In the wake of federal health care reform, Connecticut policymakers are speeding toward the state”™s first major step ”“ the creation of a pool to insure high-risk patients with pre-existing conditions.
Connecticut had plans to submit its application for the high-risk pool funding by early August, in hopes of beginning to enroll patients as of September.
Cristine Vogel, whom Gov. M. Jodi Rell assigned as the state”™s special adviser for health care reform, called it Connecticut”™s most significant accomplishment in the first few months of health reform.
Under the new law, most U.S. citizens and legal residents will be required to have health insurance (about one in 10 Connecticut residents lacks insurance), and employers will have to pay penalties if they do not offer insurance to employees who subsequently obtain coverage through regional health exchanges, with exceptions for small businesses who also can purchase insurance through the exchange.
“The federal government has some intensive deadlines for us all of us, but also for themselves,” Vogel said, speaking at a gathering of Rell”™s health reform cabinet last month. “As aggressively as we are, they are trying to move health reform at a pace we are not all accustomed to.”
Vogel has been a deputy commissioner in the Connecticut Department of Public Heath with oversight of the Office of Health Care Access. Kim Martone takes over at OHCA, having worked at the office the past 18 years.
In Vogel”™s new post, among other duties she is charged with overseeing Connecticut”™s efforts to create a health insurance purchasing exchange; review industry reforms to make sure Connecticut is ready for many of the health reform deadlines that come due in 2014; and secure federal funding to maximize the Connecticut”™s implementation of those reforms.?Vogel is marshaling the efforts of a small army of administrators racing to meet various deadlines, including Mark Schaefer, director of clinical services for the Connecticut Department of Social Services, and with Mary Ellen Breault of the Connecticut Insurance Department is readying the state”™s application for high-risk pool funding.
Schaefer said the state was on the cusp of finalizing its work in June, but hit a speed bump when actuarial adviser Milliman Inc. cited proposed rates that were higher than anticipated. Rell gave Schaefer”™s panel two weeks to examine alternatives, which included a federal “fallback” option for states not intending to operate their own high-risk pool.
“That was tough to assess,” Schaefer said, “because we didn”™t have much data ”¦ at the beginning of July as to what the rates might look like for a federal fallback for a New England state.”
After further examination, however, the group found that the proposed rates were lower for all age brackets save the two most elderly bands ”“ groups that would likely find adequate coverage under Medicare. And because Connecticut already operates the Charter Oak insurance plan that accepts all comers regardless of pre-existing conditions, the state can likely make its share of any federal funding stretch farther than states without such a plan in place.
If successful in securing funding, Schaefer said the state”™s main challenge will be managing the limited resources of a new, high-risk pool in the face of any stampede by state residents to enroll.
“There is some risk ”¦ to our ability to offer the product if we have premiums that draw too many people in and premiums that don”™t generate enough revenue, such that we threaten to exhaust the pool,” Schaefer said. “We”™ll be monitoring ”¦ very closely our enrollment relative to projections ”“ how much we are spending against the $50 million allotment. If necessary, we may ”¦ propose modifications to the premium schedule to tune it so we can avoid what we really want to avoid in those three-and-a-half years ”“ which is having to suspend enrollment.”
