Roughly 68,000 seniors and disabled residents will lose access to a Medicare financial assistance program January 1, when income eligibility requirements change under the newly enacted state budget. Currently, through the Medicare Savings Program, the state Department of Social Services (DSS) pays Medicare Part B premiums for low-income elderly and disabled adults earning less than 246 percent of the federal poverty level, or about $29,667. Part B covers things like doctor visits, lab tests and outpatient care. Those earning less than 234 percent of the poverty level, or about $28,220, can receive additional help covering co-pays, deductibles and prescriptions. In the new year, only those earning less than 100 percent of the poverty level—or $12,060—will qualify to receive all benefits under the program, and those receiving subsidies for premiums alone must earn less than 135 percent of the poverty level to be considered for eligibility.
Health insurance coverage might be more accessible and affordable in Connecticut if the state applied for certain Affordable Care Act and Medicaid waivers, according to advocates who say the options should be explored. Two waivers in particular—Affordable Care Act (ACA) Section 1332 and Medicaid Section 1115—would let the state disregard certain federal requirements, possibly lowering health care costs for some individuals, according to a policy brief commissioned by the Universal Health Care Foundation of Connecticut and the Connecticut Health Foundation. “What we need to do in Connecticut is really think about … how could we creatively, imaginatively, innovatively use waivers to expand coverage to quality care and really help improve health,” said Frances Padilla, president of Meriden-based Universal Health Care Foundation of Connecticut. “We haven’t had that conversation yet in Connecticut.”
The ACA waiver isn’t available until 2017 but the Medicaid waiver is already being used by dozens of other states to lower costs, she said. “It allows a state to get past some of the requirements of Medicaid and do some things that are innovative,” she said of the Medicaid waiver.
Struggles with unemployment, food insecurity and unstable housing can take a serious toll on individuals’ health, and stronger social supports could play a key role in improving their well-being, according to an advocacy group. While national health reform and the Affordable Care Act have focused largely on improving access to and the quality of health care, socioeconomic factors – like housing, employment and food security – play a larger role in someone’s overall health than clinical factors, according to the Universal Health Care Foundation of Connecticut. “Health is affected by many other things, not just whether you have access to a doctor, access to health care,” said Jill Zorn, senior policy officer at the foundation. “If you’re really interested in improving health, it’s not just about clinical care.”
In fact, just 20 percent of a person’s health is attributed to clinical are, according to the U.S. Centers for Disease Control and Prevention. Another 10 percent is attributed to physical environment, 30 percent to health behaviors and 40 percent – the largest share – is tied to socioeconomic factors, according to the CDC.
In Connecticut, a pregnant woman of color is more likely to lose her infant at birth than is a pregnant white woman. A woman of color is less likely to receive adequate prenatal care in Connecticut, and – if she carries to term — more likely to give birth to a low-weight baby, according to a March report from the state Department of Public Health. The state’s racial divide reaches all the way into the womb. A recent report from the Center for Reproductive Rights and other agencies paints a stark picture of racial disparities nationwide, particularly in reproductive care. Women of color are far less likely to have insurance.