Connecticut Health Insurance Exchange Should Be Consumer-Driven

December 4, 2012
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It’s time like these when I miss Jennifer Jaff the most.  Jennifer was the executive director of the Farmington-based Advocacy for Patients with Chronic Illness, Inc., and a member of an advisory committee that is helping build the state’s health insurance exchange, the online marketplace for people buying insurance as mandated by the Affordable Care Act.

When Jennifer died in September – she’d been living with a variety of ailments, including Crohn’s disease — she left a huge hole in the state’s safety net. Her board is holding a memorial service for her on Dec. 9 at Hartford’s Old State House, and if just a small portion of the people she helped show up, the building won’t be big enough.

We need her now, during the state’s organization of its exchange.

The exchange is supposed to be up and running by 2014, and if you sit in on the meetings, you hear a lot of talk about the need for a system that focuses on consumers.

But so far, the exchange falls short of that.

Ellen Andrews, executive director of Connecticut Health Policy Project, and also a member of an exchange advisory board, and others have been pushing for “active purchasing,” or the state using competitive bidding to push for lower premiums for the hundreds of thousands of state residents who will enroll through the exchange.

But Connecticut won’t take advantage of that, despite competitive bidding success in other states. Massachusetts and California have used the large number of people who will take advantage of their exchanges with great success. A report to Massachusetts’ legislators said that competitive bidding in that state’s exchange saved health consumers between $16 and $20 million in 2010.

I am no math major, but that sounds good to me. So why isn’t Connecticut on board?

Sheldon Toubman, of the New Haven Legal Assistance Association, Inc., and also member of an exchange advisory board, has spoken about active purchasing at committee meetings. He voted for compromise language, requiring that it be developed later — but even that compromise language was shot down by the board last week.

Toubman explained to committee members that his vote was  “based on an assessment of what was realistic given the clear opposition of the insurance industry and those individuals representing their interests, and my desire to at least improve on the deeply troubling original proposal of staff which would have accepted ‘all willing carriers’ for all time.”

Some more politic health care advocates call this a work in progress, but a lack of competition is just one issue. Once everything’s in place, who’s to say there’ll be enough doctors to treat the exchange patients? Andrews says that history teaches us the coverage of those patients may not be worth the paper it’s printed on if they can’t find physicians to treat them. And though the exchange is sponsoring informational meetings for consumers around the state, a meeting held last week in Hartford raised questions with no answers.

In one of our last e-mail exchanges, Jennifer wrote about her frustration over consumers — like herself – being ignored in the process.

Andrews says she sometimes forgets how hopeful she was when Obamacare passed. Now, she’s considering resigning from her advisory committee. If no one’s listening, anyway, what’s being served, other than the notion that profit will trump people.

Health care reform doesn’t have to be this way. Massachusetts, with its six-year start on health insurance reform through Romneycare, is leading the way with active purchasing and rigorous public hearings.

Why won’t Connecticut follow?

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