It’s been three weeks since the state started enrolling people in Gov. M. Jodi Rell’s affordable, no frills Charter Oak Health Plan. The state-subsidized insurance is available to any Connecticut adult, regardless of their pre-existing medical conditions.
Since that day, June 30, Rell has held three press conferences to tout plan, which she describes as the first of its kind health insurance plan in the nation for uninsured adults, and to date the Department of Social Services has answered 13,282 calls and accepted 4,629 applications from those seeking to enroll.
However, there has been a lingering question about whether doctors will be willing to participate in the plan. Last week, that question was answered and health care advocates, along with at least one lawmaker, were less than impressed with the number of doctors and hospitals – just St. Raphael’s in New Haven so far – that have agreed to participate
Sen. Jonathan Harris, D-West Hartford, co-chairman of the legislature’s Human Services Committee, said Wednesday that he’s concerned with the number of doctors for two reasons:
“First, it shows a weakness in the Charter Oak plan being able to succeed,” he said. “Secondly, now that Charter Oak and HUSKY have been coupled, it means there are no providers for HUSKY clients.”
HUSKY is the state’s Medicaid program for more than 320,000 children and family members in low-income households. Harris said the federal government looks at the sufficiency of the provider networks when it determines how much Medicaid funding the state will receive.
“This could threaten federal dollars for low-income kids,” he said.
But the Department of Social Services says any criticism of the provider networks is premature.
“It is premature for people to be criticizing the provider networks,” said David Dearborn, spokesman for the Department of Social Services. “This does not happen overnight. Building provider networks takes some time, and they are being developed day by day. We wish the critics would take a breath, step back for a while, and just let us and the insurers do our jobs to make this program work for the thousands of people who are seeking affordable health coverage.”
Harris agreed with Dearborn, saying, “I want this to work. Let’s wait and take a deep breath.”
Charter Oak and HUSKY enrollees will have three plans to chose from: Aetna Better Health, Americhoice, and Community Health Network.
If a family that lived in Tolland County enrolled in the Aetna plan they would have a choice of four family practice providers, two internal medicine providers, one pediatrician, and two nurse practitioners. If that Tolland family needed to see a gynecologist in the Aetna plan, they would have to drive to Hartford, New Haven, or Fairfield County to find a doctor that accepted their health insurance.
If your family chooses the Americhoice plan and you live in Middletown, there are currently no pediatricians available in that provider network.
Community Health Networks, which has administered the HUSKY program for the state in the past, has a large number of pediatricians and other primary care providers in each of the counties. Aetna and Americhoice are new to the state of Connecticut and just started signing up doctors at the beginning of July.
Although he agreed with Dearborn that building networks will take a while, Harris said he’s concerned because the state is running out of time to get these networks running. The Charter Oak Plan is scheduled to start Aug. 1 and a large part of the HUSKY transition is scheduled to be completed by Sept. 1.
Harris said he’d understand if there were a few holes, but more than half of the areas do not have all the required providers.
“What we’re talking about here is kids’ lives,” Harris said.
Ellen Andrews of the CT Health Policy Project said Wednesday that she is “really very worried” about the lack of providers. She said she thinks it’s unrealistic for the state to think that all of a sudden they’re going to see a swarm of doctors sign a contract with one of the three managed care organizations in the next few weeks.
“I’m not hearing a lot of providers say they are on the verge of signing contracts,” Andrews said, adding that she’s concerned about those individuals in the middle of treatment who sign up for the plan and no longer can find a doctor.
