Clock’s Ticking; Charter Oak, HUSKY Need More Docs
by Christine Stuart | July 23, 2008 6:38 PM
Posted to Health Care
It’s been three weeks since the state started enrolling people in Gov. M. Jodi Rell’s affordable, no frills Charter Oak Health Plan. The state-subsidized insurance is available to any Connecticut adult, regardless of their pre-existing medical conditions.
Since that day, June 30, Rell has held three press conferences to tout plan, which she describes as the first of its kind health insurance plan in the nation for uninsured adults, and to date the Department of Social Services has answered 13,282 calls and accepted 4,629 applications from those seeking to enroll.
However, there has been a lingering question about whether doctors will be willing to participate in the plan. Last week, that question was answered and health care advocates, along with at least one lawmaker, were less than impressed with the number of doctors and hospitals - just St. Raphael’s in New Haven so far - that have agreed to participate
Sen. Jonathan Harris, D-West Hartford, co-chairman of the legislature’s Human Services Committee, said Wednesday that he’s concerned with the number of doctors for two reasons:
“First, it shows a weakness in the Charter Oak plan being able to succeed,” he said. “Secondly, now that Charter Oak and HUSKY have been coupled, it means there are no providers for HUSKY clients.”
HUSKY is the state’s Medicaid program for more than 320,000 children and family members in low-income households. Harris said the federal government looks at the sufficiency of the provider networks when it determines how much Medicaid funding the state will receive.
“This could threaten federal dollars for low-income kids,” he said.
But the Department of Social Services says any criticism of the provider networks is premature.
“It is premature for people to be criticizing the provider networks,” said David Dearborn, spokesman for the Department of Social Services. “This does not happen overnight. Building provider networks takes some time, and they are being developed day by day. We wish the critics would take a breath, step back for a while, and just let us and the insurers do our jobs to make this program work for the thousands of people who are seeking affordable health coverage.”
Harris agreed with Dearborn, saying, “I want this to work. Let’s wait and take a deep breath.”
Charter Oak and HUSKY enrollees will have three plans to chose from: Aetna Better Health, Americhoice, and Community Health Network.
If a family that lived in Tolland County enrolled in the Aetna plan they would have a choice of four family practice providers, two internal medicine providers, one pediatrician, and two nurse practitioners. If that Tolland family needed to see a gynecologist in the Aetna plan, they would have to drive to Hartford, New Haven, or Fairfield County to find a doctor that accepted their health insurance.
If your family chooses the Americhoice plan and you live in Middletown, there are currently no pediatricians available in that provider network.
Community Health Networks, which has administered the HUSKY program for the state in the past, has a large number of pediatricians and other primary care providers in each of the counties. Aetna and Americhoice are new to the state of Connecticut and just started signing up doctors at the beginning of July.
Although he agreed with Dearborn that building networks will take a while, Harris said he’s concerned because the state is running out of time to get these networks running. The Charter Oak Plan is scheduled to start Aug. 1 and a large part of the HUSKY transition is scheduled to be completed by Sept. 1.
Harris said he’d understand if there were a few holes, but more than half of the areas do not have all the required providers.
“What we’re talking about here is kids’ lives,” Harris said.
Ellen Andrews of the CT Health Policy Project said Wednesday that she is “really very worried” about the lack of providers. She said she thinks it’s unrealistic for the state to think that all of a sudden they’re going to see a swarm of doctors sign a contract with one of the three managed care organizations in the next few weeks.
“I’m not hearing a lot of providers say they are on the verge of signing contracts,” Andrews said, adding that she’s concerned about those individuals in the middle of treatment who sign up for the plan and no longer can find a doctor.
Comments (5)
Posted by: Dave | July 24, 2008 1:34 AM
Is anyone concerned that these so called "service reps" answering the phones for the State of CT will NOT be fully explaining/disclosing the VERY LOW $100,000 annual limit imposed on all policies?? For very little more $$ folks can buy plans with better benefits, NO annual cap and a HUGE doc network! Why on earth the State didn't allow LICENSED Insurance agents/brokers in on the solicitation and brokering of this plan is mind boggling. I am sure there are going to be a lot of claims that exceed 100K and these will open up room for litigation and could leave families assets at risk...very frightening.
