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.
Forty-five percent of Connecticut adults in a survey released Wednesday reported that they have been diagnosed with a chronic disease such as diabetes, hypertension, asthma, heart disease or cancer. That rate was “very high,” said Frances Padilla, president of the Universal Health Care Foundation of Connecticut. She said she was also struck that 28 percent of adults aged 18 to 44 reported in the new Connecticut Health Care Survey that they have one of those serious illnesses. “With so many people reporting chronic illnesses and their complications, we have to have better access to care,’’ she said. Six health foundations released the results of a telephone survey of 5,447 adults conducted between June 2012 and February 2013.
Hospital administrators in Connecticut who have been involved in the unprecedented streak of mergers and consolidations often tout the financial benefits and efficiencies of such moves. But as the number of independent hospitals in the state dwindles – with more than half of the 29 acute-care hospitals now operating in networks with other hospitals or out-of-state partners – experts and advocates worry that the consolidations will reduce competition in the market and give hospitals more leverage to raise prices. Adding to their concerns is a proposal by a private company to convert four non-profit hospitals to for-profit entities. Several studies, as well as data from the federal Medicare program, suggest that mergers and for-profit conversions may lead to higher prices. But the state has yet to study the impact of mergers on patient pricing, and has no requirement that hospitals try to hold patient charges steady after a merger or conversion. The state also has no comprehensive blueprint guiding hospital configuration or limiting the number of takeovers or networks it will allow.
Why does the U.S. health care system rank in the bottom third of developed nations, even though we spend twice as much as any other country? According to Shannon Brownlee, senior vice president of the Lown Institute and author of the book, “Overtreated: Why Too Much Medicine Is Making Us Sicker and Poorer,” the crux of the problem lies within the doctor-patient relationship. “We have a dysfunctional system in this country that is largely focused on doing more,” Brownlee said. “In our headlong rush to do a lot, fast, we forget about talking to patients — about what their prospects are, what the treatment options are, what the side effects are . .
Since the Affordable Care Act (ACA) was enacted three years ago this week, Connecticut seniors have saved a total of $84 million on prescription drugs, U.S. Health and Human Services Secretary Kathleen Sebelius announced Thursday. Connecticut Medicare recipients have saved an average of $1,174, according to the HHS’ press release. Nationally, HHS said the savings have hit more than $6 billion for 6.3 million people with Medicare since the ACA became law on March 23, 2010. Advocates say the health care law is making Part D prescription drug coverage more affordable by gradually closing what is known as the “donut hole.” This is the gap in coverage where beneficiaries were paying the full cost of prescriptions out of pocket while also paying premiums.
Frances G. Padilla, president of the Universal Health Care Foundation, said the announcement was good news. “This is one of the real advantages of the Affordable Care Act,’’ she said.