Patrina Thompson of Hartford was at work on Tuesday, so she couldn’t tell lawmakers in person that Gov. Dannel P. Malloy’s proposal to end HUSKY insurance coverage for her means she will join the rolls of the uninsured.
But if she was there at the Human Services Committee’s public hearing, she would have told lawmakers that her family of three has an income below $45,000 a year. Their expenses are, on average, about $3,800 a month, so they try their hardest to live within their means.
“Enjoying a meal at a restaurant or even going to the movies is a luxury for us — we just don’t do it,” Thompson said in her written testimony.
The Malloy administration argued that Thompson and about 40,000 other parents currently receiving health insurance through the HUSKY program will be able to apply for subsidies through the Health Insurance Exchange starting in January 2014. The children of those parents will still receive coverage under HUSKY, but the parents will be forced to purchase their own insurance.
Thompson doesn’t believe she would be able to afford to buy her insurance through the Health Insurance Exchange. She said that even with the subsidies, under the federal Affordable Care Act the monthly premiums would be too high.
Health care advocates like Sheldon Toubman of New Haven Legal Assistance and Sharon Langer of Connecticut Voices for Children agree.
Using the information currently available, Toubman and Langer told the committees that the monthly premiums, high deductibles, and co-pays — even after factoring in the subsidies — mean many of the parents will go uninsured.
“The research shows that if you don’t cover whole families on the same program, if a parent is uninsured or doesn’t utilize health care themselves, children are less likely to be covered even if they’re eligible,” Langer said.
She said the state shouldn’t experiment with a vulnerable population that’s currently insured.
Toubman said having parents and kids in completely different programs with different provider networks is not good and “will make it less likely that a parent who signs up for insurance also gets it for his or her kids.”
Rep. Betsy Ritter, D-Waterford, said she worries about the affordability of the plan that will be offered on the exchange for these parents.
But at the moment there are no good answers.
Specific information on rates and benefits available through the exchange won’t be available until July, which is a month after the end of the legislative session.
Office of Policy and Management Secretary Ben Barnes, who also is a member of the Health Insurance Exchange board, said there is still plenty of time to address affordability concerns.
“We believe to those who would argue we’re rashly pushing people into a program of unknown affordability, I would argue we’re doing that with a year’s notice and will hopefully have an opportunity to make adjustments,” Barnes said.
He said the state is giving parents about a year’s notice before pushing them into the exchange where it’s unknown what the benefit plan or the monthly cost would be for those between 133 percent and 185 percent of the federal poverty level.
Nevertheless, Toubman says “the proposal to end coverage for these parents flies in the face of the governor’s state commitment to preserving the health safety net — it would do just the opposite, throwing many of these vulnerable parents into the rolls of the uninsured.”
Committee members asked advocates to provide them with more information about the impact of cutting the program on children and families in the state.
Low-Income Adults
In 2010, Connecticut became the first state to expand its Medicaid program for low-income adults under the Affordable Care Act. But it never anticipated that the increase in enrollment would occur so quickly.
The program now covers adults up to 133 percent of the federal poverty level.
In just a few years, enrollment has risen from 45,000 to 80,000 individuals. In an effort to pare down that number, the administration sought a waiver from the federal Centers for Medicaid and Medicare Services (CMS). The waiver would have allowed the Department of Social Services to impose an asset test and to eliminate more than 13,000 from its rolls to save $50 million.
Department of Social Services Commissioner Roderick Bremby told the committee Tuesday that he spoke to a CMS representative from Boston and they’re trying to push the Baltimore office into giving the state a written response.
“It is our opinion that the waiver will not move forward,” Bremby said. “But till we say that in writing I’m reluctant to say that the waiver is denied.”
However, the governor’s bill eliminates it from consideration by the legislature. Since there are only about nine months before the state is reimbursed 100 percent by the federal government for the low-income population, the issue is pretty much moot.
After an unrelated event Tuesday, Malloy said people have to realize that 40,000 more people have insurance through this program than anyone anticipated. He said under “Obamacare” more people will be covered than ever before and the health care industry needs to adjust to this new reality.
“People need to get ready for the new system of Medicaid and what medical insurance looks like,” Malloy said. “We need to adjust to that new system as a state and I think the industry needs to adjust to that new system as a system.”
He said those 40,000 who may have in the past show up at hospitals unable to pay for the services rendered are currently receiving coverage, which means hospitals are being reimbursed for the care provided.
Malloy said that hospitals are now being reimbursed for the care provided to 40,000 people who, in the past, may have shown up at hospitals unable to pay for services rendered.
But the hospitals are vocal opponents of the governor’s cuts and don’t agree with his analysis.
The governor’s bill cuts about $550 million from the state’s 29 acute care hospitals over the next two years.
The cut, according to Griffin Hospital CEO Patrick Charmel in Derby, means his hospital would have to cut services and staff. He told the Appropriations Committee last Friday that he knows they’ve been told “hospitals can absorb the funding cuts,” but the margins are small. He said the only way hospitals will be able to manage this is if they increase revenue or decrease their operating costs.
“I’ll be very frank. Our go-to strategy in the past, when state payment to hospitals was inadequate, the only way we made up for that, is to shift that underfunding to commercial insurers,” Charmel said. “That’s no longer an option.”
He said over the last two years Griffin Hospital has eliminated 80 positions, cut pension benefits by 60 percent, and asked employees to pay a higher portion of their health insurance.
If Griffin is forced to lay off any more employees to account for the state budget cut, it will impact the services and clinical care it delivers, Charmel said.
But Barnes doesn’t believe the hospitals will be injured that greatly by the cuts. He told the Human Services Committee Tuesday that that cuts were “small compared to the relative increases we’ve been making over the years.”
On average most of the hospitals are in the black by three to four percent and as recently as 2011 only about six were running deficits, Barnes said.
He said that given the difficult choices, cutting funding to state hospitals was “the best of a series of very difficult options we face.”
The Connecticut Hospital Association didn’t testify on the bill Tuesday, but Barnes discussed the cuts because he believes the hospitals will receive more money because of the increase in residents getting insurance under the Affordable Care Act.
