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M.D.s propose plan in new health exchange

Alexander Soule by Alexander Soule
October 7, 2011
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Connecticut physicians want to create a health insurance plan focused on small businesses and individuals to sell in the state”™s health insurance exchange taking shape.

The Connecticut State Medical Society filed notice with the U.S. Department of Health and Human Services to tab its HealthyCT insurance package as a consumer-operated and oriented plan (CO-OP) under HHS rules revealed this past summer. CO-OPs are eligible to apply for some $3.8 billion in startup funding from HHS.

“As physicians ”“ and as employers and consumers ourselves ”“ we know that it”™s time Connecticut had more options in the health insurance marketplace,” said Dr. David Katz, immediate past president of CSMS, in a prepared statement. “We at CSMS know from our own involvement fighting rate hikes on behalf of our patients that they don”™t have access to insurance options that focus on quality of medical care and emphasize the patient-physician relationship.”

Under the Patient Protection and Affordable Care Act of 2010, states are setting up exchanges to help people find insurance at competitive rates, if they cannot do so through their employers.

In a September meeting of a planning board chaired by Lt. Gov. Nancy Wyman, members got their first look at the state”™s new Office of Health Reform and Innovation, which is charged with getting an exchange up and running in Connecticut by January 2014 in accordance with federal law. The board has begun the process of a national search to land a CEO to run the exchange.

At deadline, New York had yet to pass its own law that would set the terms for a health insurance exchange there, as Republicans in the state Senate balked at language in the law.

States have the option of signing onto a multi-state plan offered by the federal government; in August the National Association of Insurance Commissioners said that multi-state plans could have a built-in competitive advantage because they will be able to spread administrative costs over a larger number of insured people.

Like many states, Connecticut and New York are opting to build their own plans in order to ensure they connect seamlessly with their unique state health and technology systems.

Mercer Health and Benefits L.L.C. is consulting to Connecticut in the early stages of creating a health exchange, with the state having received a $6.7 million planning grant in August to work out administration, business operations and customer support. The state has applied for a grant from the National Academy for State Health Policy to secure sufficient funding for “navigators” to help people learn about the health exchanges.

The American public remains largely in the dark about health insurance exchanges, according to the Employee Benefit Research Institute and Mathew Greenwald & Associates Inc., which conduct an annual “health confidence” interview querying Americans on their perceptions of the health care system.

The institute reported that most Americans surveyed are not familiar with the health insurance exchange aspect of the law ”“ in fact only 3 percent said they are very familiar with health insurance exchanges, with more than six in 10 people saying they are not at all familiar with them.

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