Rell Celebrates One Year Anniversary of Charter Oak
by Christine Stuart | August 17, 2009 3:16 PM
Posted to Health Care
It’s been a year since Gov. M. Jodi Rell initiated enrollment in the Charter Oak Health Plan, a state-subsidized health insurance program for the uninsured.
For $75 to 259 per month, the plan will accept any individual, including those with pre-existing medical conditions, as long as the individual has been without insurance for six-months or more.
In press release last week Rell hailed the one-year anniversary by touting its enrollment.
“Today that program is covering 10,257 individuals and another 5,884 applicants are eligible for coverage as soon as they select from one of three contracted health plans and begin paying monthly premiums,” she said in a press release. “That means more than 10,000 people who - a year ago - had no health coverage or could not afford the coverage they had now have affordable health care.”
The Department of Social Services which helps administer the program says that over the past year it has approved 19,943 applications and has denied 24,452 applications—mostly because those applicants hadn’t been without insurance for six months.
Another 4,457 individuals have dropped out of the program due to changing health benefit situations such as employment, moving out of state, not paying premiums, and various other factors, David Dearborn, a spokesman for the Department of Social Services, said.
But even with more than 10,000 individuals enrolled in the plan, some lawmakers still wonder what kind of coverage and medical care those residents are receiving.
“The jury is still out on what kind of health care is being provided,” Sen. Jonathan Harris, D-West Hartford, said Monday.
As co-chairman of the legislature’s Public Health Committee Harris said based on enrollment numbers alone he’s not sure he can judge the success of the program. He said he wants to know how many of these enrollees were able to schedule doctors visits and get the medical attention they need.
Public Health Committee Co-Chairwoman, Rep. Besty Ritter, D-Montville, said she was also concerned about “what kind of health care they’re getting or not getting as part of the Charter Oak Plan.” She said getting the number up to 10,000 is impressive, but it doesn’t give you the entire picture.
As of last August only two of the hospitals, St. Raphael’s in New Haven and St. Mary’s in Waterbury, had signed up to participate in the plan. And as few as four or five family doctors had signed up to participate in the Charter Oak Health Plan in all of Hartford County, during its first week last August.
Since last year the insurance companies that administer the Charter Oak Health Plan for the state have made progress in increasing the number of doctors and hospitals that participate in the plan.
According to Dearborn participation by primary care physicians as grown from 3,039 to 6,322 and the number of specialists participating has grown from 4,949 to 8,465. Also the number of hospitals accepting Charter Oak enrollees has increased from two to 16.
“The bottom line is that Charter Oak enrollees are getting access to health care,” Dearborn said Monday. He said it’s even helped individuals with cancer get coverage that they couldn’t get anywhere else.
Here are a few statistics from the Charter Oak program and the three insurance carriers Community Health Network, AmeriChoice, and Aetna:
·Community Health Network of CT (CHNCT) reports paying claims for 3,707 inpatient services, 16,392 outpatient services, 15,318 medical/office services and 28,921 other (lab, durable medical equipment, home care, etc.) over the past year.
·CHNCT reports that it has been case-managing for cancers of all types, heart disease, liver disease, respiratory conditions, diabetes, high-risk pregnancies, etc. Four members have over $50,000 in claims. The health plan reports that it has paid medical claims for about 88% of its members so far.
· Aetna Better Health reports a medical expenses breakdown of about 31% for hospital outpatient; 27% for hospital inpatient; including chemotherapy and dialysis; 27% for physician services; and 15% for other practitioner. The plan reports that about 67% of its members have already accessed health care services.
·AmeriChoice by UnitedHealthcare, as an example of access to services, reports paying 182 claims so far for dialysis treatment and other services for one enrollee’s care since January.
·In any health coverage program or product, not everyone accesses services immediately, as membership grows and new people come on. However, the above information affirms that Charter Oak enrollees do have access to health care services paid for by the program, and are using the services as needed.
Comments (19)
Posted by: Gannon | August 18, 2009 8:59 AM
Having to wait 6 months without insurance without qualifying for Charter Oak doesn't make any sense. How about something that caters to unemployed people, and the newly unemployed?
There's no way this plan is better than the pooling bill passed by the General Assembly today.
