CT News Junkie | Committee Struggles With Benefit Plan Recommendation

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Committee Struggles With Benefit Plan Recommendation

by | Jul 11, 2012 5:30am
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Posted to: Health Care

A health care advisory committee struggled Tuesday with what health insurance benefit plan it should be offering individuals who aren’t covered by the state’s Medicaid program, but are too poor to purchase their insurance through the Insurance Exchange without the help of government subsidies.

The Connecticut Health Insurance Exchange Consumer Experience and Outreach Advisory Committee recommended to another committee to adopt an Essential Health Benefit plan similar to the one offered by ConnectiCare, to those who purchase their insurance through the Insurance Exchange. The ConnectiCare plan which covers a number of state mandated medical procedures will set the benchmark for private insurance companies offering their products through the Insurance Exchange in 2014.

But the committee struggled with how rich the benefit plan for residents who fall in between 133 percent and 200 percent of the federal poverty level—which for a family of three is between $25,000 and $38,000 a year—should be. Those who fall below 133 percent of the federal poverty level will be covered by Medicaid, but those who earn slightly more may be covered through the Basic Health Plan, or BHP.

The BHP was established by the Affordable Care Act and is a federal program, but the state first has to decide whether to implement it.

State Healthcare Advocate Victoria Veltri, who co-chairs the committee, questioned why it was necessary for the working group focused on the Essential Benefits Plan to make a statement about the Basic Health Plan, which has its own working group.

Jennifer Jaff, executive director of Advocacy for Patients with Chronic Illness, made a motion to recommend that the state establish a Basic health Plan with a robust benefit package similar to the one offered through the state’s Medicaid program.

“I sit on the exchange as the healthcare advocate, so I do have major concerns about what will happen to people who are below 200 percent of federal poverty level in terms of affordability and access,” Veltri said.

However, she remained reluctant to support sending such a strong message to the other working group and ultimately legislators who will still have to decide whether the state should even offer a Basic Health Plan.

Dr. Robert Scalettar, an exchange board member, assured Veltri that voting on Jaff’s motion was not a personal endorsement of the Basic Health Plan or the committee’s endorsement of it. Rather, it was a vote on whether a Basic Health Plan ought to have a robust benefit package, he said.

Veltri supported consideration of a recommendation, but said an actual recommendation was premature since the Essential Health Benefits committee has yet to meet with the Basic Health Benefits committee.

“It’s fine to make a recommendation to consider a stronger benefit package; that I don’t have a problem with. But to recommend it today without having done the combined meeting next month I think is premature,” Veltri said.

Sheldon Toubman, a legal aid attorney who is a member of the committee, didn’t support any suggestion that did not require making a formal motion.

Though he understood the benefits of waiting until the joint meeting, he said, “Some of us have been working on this for many months and studied extensively and are prepared now to strongly recommend the BHP.”

Ultimately, he won out and the formal motion to recommend consideration was made. The committee took a roll call vote and the motion passed with only one member, Gerard O’Sullivan, abstaining from the vote while all others supported it.

After tackling those two huge issues, the committee was unable to make a decision regarding what type of prescription drug plan it should recommend.

“I think it’s better to vote with information rather than to just vote for the sake of voting,” Veltri said.

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Archived Comment

posted by: GoatBoyPHD | July 11, 2012  11:04am

GoatBoyPHD

One policy to heal them all.

What better time to standardize policy terms based on Medicaid coverage.

The approach of other states has been to offer sub standard policies for those above the Medicaid cut line and the for those with subsidized policies.

In other words a hidden tax on the working poor and blue collar in hard times. Usually there is some mealy-mouthed excuse like “We can’t afford to treat the working poor fairly or as well as Medicaid clients.

Morally unconscionable to me to put Medicaid benefits above the working poor and blue collar. It’s another work disincentive to offer less if you have any limited and slipping assets or p/t work only.