Christine Stuart photo
Access to health care, even for those who have health insurance, has become increasingly difficult for many in the state. Recognizing the obstacles Gov. M. Jodi Rell along with health care advocates wanted to use Monday to recognize those who ensure the state’s needy have access to health care.
Jennifer Jaff, executive director of Advocacy for Patients with Chronic Illness, said patient advocacy happens on a variety of levels. It’s not always a fight with the insurance company over what they will or won’t cover, she said. Sometimes it’s a battle with a school that gives a child with a medical condition a hard time for going to the bathroom 10 times a day, or it’s a mediation session with an employer over an employee’s rights under the Family Medical Leave Act.
Often when there’s a fight for access Attorney General Richard Blumenthal (pictured) and Connecticut’s Healthcare Advocate Kevin Lembo are on the front lines.
Blumenthal said his office fights for more than 1,000 patients each year who are denied health insurance coverage often necessary for a life-saving treatment. He said 95 percent of the disputes with insurance companies are resolved within the appeals process and never reach the courts. But for each case that is reported to the Attorney General’s office there are tens-of-thousands more than that never even get to our office, he said.
“Now, more than ever, advocates are needed to help consumers navigate the tangled web of healthcare and healthcare financing in Connecticut,” Lembo said.
He said at the moment insurance companies have an advantage because the burden of proof when it comes to the definition of “medical necessity” is on the patient, not the insurance company. The legislature has an opportunity to change that this year. They could reverse the burden of proof and make it the insurance company’s responsibility to prove the patient doesn’t need the procedure or medication, Lembo said.
He said the legislation would apply to private insurers because there’s already legislation that defines medical necessity for the MCO’s that run the state-funded Husky program. Some health care advocates have argued the definition in the contract between the state and these MCO’s is improperly applied and rarely enforced by the Department of Social Services, but that’s another dispute for another day.
For those who need help, it’s just a phone call away. There are no forms to fill out or bureaucratic loopholes to jump through, Lembo said. He said if someone is having a problem accessing coverage through their managed care organization they can contact his office by calling 211 the state’s information line, or find out more by visiting the Office for Healthcare Advocate online at: http://www.ct.gov/oha/site/default.asp
How important is universal health care?
A Quinnipiac University poll released last week found “Two-to-one, Americans say that adequate health care – for everyone – is Washington’s responsibility,” said Maurice Carroll, Director of the Quinnipiac University Polling Institute.
“Paying for it? That’s always the rub and it’s true on the health-care issue, where support drops from 2 – 1 to a slim majority,” Carroll said in a press release.
By a 64 – 31 percent margin, American voters say, “It’s the government’s responsibility to make sure everyone in the United States has adequate health care,” according to a poll of 1,536 American voters.
Democrats support this position 81 – 15 percent, as do independent voters, 67 – 28 percent, but Republicans oppose it 55 – 41 percent, the poll finds.
American voters also say, 53 – 42 percent, that they would be willing to pay more in federal taxes to provide health care to all Americans. Democrats back higher taxes 70 – 26 percent, along with independent voters, 56 – 39 percent. Republicans oppose paying higher taxes for health care 63 – 32 percent.
Click here to see the results of the survey that has a 2.5 percent margin of error.
