Connecticut’s health insurance exchange, Access Health CT, is getting a lot of good press because the website works. But how are we really doing?
Enrollment has been slow. Through the first month and a half, only 7,092 Connecticut residents have bought insurance through the exchange — 2,482 with federal premium subsidies. A new analysis from the Kaiser Family Foundation estimates that 216,000 Connecticut residents could benefit from exchange coverage — 109,000 with premium subsidies. We aren’t even close.
The big problem is the cost of coverage. Many people are experiencing rate shock as they shop on the exchange. Connecticut’s premiums are higher, on average, than any other state-based exchange. While many state residents will qualify for Medicaid or premium subsidies, thousands don’t and are facing the full share of premiums and other costs. Very few small businesses qualify for subsidies and many are reeling at the expense.
Our exchange premiums are fourth highest in the US, but we are the sixth healthiest state, which should lower our costs. We are one third less likely to smoke than Pennsylvania residents, but our exchange premiums are 48 percent higher. We are one third less likely to be obese than Michigan residents, but we will pay 53 percent more for coverage in our exchange.
Enrollment in former Gov. M. Jodi Rell’s soon-to-be-closed Charter Oak plan to cover the uninsured never topped 15,000. Costs in that plan were similar to the exchange’s plans. It attracted largely older, higher cost members causing an escalation in premiums, which led healthier people to flee the program, creating the death spiral that doomed the program. As in Charter Oak, the exchange’s low enrollment so far is skewed toward older members and missing younger, generally healthier, members to keep costs affordable for everyone.
Unfortunately, this doesn’t have to happen again in Connecticut. There are at least six policy options available to the state that could provide some relief. One of those, active purchasing, was the subject of a bill raised in last year’s legislative session. The bill directed the exchange to negotiate premiums with insurance plans on behalf of consumers as large companies do to keep costs down.
Six other states’ exchanges, including Massachusetts, Rhode Island and New York, negotiate premiums with insurers, and consumers in those states are paying less for coverage than we do. Connecticut policymakers can revisit the decision to let insurers charge whatever they want and direct the exchange to negotiate affordable premiums. Successful health reform requires affordable coverage; Connecticut policymakers should use all available tools to make that happen.
Ellen Andrews is the executive director of the CT Health Policy Project.