Posted by: cedarhillresident![[TypeKey Profile Page]](http://www.ctnewsjunkie.com/nav-commenters.gif)
| August 18, 2009 9:03 AM
BIG SHIT!!!!
Ya know I keep hearing story's about no doctors take it! My thyroid doctor said she has people driving half way across the state to see her. She is one of few that takes it. And those people tell her the lack of doctors that will take it. Rell should never vetoed what the leg. had.
Posted by: David Dearborn | August 18, 2009 10:21 AM
From CT Dept. of Social Services: the statutory waiting period is waived if a person has lost employment and health coverage. Unemployed residents (and other adults aged 19 through 64 without health coverage) can call 1-877-77-CTOAK or visit www.charteroakhealthplan.com to download an application.
Posted by: Sean | August 18, 2009 10:29 AM
Lots of questions that the reporter never answered. Let's try some of them:
First, Christine reports that more than 10,000 people have enrolled in the program. But if she were to provide critical perspective, she would point out that that figure is a drop in the bucket compared with the more than 350,000 uninsured in Connecticut. Indeed, that represents less than 3% of all of the uninsured in the state a year after it was begun.
Next, the article should have pointed out that the program is far too narrow, because it doesn't help the working uninsured, who comprise over half of all uninsured in the state. And the program also does nothing to mitigate the problem of the under-insured, which comprises another 10% of the population, or 350,000.
The reporter should also question why there are far more doctors signed up to participate than there are patients. What's going on here? And how is the program supposedly working well if more than half of the applicants are denied, and a quarter of all of those approved still don't actually sign up? And what is the average monthly premium, since the article quotes a very wide range? And for the unemployed who aren't making any money, does it make sense to charge them anything at all? If no cash is coming in, is it not cruel and cynical to demand insurance payments from them? And are the patients required to pay copays as well? Do those onerous requirements explain the extremely small number of nutmeggers participating in the program?
The reporter should also try to avoid subtle value judgments such as implied by this sentence:
"But even with more than 10,000 individuals enrolled in the plan, some lawmakers still wonder what kind of coverage and medical care those residents are receiving."
The implication is that with over 10,000 people in the program, how could any rational person question their coverage?
A year into this program it doesn't appear that a celebration is in order. On the contrary, it seems as though the program is a major bust, covering only a fraction of the uninsured and only a fraction of the families affected by unemployment. And with more doctors than patients signed up, something is definitely amiss.
Seems as though some serious investigative reporting would cull up some major problems with Charter Oak.
Posted by: Sean | August 18, 2009 11:12 AM
Here's another important factor to consider- and to report. Aetna Better Health reported the breakdown of its medical expenses. But it doesn't give the figure for its total revenue from the program. Aetna reported in its second quarter returns that it more than 30% of its total revenues do not go to medical expenses, i.e., for actual treatment of the people paying insurance premiums. What percentage of the program's revenues are actually going to medical care- "medical expenses"?
The General Assembly passed legislation to set up a health care system that would be administered by the state. If it can be run for something close to Medicare's 2% overhead, rather than the far higher overhead of Aetna, why is Connecticut allowing the private insurance companies siphon off what is probably an enormous percentage of the revenue into overhead and profit?
Posted by: christine | August 18, 2009 12:32 PM
To answer your last question the HUSKY contract and Charter Oak contract are one in the same and the total amount of money for the five-year $3.5 billion contract to the three managed care organizations: Community Health Networks, Aetna, and AmeriChoice. An audit by the Comptroller already found the state overpaid the MCO's more than $40 million to administer the $800 million HUSKY program. I forget how much money was budgeted for subsidies for Charter Oak because some of that money was taken out of the budget. I believe about $11 million is available for those below 300 percent of the federal poverty level which is where the sliding scale on premiums from $75 to $259 per month comes in. In July there were 3,985 people at the $75 dollar level and 706 at the $259 level. Those were numbers as of July. If you want to know more about the qualifying income levels go to the plans web site.
Posted by: Sean | August 18, 2009 2:31 PM
Thank you, Christine.
Actually, I think it's important to know how much the state pays for Charter Oak itself, even though it is tied into HUSKY. The state should be able to find out how much it is paying to those three companies apart from HUSKY. And given that Medicare costs us only two cents of every health care dollar in overhead, finding out how much we are shoveling to the for-profit insurance companies would help voters understand whether it makes more sense to just do it directly through the government.
