Department of Social Services and are supposed to provide a range of services and benefits to Connecticut’s neediest.
But are the insurers doing what they’re supposed to? One big question is the determination of “medical necessity.” The state already has criteria established for what constitutes medical necessity – the standard for when care is obligated. Do the MCOs follow that rule, or are they unfairly applying higher standards and thus restricting needy patients’ access to health care?
And what do the insurers pay the doctors with whom they contract? Are those contracts designed to reward doctors for skimping on some kinds of treatment, or prod them to treat some patients like cattle, moving them in and out quickly?
So legal aid lawyers in New Haven took on the insurance companies. The attorneys argued that, as contractors to the state, the insurers’ policies are subject to the Freedom of Information law, and should be available for review.
The Connecticut Freedom of Information Commission agreed, and ordered the insurers to comply. The gist of its reasoning is the companies — Anthem, HealthNet and Community Health Network — are performing a governmental function, and are therefore subject to governmental accountability.
The insurers promptly sued, and quickly lost. Kevin Lembo, the state’s health care advocate, was cheered by the ruling. “Without the transparency that flows from this decision, we would never know what percentage of our HMO premium is actually spent on public health care, and what percentage is spent on executive bonuses and overhead,” he said.
He added that, “the managed care organizations tried to have it both ways – monopolistic access to public money through public contracts, as well as secrecy in their business practices that put them in violation of state sunshine laws.”
Of course, the judge’s ruling is on its way to the state Supreme Court, to be heard on appeal. Meanwhile, the insurers are trying to influence legislation to moot the FOIC’s ruling.
Several bills emerged this session that would state specifically that such contracts are for the performance of a governmental function, and records concerning that function would be subject to FOI, even in the hands of the private contractor. Because the MCOs are lobbying hard against this legislation, a couple of the good FOI bills were altered in a negative way. So what started out as positive FOI legislation may actually weaken the FOI Act overall.
Lawmakers need to back off that tack immediately. No matter how audacious the argument, outsourcing government affairs to private concerns shouldn’t result in demeaning the public’s right to know how it’s money is being spent.