Posted by: Michael | July 30, 2008 11:11 AM
Charter Oak is an Economics 101 lesson in government-sponsored health care.
I explore why the plan will fail to enroll a sufficient number of physicians at the CT Health Care Blog
Posted by: moe | July 31, 2008 8:22 AM
i have medical insurance were i work and pay a lot less...who found this plan anway....plan needs more doctor's and hospitals...persriptions dould be lower way lower..do away with the tierd section....and go to wal-mart were scripts are $4.00 30 day
Posted by: Terri | August 18, 2008 11:13 PM
This comment is in response to Dave, Mike and Moe. I respect your concerns and your opinions, however, To Moe, what you fail to realize is that not all medications cost $4.00 at Wal-Mart. The medications Wal-Mart and other pharmacies and stores offer for $4.00 are not all inclusive. Actually they represent a very small fraction of the drugs available and prescribed to patients. These drugs are generic only. If a patient takes one or more non-generic drug (s), the cost can be astronomical. And also, you are very lucky to pay a "small" premium. Not all companies are as generous as yours.
To Dave, a $100,000 dollar annual limit is a godsend to someone with no insurance at all and responsible for the full payment of their and their children's hospital bill. That limit as it may be low, can mean the difference between someone seeking medical care or not. And if they were to seek medical care with no insurance they are at a tremendous risk of losing their home to foreclosure from medical bills or being sued. The hospitals can be very aggressive in seeking payment for services. It is sad to think that a child may lose a parent because they did not seek medical attention for fear of the reprisal from having no health insurance at all. You also must realize that most adults have pre-existing medical conditions and would not qualify for any private medical insurance. If a person with Diabetes,(a prevalent disease today), were to apply to any private health insurance company here in CT, they would automatically receive a denial and the cost is not inexpensive as you suggest.
To Mike, I realize the doctors available under Charter Oak at this time are few and far between. However, most people would drive any distance to keep their health at a price they can afford.
I am a Registered Nurse and have far too often seen the tragedies suffered by husbands, wives and children for lack of insurance. This insurance with its 'no denial for pre-existing clause', is a step in the right direction for those that are not as privileged as others.
Posted by: Dave | August 20, 2008 6:55 PM
Terri, while I respect your service in the profession of Nursing, my experience of over 15 years in the Health Insurance field has shown me some things on the patient responsibility side (billing) that you may never have even seen. First of all, 100K annual limit is AWFUL, and way, way too low. As I mentioned previously this could still subject property owners to liens if the bill (which would be insanely easy to do with a Heart/Cancer claim or bad accident) exceeds 100K and the provider elects to pursue the additional monies (they will). Why would any healthy person elect to subject themselves to that crazy limit on coverage?
Also, what if someone needs specialty care while traveling, or just elects to go to Dana Farber for Chemo or chooses to have a specialist from Europe flown in for treatment...NOT covered under this C.O. plan! Very dangerous to spend $$ on a plan that limits you even far more than the average HMO.
Finally, while it is true that this plan is better than going uninsured for those with significant pre-ex conditions, it's not true that no Individual carrier will take Diabetes, as Aetna will write some Type 2 Diabetics without major other issues co-existing. Also, many "uninsurables" who are business owners can set up a group to obtain coverage or do so through the Chamber of Commerce with FAR better plans (and less restrictions) than this Medicaid based program and only moderately more pricey.
I don't think any of this will matter in 12-18 months because I think the plan will unravel, sadly, as it would have been far more productive for the state to just utilize the existing system in place and allow consumers to choose quality plans through existing carriers and just subsidize their premiums through tax credits or rebates, and this way licensed professional agents could have helped them choose a plan that meets their needs and not try to stuff everyone into one very weak box.
We shall see what happens I guess.