Three out of the five health insurance companies expected to bid on the HUSKY insurance program submitted their proposals Friday to the Department of Social Services. The HUSKY program, which serves more than 333,000 low-income children and family members, was lumped together with Gov. M. Jodi Rell’s new Charter Oak Health plan for uninsured adults—a move that made health care advocates nervous.
“The state is combining the procurement to allow the successful bidders to balance the familiar risk and large size of the HUSKY enrollment with the less familiar and less predictable size of the Charter Oak enrollment,” DSS Commissioner Michael Starkowski said in the press release Friday.
AmeriChoice, a subsidiary of United Health Group Inc., Community Health Network, and Aetna Better Health LLC, a subsidiary of Schaller Anderson Inc. all submitted bids, but the content of the bids is still unknown since the five-year, $3.5 billion contract has yet to be awarded.
The lack of information made it hard for lawmakers and advocates to comment on the plan. Sen. Jonathan Harris, D-West Hartford, said “what we don’t know is what the programmatic bid entails.”
Regarding the new Charter Oak Health plan, Harris said he doesn’t know what kind of benefits the companies will be offering for the $250 per month premium.
Department of Social Services spokesman David Dearborn said Friday that the benefit levels included in the request for proposals are the level of benefits that will be included in the plan. He said the only thing the companies can do is shift the cost sharing of benefits.
For example, the company can increase the co-pays for services if it will allow them to keep the plan affordable, he said.
But Harris said that’s not how it has been explained by the social services department. He said it was his understanding that the insurance companies could suggest different benefit levels to meet the $250 per month premium. For example, he said the company could lower the $7,500 annual pharmacy benefit if it would help it meet the $250 per month premium.
Harris said it was also his understanding that mental health care coverage is not included in the proposal.
In an emailed statement on the issue, Governor Rell’s spokesman Adam Liegeot said, “The parity question with Charter Oak depends on the cost factor. The whole premise of Charter Oak is to offer credible, affordable health coverage without breaking the bank for the uninsured adults who need it, and for the taxpayers who will subsidize it.”
The emailed statement goes on to say “Governor Rell will be looking to the Department of Social Services, the Office of Policy and Management, and the Office of Fiscal Analysis to provide some specific information about cost options and impacts before a final decision is made on mental health parity. In the meantime, we are moving forward with implementation of Charter Oak, and Governor Rell will veto any bill that interferes with that priority.”
“It’s about being fair, not discriminatory,” Harris said. He said getting mental health care coverage into the benefit package for Charter Oak is non-negotiable. But he would be willing to talk about how to get it done.
Health care advocates remain skeptical about the Charter Oak plan, which is being sold as a plan that will offer, “credible, affordable health coverage to adults who don’t have medical benefits through work and don’t qualify for a public program like the HUSKY plan, Medicaid, or Medicare.”
An internal email from one of the consultants who helped the department develop the plan explains how having limits on the benefits prevents adverse selection, which makes it less desirable to someone who is chronically ill. However, it’s the chronically ill individuals who can’t get health insurance on the private market because they have pre-existing conditions.
While this plan doesn’t exclude them, it could make it very expensive for someone with a lot of medical needs, advocates say.
Attorney Jennifer Jaff has said that with her chronic condition she would blow through the annual $7,500 pharmacy deductible in a few months. Click here to read more about this issue.
This is the first time in more than a decade the HUSKY program was put out to bid by the state. Three of the four HMOs that previously ran the program decided not to bid on the five year, $3.5 billion contract.
Community Health Networks is the only Connecticut-based company to bid on the contract. It is one of the HMOs currently administering the HUSKY program to more than 33,000 individuals.
The two other companies that submitted bids are out of state: AmeriChoice is based in Vienna, Virginia. and Aetna Better Health is in Phoenix, Arizona.
“I am somewhat concerned that two of the three bidders have no experience in Connecticut and will have to create networks of doctors and hospitals in less than 11 weeks that will serve a third of a million people,” Harris said in an emailed statement.