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Connecticut consumers could soon have the choice of buying health insurance from a non-profit co-op with innovative policies focusing on the needs of patients and the skills of physicians, rather than the demands of actuarial tables and cookie-cutter standards of care.
The U.S. Department of Health and Human Services last week informed HealthyCT that it has qualified for $75.8 million in federal loans to meet start-up expenses and provide a reserve fund as it seeks a license from Connecticut to offer health insurance. The Connecticut State Medical Society (CSMS) and the CSMS-IPA, the association of independently practicing physician in the state, sponsor the non-profit HealthyCT.
Dr. David S. Katz, the HealthyCT board president, said insurance company requirements that don't make practical sense in the care of patients leave many doctors frustrated. Among the goals of HealthyCT, said Dr. Katz, is to develop innovative approaches in providing health insurance coverage. Such a model would put a greater premium on managing care, while providing doctors more latitude in assessing and meeting the needs of individual patients. The intent, he said, would be to free doctors to make best use of their skills, rather than taking approaches preordained by insurance coverage requirements and paperwork dictates.
A provision in the Affordable Care Act permits the creation of such non-profit Consumer Operated and Oriented Plans (co-ops) to provide health insurance in the individual and small-business markets. Dr. Katz said the medical association's decision to pursue development of such a co-op was in part an outgrowth from the frustration small, independent medical offices face in getting health insurance for their own employees. The CSMS-IPA pulled together 5,600 people in small-sized medical offices to collectively purchase health insurance, but found no takers in the existing, for-profit market.
"We couldn't even get commercial insurers to even give us quotes for that group," said Dr. Katz.
HealthyCT will serve as an option for those small-practice doctors as well as for other small businesses and for individuals. While HealthyCT will set its own policies, administrative duties will be contracted out to a separate party, likely an existing insurance company.
Approval of the group's application for federal seed money followed a nearly nine-month review by the Centers for Medicare & Medicaid Services. The agency has approved 12 other loans to co-ops in 12 other states. HealthyCT was assisted in its application by the office of U.S. Rep. Joe Courtney of the 2nd District, who has been a persistent advocate for health care reform and universal coverage.
In addition to providing insurance coverage options, the co-ops will serve as incubators testing new approaches, which if successful in improving care and controlling costs could be adopted by traditional insurers. The mandate requiring every American to obtain health insurance will add millions of people to the market when it takes effect in 2014. HealthyCT expects to begin issuing insurance in October 2013.
Of course all this could unravel if the U.S. Supreme Court declares the Affordable Care Act unconstitutional. Dr. Katz said he expects the fledgling co-op and its loan would survive an adverse high court ruling, but that is not at all clear. In fact the unraveling and confusion such a ruling would have - as hundreds of millions of dollars approved for creation of health insurance exchanges and other programs is cast in doubt and argued over - is all the more reason for the court not to interject itself into the health care debate and let the legislative process address it.
Also at risk from a negative court ruling are popular aspects of the bill, including coverage of family members up to age 26 and the prohibition against denying coverage because of pre-existing health conditions.
Republicans have vowed that if they get control of the White House and Congress they will repeal the Affordable Care Act. While repairs may be necessary, outright repeal would be a major mistake. But at least that debate will take place with clear options for voters. The Supreme Court should not practice judicial activism by superseding congressional authority with its own policies.
In the meantime, we urge Connecticut to proceed expeditiously in evaluating the insurance license application from HealthyCT.