Healthcare costs featured prominently in CT News Junkie’s 2020 candidates’ survey. It’s very likely that candidates will hear the same concerns from voters again this year. Last year, policymakers accomplished little, and healthcare costs haven’t gotten any better since then. Incumbents will be asked what they did this year to provide some relief. Unfortunately, they have little to offer.
Many survey respondents in 2020 recognized that hospital consolidation is a main driver of rising healthcare costs. This year, SB 416 would have removed big health systems’ monopoly powers to jack up prices by prohibiting anti-competitive contracts with insurers. Two lawsuits have been filed against Hartford Healthcare for using their monopoly power to drive out their competition and raise prices. The bill came out of a legislative forum in September, passed out of the Insurance and Real Estate Committee unanimously, and passed the Senate 29 to 4. But it died on the House calendar.
The governor is promoting HB 5042, which passed in the budget implementer, as a path to reducing healthcare costs. The bill codifies a project of the Office of Health Strategy (OHS) started two years ago under an Executive Order. OHS’s committee leading the project is dominated by the insurance and hospital industries.
The project has two initiatives that OHS believes will lower costs. The first is a name-and-shame report about healthcare spending – identifying health systems, insurers, and potentially drug companies with spending growth above a cap set by OHS. The high spenders may have to participate in an informational public hearing to explain themselves and how they intend to fix their spending levels. Since 2013, Massachusetts has had a similar project but it hasn’t lowered costs or made insurance more affordable there.
The second part of OHS’s plan, the Primary Care Roadmap, is more controversial. Driven by primary care physicians, OHS plans to double the proportion of total Connecticut healthcare spending devoted to primary care. It’s estimated that it will cost Connecticut’s health system an extra $3.9 billion by 2025, when it’s fully implemented. OHS’s hope is that prevention and care coordination will save money. It’s a fine thing to do, but it hasn’t saved money in other programs across the US. It is very likely that the extra spending on primary care will raise insurance premiums and lead to cuts in other critical healthcare services. People with disabilities, seniors, and Black and brown communities are especially concerned about losing access to essential care.
Because advocates and some thoughtful legislators raised significant misgivings about OHS’s very weak plan to monitor for HB 5042’s unintended harms, the bill includes some opportunities for accountability and transparency. OHS must get approval from the Insurance and Real Estate Committee for changes to either the spending cap or primary care spending levels, above a threshold. OHS must also report to the committee on a “plan for monitoring any unintended adverse consequences resulting from the adoption of cost-growth benchmarks and primary care spending targets and the results of any findings from the implementation of such plan.” The Insurance Committee focuses on insurance premiums. Other legislative committees that focus on the populations and services likely to be cut because of HB 5042 were left out of the legislation.
There were other good things the legislature passed, but they aren’t focused on controlling healthcare costs. Expanding HUSKY coverage for low-income children to age 12, regardless of immigration status, is important to those children and to our collective public health. Increasing funding for children’s mental health is critical, especially since the pandemic. And the state is addressing adult mental health issues with SB 450, AAC Connecticut Valley and Whiting Forensic hospitals. According to advocates, it’s a good start.
I can’t wait to see what candidates hear from voters this year. Hopefully, they will come back into session next year with serious plans to lower healthcare spending.