Major health care bills died in the Connecticut legislature earlier this year, including proposals for a public option insurance program, prescription drug pricing, and spending.
With health care policy shaping up to take prominence in both local and national politics next year, state lawmakers hope to get a jump-start on ways to lower health care costs and spending in Connecticut.
And they don’t want a repeat of this past legislative session.
“We hear it time and again, whenever we meet with constituents, whenever we knock on people’s doors, how important health care is to their family, and how difficult it is to pay for that health care because of increasing cost of premiums and the cost of care that is delivered in this state,” said state Sen. Kevin Kelly.
Per-person health care spending in Connecticut is among the highest in the nation, averaging about $9,859 a year among those with Medicare, Medicaid and private insurance, according to the most recent data from the U.S. Centers for Medicare and Medicaid Services.
That’s why both Democratic and Republican lawmakers met with health policy experts in Hartford this month to consider three possible options to make health care more affordable for Connecticut residents.
One proposal would create, or re-create, a reinsurance program. The Affordable Care Act offered a reinsurance program in its first few years to attract insurance carriers to the new state exchanges, but it was only temporary.
A state-based reinsurance program would use federal and state money to help health insurers pay for some of the highest patient claims, which experts said should allow insurers to keep premium prices down for residents.
Connecticut would have to apply for an Affordable Care Act Section 1332 State Innovation Waiver from the federal government for approval and federal funding. Twelve other states have successfully done this for a reinsurance program, including Maine, Rhode Island and New Jersey.
But it may take a significant amount of state money. A report by Avalere, a health care consulting firm, showed that while nearly all states with existing programs saw lower premiums in the first year, the financial burden to run the program was considerable for some states.
The amount of state money needed for the programs ranged from $1.5 million in Alaska to $143.5 million in New Jersey.
But Christine Cappiello, director of government relations at Anthem Blue Cross Blue Shield, told legislators it would be a worthwhile investment to keep as many people insured as possible.
“It is a lot of money, but it helps to stabilize that [insurance] market and those big premium shifts,” she said. “And that’s very important because, particularly on the individual and the very small business side of the small group market, they’re incredibly price sensitive, and you really do want them to stay in the system.”
But Paul Lombardo of the state Insurance Department warned legislators about the risk of committing to such a program.
“Because if the program goes away, we’re going to see a big hit in the next year after it goes away, and we’re going to be stuck approving rate increases at the agency,” he said.
Another option legislators discussed would involve creating benchmarks for health care costs and spending to encourage health care providers to keep prices low while providing high-quality care that helps people avoid costly health services down the road.
Vicki Veltri, executive director of the state Office of Health Strategy, said experts have followed this strategy in states like Massachusetts and Delaware to see how it might help Connecticut reduce disparities in health care access and affordability, and health outcomes.
“You can see even across the state there’s significant price variations for various services,” Veltri said. “That’s impactful to people, when where you live, your services may cost you more in one area of Connecticut than another.”
A third possible option is to import cheaper prescription drugs from Canada. National reports show that rising pharmaceutical prices are one of the biggest drivers of increasing health care costs for residents.
But Shabbir Safdar, executive director of the Partnership for Safe Medicines coalition, said programs like these have posed safety risks and problems with counterfeit drugs.
“I have studied all the major importation programs that states have attempted to implement over the last 15 years,” he said. “I’m going to spoil the ending for you and tell you that none of them are in existence today, none of them delivered the promised savings, and they all had patient safety violations.”
However, Anna Doroghazi, associate state director of advocacy and outreach at AARP, said people are already tapping into the Canadian market for less expensive prescriptions, especially in New England and in border states.
She said rising prescription drug costs is a top concern among older adults and people with chronic conditions.
“I do think that there are ways to build in some safety and protective measures into how we structure the program,” Doroghazi said.
Lawmakers said these ideas will likely come up for debate in the next legislative session, which begins in February. They hope that this time around, they’ll be able to pass bipartisan legislation.