Today marked yet another chapter in an ongoing Freedom of Information Commission battle, waged by health care advocates, to find out just how four HMO’s spend over $600 million in taxpayer money running the HUSKY health insurance program. The HMO’s adamantly resist disclosing how much money they pay certain specialists, like cardiologists. And lawyers like Sheldon Toubman of Greater New Haven Legal Aid think the Department of Social Services drags its feet in forcing the HMO’s to turn over the goods. Now, according documents released yesterday (prompted by an order from the governor’s office), Community Health Network President Sylvia Kelly explicitly warned DSS last month that disclosing the information would result in “substantial increases in the premium rates paid by DSS for the Medicaid managed care programs.“Translation: Give up the info, and it will cost you.
Toubman calls the HMO’s statement a threat, meant to cower DSS and make it resist disclosure. And in his view, DSS’s decision to release documents yesterday doesn’t fulfill their responsibilities under FOI law. The commission hearing today revolved around whether DSS pared down Toubman’s request for information when the department forwarded it to the HMO’s.The department also supports the HMO’s position that they are exempt from FOI law.But DSS brass heatedly rejects the idea that they have been running interference for the HMO’s. DSS Deputy Commissioner Michael Starkowski said that Kelly’s statement about higher costs to the state “has no relationship to the decisions we made” to release the documents yesterday, because the governor made a policy choice in favor of disclosure. “The overriding decision is that it’s the public’s right to know,” Starkowski said. “At the end of the day, the public’s right to know and release of information may have consequences on the rate structure on the plan.“Why do the HMO’s think disclosure will hurt their bottom line? And why would it then cost the state?Community Health Network pays some specialists more than others, according to Kelly’s letter to Starkowski. Without those favored specialists participating in the network, the HMO wouldn’t be able to fulfil its access requirements, they claim, so they pay those docs more in order to participate.If those rate discrepancies become public, CHN fears doctors will hold out for the rate the insurer pays to those favored few. CHN wouldn’t be able to negotiate, and the system will cost them more. The company’s ability to hold down rates “is critical to its ability to provide needed services within the budget dictated by the premium rates it now receives from DSS,” Kelly wrote.The state is currently renegotiating its contracts with the HMO’s. Starkowski believes that the HMO’s could potentially argue this line, meaning the legislature might have to appropriate more money.“The legislature would be on notice,” Starkowski said.Toubman doesn’t buy the company’s argument. Doctors currently have no ability to negotiate rates, he said, and that wouldn’t likely change even if they knew what other doctors get paid. “I’m told they have no bargaining power,” Toubman said.But low rates are the whole reason this FOI battle started: Medicaid clients couldn’t get in to see specialists, and advocates suspected it was because the HMO’s weren’t paying the docs enough money.If the HMO’s are really constrained by what the state budgets for them, then shouldn’t the legislature be paying them more, so the docs get fair rates and don’t freeze out Medicaid clients?Toubman said the level of state funding is one valid issue, but that the companies squander too much money on administrative costs. CHN spends 89 percent of its operating expenses on medical costs, Kelly claimed in her letter to Starkowski.If Toubman’s side is successful in its FOI battle, the public could conceivably seek a range of documents from the HMO’s that would prove or disprove that claim.