OP-ED | Governor’s health record misses opportunities

ELLEN ANDREWS

Last week, Connecticut Governor Ned Lamont and his administration held a press conference to promote their efforts to reduce health care costs, but more importantly to limit the damage. There have been understandable criticisms of the state insurance department’s decision to reduce insurers’ unwarranted rate increase requests for next year from 20% to 13%. Insurers have been very profitable before, during and since COVID and 13% is not affordable for anyone. But this isn’t the first time the governor and his administration have let us down on health care.

At the news conference, the governor agreed that the rate hikes demanded by insurers were “outrageous” and that the Insurance Department’s topping is “not good enough.” But such a mess cannot have only one cause. He is right to say that a large part of the problem lies in the underlying prices of medicines and monopolized health services. But then they lost me. He and his commissioners have only come up with tired old projects that don’t work, and others that are just bad ideas.

But the APCD [database] misses most state residents, including the uninsured, Medicare beneficiaries, Medicaid members, and residents of employer-sponsored plans. Additionally, the APCD’s drug spending data does not include discounts, which vary widely, averaging 51% of list prices for commercial plans. Any missing data exists elsewhere but is not in the APCD. Bad things can happen when designing a policy based on a Swiss cheese database.

The administration’s grand plan to rein in rising health care costs is a name-and-shame report that risks being criticized from all quarters, rendering it unnecessary. More than two years later, they learned that huge monopolistic healthcare systems and drug prices drive up healthcare costs, but we already knew that. Massachusetts has had a similar cost cap in place since 2013, but it hasn’t worked.

The administration also offered its All Payers Complaints Database (APCD), as an achievement. The database is expected to include all of Connecticut’s health care payments and is the basis for most of their cap calculations. But the APCD is missing from most residents of the state, including the uninsured, Medicare beneficiaries, Medicaid members and residents of employer-sponsored plans. Additionally, the APCD’s drug spending data does not include discounts, which vary widely, averaging 51% of list prices for commercial plans. Any missing data exists elsewhere but is not in the APCD. Bad things can happen when designing a policy based on a Swiss cheese database.

Latest and best data, from independent sources showing all their math, reveals that Connecticut is among the best in the nation when it comes to controlling overall health care costs. We should be very, very careful in making changes, or we might destroy what works. The law of unintended consequences is very strong in health care – especially here in Connecticut.

The administration’s plan to pump an additional $3.9 billion into primary care may be a good idea, but it won’t save money. So far, this has only sparked a feeding frenzy among vendors. The state certificate of need regulatory process, which is supposed to curb health monopolies, keep markets competitive and control prices, is not working at all.

The governor rightly points to federal grants to help make insurance coverage affordable through Access Health CT that have been extended for three years. He can take credit for leveraging these grants with Covered Connecticut to expand services and cover out-of-pocket costs. But there are only 11,700 people currently registered. According to the U.S. Census, there were 163,000 uninsured Connecticut residents in 2020.

I am puzzled that the administration is promoting their health information exchange as a major achievement and cost saving. An extensive investigation revealed that the Connecticut system is behind schedule, over budget, and shutting down an exceptional system that we had already paid for. They also intend to fund the system by selling access to our sensitive medical records.

The governor kind of buried the best thing he came up with to cut costs. Two years in a row, he has proposed reversing extreme increases in drug prices. Recently, Congress went further and reduced drug price increases in Medicare to the rate of inflation. While the governor’s bill has gone nowhere, Connecticut will have to pass it next year, or drug companies could just pass their Medicare losses onto those of us covered by private plans — because that they can.

The governor can and should do a lot to reduce health care costs if voters get him back. He did nothing to bring down the prices of the monopoly health care system. These price increases are the main driver of rising healthcare costs. They squash competition and consumer care choices. Last year, the state Senate overwhelmingly passed a bill to limit anti-competitive contracts by these huge systems, but it died on the House calendar. The governor should put his weight behind the passage of this bill. It should also either fix our faulty need certificate process or remove it.

The governor really needs to take improving health seriously. He needs to go upstream to solve health problems. It is increasingly clear that the main contributors to our health are not medical. We need to focus on preventing costly conditions by directing resources to safe homes and communities, healthy food, economic security, and proven public health initiatives. The state could play an important role in ensuring that medical savings are reinvested in community services that have avoided problems, and not captured by huge health systems and insurers.

But mistrust derails even good ideas, and Connecticut’s healthcare system has trust issues. This governor did not create them, but he must recognize them and correct them if we have any hope of progress. Use evidence and good data to guide solutions and evaluate results. Beware of convenient myths and shiny new health policy trends that don’t work. Listen up everyone – good ideas come from unlikely places. Don’t let petty politics or turf battles get in the way of you doing the right thing. We need our next governor to succeed.

About John Tuttle

Check Also

Healthcare Fraud Analytics Market to Reach $6.65 Billion by 2027 by Size, Share, Growth and Key Players Analysis

Emerging research logo Growing number of health insurance fraud incidents across the world and growing …