When state Healthcare Advocate Ted Doolittle said, “Folks in [the] industry, we want to know your pain points,” the responses from assembled health insurers, pharmacy benefit managers, industry associations and policy analysts were swift and numerous. They were gathered Thursday morning for a forum on health care cost drivers in Connecticut, co-hosted by the Connecticut Insurance Department, the Office of the Healthcare Advocate and the Office of Health Strategy.
Many aspects of health care are experiencing increased costs. Reasons include higher demand and limited supply of medical equipment; sicker hospital patients who need more care; higher costs associated with extended ER visits by patients in a mental health crisis for lack of a hospital bed; hospital consolidations; a rise in employee cost-sharing plans; increased costs to hire health care workers through staffing agencies; and pharma coupons for branded drugs.
“Patients in hospitals are sicker today than they were pre-pandemic,” said Jim Iacobellis, vice president of government relations for the Connecticut Hospital Association. “The acuity of the patients has gone up. We measure that in terms of length of stay, and we are seeing increased length of stay in Connecticut.”
Also, Connecticut is seeing an increase in plans with more expensive employee cost-sharing tiers, and that’s driving up overall costs, noted Kelly Ryan, deputy vice president of state policy with PhRMA. “This is kind of the opposite of how insurance is supposed to work,” she said.
“We just issued research in the last week or so that shows patients pay six times more out of pocket for medicines when they have deductibles or coinsurance, as compared to flat copayments,” Ryan said.
At the start of the pandemic, Connecticut ranked ninth in the country in per capita health care spending ($12,500 per person) and 12th in average employer health insurance premiums ($7,700), according to the Kaiser Family Foundation (KFF).
Yet, the U.S. had fewer doctor visits – that is, less utilization of services – compared to other countries with similar outcomes and lower overall health care costs.
Cynthia Cox of KFF pointed out that when the pandemic hit, there was a sharp drop in utilization of services. “It’s hard to tell how much of that missed care might lead to worse health outcomes,” she said.
In the coming year, as many as 390,000 people could lose Medicaid coverage this January, becoming uninsured and further driving up costs.
“The public health emergency was extended to January of 2023 and will then trigger redetermination and recertifications of Medicaid membership over the next year,” said Louis Gianquinto, president of Anthem Blue Cross and Blue Shield of Connecticut. “And, if we don’t do things right here, this could end up causing a lot of members to become uninsured.”
Gianquinto says insurers must get the word out about plans on the Access Health CT exchange that have no or minimal costs.
Gov. Ned Lamont responded to the issues raised, saying in a statement that health care consolidations have reduced competition and are “raising prices by concentrating market power.” He said that “a high-quality system that patients cannot afford to access is not sustainable.”