Tucked in the corner of a small New Britain pharmacy, Gov. Ned Lamont promoted on Tuesday legislation his administration contends will reduce health care costs by capping out-of-network expenses and prohibiting certain contracting practices by state health systems.
The bill, which was scheduled to receive a public hearing Tuesday afternoon in the legislature’s Insurance Committee, would limit out-of-network costs to 100% the area Medicare rate. It would also prohibit facility fees for off-campus appointments.
The governor pitched the bill and another proposal aimed at reducing prescription drug costs with other policymakers during a morning press conference at Beacon Prescriptions in New Britain.
“I hear every day the system is broken,” Lamont said. “What we can do at the state level while we wait for the federal government and wait and wait for them to make sure that universal, affordable health care is a basic right for everybody.”
Lamont’s legislation would also outlaw a handful of contracting clauses sometimes used by state hospital systems in negotiations with insurance carriers.
They include “all-or-nothing” provisions that require plans to accept every provider in a hospital network and ban so-called “gag-clauses,” which prevent the third-party disclosure of terms or prices included in agreements. Other stipulations that would be banned under the bill include so-called “anti-steering” clauses, which stop insurers from steering patients to other providers.
“I want to be able to trust my primary care physician,” Lamont said. “I want to make sure that that physician does not have any restrictions in terms of where they direct me to go to get that next level of attention I need. There’s some contracting things, limitations and steering where sometimes people don’t direct me to the places where I know I will get the very best value.”
In addition to state officials, the administration invited several patients and advocates to speak at the event. Some told stirring stories of their own experiences meant to highlight why Connecticut must find a way to bring down the cost of health care.
Susan Millerick spoke of receiving a $950 bill for her son’s 15-minute dermatologist appointment. An out-patient facility fee, like the kind Lamont has proposed to ban, made up roughly half of that cost of that bill, Millerick said.
“It’s completely out of control where we have gotten to with health care costs,” Millerick said. “I’m so tired of being told that patients are at the center of everything everybody does because unless we’ve got a dollar sign target on our bodies — that’s the only thing that we’re the center of.”
Lamont’s proposal was met with emphatic opposition by the state’s hospital networks. The Connecticut Hospital Association issued a Tuesday morning press release, which argued the bill would result in billions of dollars in losses and “devastate” local hospitals.
“Policies that result in severe reductions to local hospitals will only further strain the healthcare system,” Paul Kidwel, the association’s vice president of policy, said. “Hospitals cannot sustain a robust healthcare delivery system for patients across the state if hospitals cannot cover their costs and are pushed into the red. The math doesn’t work.”
The hospital association contends that the proposed cap on out-of-network rates would “drastically shift power” to insurers while doing nothing to require them to pass along savings to patients.
Meanwhile, the group said the bill’s ban on contractual clauses would impede health care systems’ efforts to ensure a “full spectrum of services,” according to the press release.
Dr. Deidre Gifford, executive director of the Office of Health Strategy, said the administration was open to the health care networks’ concerns including reservations about eliminating off-campus facility fees.
“We all need to work together to solve this problem. So we want to hear their concerns and we certainly want to support our community hospitals,” Gifford said. “They are not generally the ones with lots of off-campus sites, however, so I’m not seeing the problem.”
