When I first heard the rumor from various sources that Gov. Ned Lamont was exploring returning control of the HUSKY insurance program to a managed care company, I didn’t take it seriously and neither did they. But apparently it’s true.
Initiated by Gov. John Rowland in 1995, HUSKY managed care was a nightmare of high costs and poor care for 16 years. Since we came to our senses and got rid of managed care organizations (MCOs) from Medicaid, people are getting better healthcare and we’re saving billions of taxpayer dollars, opening room in the state budget for other priorities. It’s not clear how putting another hand back in the till would help anything.
Our Medicaid program is a national model of innovation and efficiency. We lead the nation in lowering per-person costs in our program while enrollment grew. We spend 8% less of our state budget on Medicaid than the US average. That opens up $4 billion in our budget for other priorities. Other states would love to have that space in their budgets. According to Medicaid.gov, we score in the best quartile on 30 of the 50 federal quality standards and over the US average on 72% of them.
Just a short history of managed care in HUSKY provides plenty of red flags. In a mystery shopper survey commissioned by DSS, 40% of providers listed in MCO panels did not participate in the program. MCOs refused to comply with state Freedom of Information laws. An audit by the Office of State Comptroller found that the state was overpaying MCOs by five percent. Doctors filed suit against the Medicaid MCOs for engaging in deceptive and improper practices that harm patient health. One year after Connecticut’s transition to Medicaid managed care, the Office of State Comptroller documented problems with attracting enough providers to the program resulting in enrollment suspensions and difficulties reporting data on services delivered.
Managed care plans are paid through capitation, a fixed per-person fee to provide all the care members need. They can do that by improving our health, but that’s a long and uncertain game. Or they can make more money by just denying people necessary care, which is what they did in the past and do now in Medicare Advantage. Medicaid covers many of our most fragile state residents including the poor, the elderly, and people with disabilities. Denying medically necessary care can be deadly.
Large employers, including the state employee plan, have moved away from capitation to self-funding their members. They have experienced lower costs and have more control over how healthcare for their employees is delivered. Currently, 81% of Connecticut businesses with over 500 workers are self-funded. With almost a million members, it doesn’t make sense for HUSKY to go backward.
If managed care returns to HUSKY, we will reverse a great deal of progress. It’s taken years of trust-building to heal from the mess managed care created. In confirming the rumor, the governor’s spokesperson cited important work that DSS is doing with stakeholders to improve the program even more. I’m on one DSS committee with many others working to support primary care and connect people to things beyond medical care that improve health, such as healthy food, safe housing, and community resources. Other people are working on updating provider payment rates, improving mental health care for children, and transitioning justice-involved people in Connecticut. If the MCOs come back, those innovations would be under the control of private companies. Taxpayer investments would just go to fatten corporate profits. If we wanted improvements, we’d have to lobby the MCOs to do it, and probably pay them more. Returning MCOs to the program will take all the oxygen out of those rooms.
HUSKY’s successful Person-Centered Medical Home and Intensive Care Management programs, that are likely responsible for a great part of our success in lowering costs and improving health outcomes, could be lost. Or the state could continue funding these programs, but all the savings would go to the MCOs instead of taxpayers.
Rep. Jillian Gilchrist is right. We can’t afford to go backward. Our budget is tight enough now not to make another attempt at a failed concept. The people who depend on HUSKY for their health deserve more.