And the $40 million "overpayment" doesn't really answer the question of how much from the state didn't go to health care, and did go to admin and profits. It would also be interesting to ask Governor Rell how she justifies asking unemployed workers to pay hundreds of dollars a year for insurance premiums when they're unemployed? Is that ethical?
I think it's a good topic for you all to look into, since this is such a critical issue today.
Maybe you could copy those questions over to the governor's office for answers...?
Posted by: David Dearborn | August 18, 2009 3:26 PM
From CT DSS: The Comptroller's HUSKY rate-setting review mentioned by Christine was subject of strong disagreement between the Comptroller's actuarial consultant and the Department of Social Services actuarial consultant. The Governor's supplemental budget recommendation in May effectively superseded the dispute by recommending a reduction in HUSKY capitation rates of 6%, citing the Comptroller's draft report.
Sean's statement that Charter Oak should help Connecticut's working uninsured is actually the case; since August 2008, Charter Oak has been available to working and non-working uninsured. Besides working people, Charter Oak serves retirees too young for Medicare and other Connecticut adults without health coverage.
Charter Oak is open to applicants with pre-existing medical conditions. The same premium rates also apply to applicants with pre-existing conditions, another distinguishing factor about Charter Oak.
The Governor proposed Charter Oak and the legislature approved it during the 2007 session. The program operates under statute and rules, which include the reduced-price premium structure for applicants earning under 300% of the federal poverty level. The unsubsidized premium level is currently $259 monthly.
Denials of Charter Oak applications are normally due to applicants already having health insurance and not qualifying for exceptions to the statutory waiting period. These exceptions to the waiting period include loss of employment, loss of health coverage, losing HUSKY coverage due to income or age, and financial hardship in paying current health coverage.
Charter Oak was created and approved as part of Connecticut's public policy as an option for Connecticut's uninsured that shares cost between enrollees and taxpayers. In the current fiscal environment, it is hard to imagine a viable alterative in the budget right now, especially one that includes people with pre-existing health conditions. Charter Oak's enrollment is 10,200+ and growing, and available to Connecticut's uninsured right now.
Prospective applicants can call 1-877-77CTOAK or visit www.charteroakhealthplan.com to apply.
Posted by: Paul | August 18, 2009 4:56 PM
Sean,
Not sure where you got your Aetna numbers from, but their 2009 quarterly filings filed with the SEC show a 92.2% medical benefit ratio for Q2 across their entire Medicaid enrollment segment.
Posted by: Paul | August 18, 2009 5:01 PM
Oops, clicked "post" too soon...
So, with a 92.2% MBR that would leave 7.8% for admin/overhead and, theoretically, profit. I know you want that 7.8% number to be 0%, but in the real world that is not going to happen. And as far as the 2% you quote for Medicare admin, keep in mind that 2% doesn't give you: customer service, health service, quality programs, disease management programs, cost controls - not even a death panel! You get what you pay for.
Posted by: Nina | August 18, 2009 6:49 PM
Hi, can anyone help me find a PCP that will take this plan in either the Middlesex or New London County. Neither Community Health Network, Aetna Better Health, or AmeriChoice can give me a physician or a hospital. Seems to me the Health Insurance is no good if I cannot find a physician that accepts it. None of the 3 surrounding hospitals, within a 30 mile radius of me, will take Charter Oak either.
I have called each of these Insurance plans 3x and to know avail. I have called the hospitals that many times also. Also, to no avail.
Is this a joke or a case of "bait & switch".
Posted by: Doug | August 18, 2009 7:35 PM
Hi Nina... christine's going to make some calls regarding your comment and get back to you.
Posted by: David Dearborn | August 19, 2009 9:25 AM
From CT DSS: Responding to Nina's post, assuming you're a Charter Oak enrollee, the membership services department of the Charter Oak-contracted plan you chose will help you with Primary Care and Specialist Providers and any hospital or other services you need, per the benefits package.
Backus Hospital in New London County is enrolled, and out-of network services are arranged if necessary. The specific health plan you chose is responsible for making sure you receive the health care benefits.
If you cannot get the assistance you need from your health plan for some reason, the Department of Social Services, as administering agency, will assist you. Feel free to email me at david.dearborn@ct.gov for referral as necessary.
