Christine Stuart / ctnewsjunkie
Rep. Tom Delnicki, R-South Windsor (Christine Stuart / ctnewsjunkie)

HARTFORD, CT — A South Windsor lawmaker told executives from two health insurance companies Wednesday that if they want to keep customers then they can’t keep proposing double digit or near double digit rate increases.

“I hear it almost every day from the people in my district,” Rep. Tom Delnicki, R-South Windsor, said. “They make very difficult choices: are they going to buy food, buy clothes for the kids or pay for the plan and that quite frankly is not acceptable.”

Anthem Health Plans and ConnectiCare Benefits spent about an hour explaining their average 9.1 percent and 13 percent premium increases for their 2019 plans at an Insurance Department public hearing. The hearing is part of the annual review process by the Insurance Department for health insurance plans offered in the individual marketplace.

Insurance Commissioner Katharine Wade explained that the Insurance Department regulators will go over the rate requests to make sure they are not “unfairly discriminatory.”

The Insurance Department’s job is to make sure that the premium covers the claims and it doesn’t discriminate against any specific group of clients. The rates have to be adequate, and they can’t be excessive or unfairly discriminatory, but beyond that there’s little regulators can do to reign in costs for consumers.

Wade said they worked with Connecticut’s insurance exchange, Access Health CT, to see what they could do this year about plan designs and alternative provider networks to help reduce costs for consumers.

“This is very challenging for consumers and we’re very cognizant of that,” Wade said.

Rose Ferraro, of the Universal Health Care Foundation of Connecticut, said they continue to be frustrated that their testimony will not impact the outcome of the rate review process.

“We recognize that the Connecticut Insurance Department takes this process very seriously. We understand that rate review is an actuarial exercise for regulators, but right now premiums are not an abstract math problem for families,” Ferraro said.

She said she understands the cost of health care continues to rise and that it impacts rates, but if we continue to “ignore the enormous elephant in the room of health care costs we will continue to see those costs rise.”

A Kaiser Health Tracking Poll released Wednesday found nearly nine in 10 Americans say they are concerned about the increases in the amount individuals pay for health care, with about six in 10 saying they are “very concerned.”

Who do they blame for the increase in costs?

The survey of 1,201 Americans found 78 percent blame drug companies for the rising cost of health care, while 71 percent believe hospitals charge too much and 70 percent believe insurance companies make too much money.

Neil Kelsey, chief actuary for ConnectiCare Benefits, said Wednesday that those who exit the market are younger and healthier and those who remain are sicker.

He said families and individuals who don’t qualify for subsidies through the ACA are unable to afford the increases and some are leaving the marketplace creating another uninsured population.

Not unlike car insurance, if 25 percent of the best drivers left the market, then the costs for everyone else would go up, Kelsey said. He said the reduction in participation in the health insurance results in a 3 percent increase in costs.

But aside from the exodus of healthier individuals, the cost of healthcare is also going up. 

“For the first time our pharmacy cost now exceeds our in-patient hospital costs,” Kelsey said. “In past years we saw an increased use of generics, which dampened the impact.”

Christine Stuart / ctnewsjunkie
Paul Lombardo, the director of the Insurance Department’s Life and Health Division, and Insurance Commissioner Katharine Wade (Christine Stuart / ctnewsjunkie)

But specialty drugs and the rising cost of generics have impacted the cost of care.

“Overall medical costs contribute 11 percent toward the proposed increase to our rates,” Kelsey said.

Forecasting the cost of health insurance in 2019 is no easy task.

“Planning and pricing for ACA-compliant health plans has become increasingly difficult,” Steve Ribeiro, regional vice president of sales for Anthem, said. “This challenge is due to the shrinking number of participants in the individual market; the corresponding increase in the population’s morbidity; and uncertainty around marketplace features.”

In the end, “the cost of healthcare services and use of those services continues to outpace premium increases,” Ribeiro said.

ConnectiCare Benefits covers 63,000 people and Anthem covers 45,000 people both on and off the exchange.

The Insurance Department is expected to finalize the rate requests by the end of the month because the 2019 plans will be available for purchase beginning Nov. 1.