Posted by: Darma | August 21, 2009 5:13 PM
I can't believe Gov. Rell can be out there celebrating CHARTER OAK which sucks by the way when there are so many unemployed people without benefits. An article put out a short while back says Gov. Rell has the ability to tap into funds to help the state. Of course, if the rate had been 8%, it would have been totally funded by the Government. I work for the Dol and it's so sad to know so many more people are unemployed than what's reported. Residents need to ban together, completely overfill Gov. Rell's email, call her office and leave as many messages as you can, call your senator etc. Something needs to be done. I had someone call me today and cry that she can't even buy the paper to look in the want ads let alone sanitary napkins for her daughters first period. Truly pathetic Gov Rell! Do something for goodness sake. No one cares about charter oak and don't get me going on her obsession with getting jobs for 17 year olds!
Posted by: Linda | August 22, 2009 5:07 PM
My husband and I are enrolled and as we have looked for Providers, many will accept Huskey but not Charter Oak even though it states on the Provider List that Charter Oak is accepted. After going through Physical Therapist possibilities for Hartford County...none of them accepted Charter Oak ( the last one we tried said over the phone they did accept Charter Oak but when my husband went for his appointment...they only take Huskey)
Posted by: Roynn Lisa Simmons | August 25, 2009 2:30 PM
I was one of the first people to apply to Charter Oak and after waiting 9 months was so thankful to have it. However when I started to use it I have a different opinion. Depsite the glossy brochure and list of benefits it's fight and a wait for everything. They said they'd cover my mammogram fully.AETNA paid half of the cost because my mammogram was "routine" not "preventative".
Supposedly I could select one of their Specialist in the HMO and even get a second opinion. I need a hip replacement. However there were no specialist and it took over 3 months to get to the only place that would take me the St. Raphael's orthopedic clinic. What second opinion? Once I got to the clinic I was told that I was a charity case and could get no definate date of when I could expect surgery. They'd just fit me in if there was a cancellation because AETNA doesn't pay the doctors very much. Nothing like this was explained about Charter Oak either on the web site or in the AETNA brochure. Now the whole process has taken so long I can hardly walk and my bathroom is upstairs. Supposedly, I have durable medical provided by AETNA CHARTER OAK. However when I called to make sure that I could get a stair lift AETNA just told me ...well we don't know have your Doctor call our authorization department and we'll see. This is Charter Oak.. no doctors, arguing over every bill, limbo and in pain. Charter Oak is no great Health Plan. I hope Connecticut can do better. Maybe the reporter should talk to the recipiants of this health plan... hope the reporter has better coverage than this.
Posted by: waterboarder | August 26, 2009 10:48 AM
No reason to celebrate. Just open your ears and listen to the people who signed up for the plan. No doctors. Many of the doctors listed are not taking any more clients, and are counted up to 3 times when in fact they are one. Has anyone called to find out what the wait list is for the doctors who are actually on the list? Nope. Secret shopper time Gov. Rell. Most of the people who had the plan don't have it now...the state reports because they could not pay their premium as the only reason they dropped. Nope. Misinformation again. They chose not to pay the premium because they could not get the care they needed, as promised by the Gov. Its a sham. The whole CO program is a sham. Could one person come forward and tell us it is working for them? Where is that in the article? Can't find one. Not one. Just Jodi throwing money at the insurance industry as usual. Ugh. Celebrate a year? Please.
Posted by: Stuart Lane | September 1, 2009 7:14 AM
I am the director of an AIDS service Organization in Norwalk CT and everything I have read to date rings true with our experiences. This is a sham. What is the point of having a program if it doesn't work because there are no doctors or hospitals willing to take the insurance, plus it is so difficult to qualify and the state bureaucracy is so heavy and barely functions that most people give up before they can get on the program. What can we do ? We have to band together and stop this foolishness. I would like to know who and where and when we can start to address this. Does anyone know?
Stuart
Posted by: cedarhillresident![[TypeKey Profile Page]](http://www.ctnewsjunkie.com/nav-commenters.gif)
| September 1, 2009 11:11 AM
Stuart Lane
I would like to know who and where and when we can start to address this
The day we get a Dem in the GOV seat and keep the Dem in power in leg.
And it will take some work on everybodys part to support who ever runs