Connecticut Races To Reach Uninsured, Open Health Insurance Marketplace

HARTFORD, Conn. — In the nation’s insurance capital, the hunt to find uninsured people and get them enrolled in the state’s new online health insurance marketplace has already begun.

Officials working for Access Health CT, created under the federal health law, have collected names of more than 1,300 people needing coverage at recent town-hall meetings across the state. This spring and summer, they plan to use booths at festivals and street fairs to gather thousands more. Come fall, they’ll also pay community groups and small businesses, such as barbers and beauticians, in New Haven, Bridgeport and other cities with high uninsured rates to reach out to people and sign them up for coverage on the spot.

The marketplaces open nationwide Oct. 1 and are key to the health law’s expansion of coverage to millions of individuals and small businesses.  In Connecticut – one of 16 states slated to run its own marketplace, also called an exchange – the goal is to sign up 220,000 people by next March, or two-thirds of the state’s uninsured. That’s ambitious considering that only a third of the uninsured nationally are expected to enroll in the first year.

“We are on a mission to make history,” Access Health CEO Kevin Counihan said in an interview at his downtown office that looks out at UnitedHealthcare Center and the golden dome over Aetna’s corporate headquarters.

Looking around his headquarters, where 25 staffers work alongside employees from private contractors, including Deloitte Consulting and KPMG, he said, “It’s not Groundhog Day here.”

‘Connector On Steroids’

From 2006 to 2011, Counihan was chief marketing officer for the Massachusetts Health Insurance Connector Authority, which attracted national attention because it helped the Bay State achieve near universal health coverage and become the model for the federal health law. Massachusetts also won kudos for its marketing to the uninsured, which included advertising at Fenway Park during Red Sox games.

Those experiences prepared him for his current challenge, which Counihan describes as “the Connector on steroids.” He said the Connecticut exchange is a more ambitious start up because it must be a one-stop shop for both private coverage and Medicaid, and because of the federal law’s extensive insurance reforms.

As in Massachusetts, Counihan and Access Health have had to balance the sometimes conflicting interests of health insurers, hospitals, doctors and other providers, employers, insurance agents and consumer advocates. Ellen Andrews, executive director of the Connecticut Health Policy Project, a consumer group, predicts the private plans offered by Access Health will be too expensive for many people, even those with subsidies to defray the costs. At least half of the people buying policies in the marketplaces are projected to qualify for subsidies.

“We are concerned the standard plan is very expensive,” she said, citing the exchange board's decision to use the state’s most popular small group plan as the basis for the benefits required of every policy sold in the exchange. Most state exchanges did the same thing to reduce disruption in the insurance market.

Health plans begin to submit their prices to the exchange next month for coverage that begins in January.

Andrews said Access Health’s decision not to negotiate rates with insurers initially -- as Massachusetts does -- will also result in higher prices.

Small business groups say they share that concern. “Relying on the carriers to be able to bring plans into the exchange with no structures to challenge price is just plain irresponsible,” said Kevin Galvin, chairman of Small Business for a Healthy Connecticut.

Exchange officials say they opted against negotiating with carriers initially because they did not want to dissuade any from participating, said Jason Madrak, chief marketing officer. Five insurers, including all the major carriers in the individual and small group markets, plan to participate.

A Public With High Expectations, Little Patience

Despite such criticisms, Connecticut has advantages over other state exchanges.

That’s because it started more than two years ago with more than $100 million in federal grants. And the state’s small size means it can more easily pinpoint outreach efforts. Most of the uninsured are in a handful of cities including Hartford, New Haven and Bridgeport, and the exchange knows which neighborhoods to find them in from Census reports.



Access Health CEO Kevin Counihan



As the nation’s insurance capital, the state may have less of a challenge convincing people of the value of health coverage, Counihan said. Being the wealthiest state in terms of per capita income should also help.

While the exchange will advertise on television, newspapers and billboards, the focus will be on working with community health centers and other providers to identify the uninsured when they seek health care, Madrak said. The group will also work with local chambers of commerce to get the word out to small businesses. Nearly 10 percent of Connecticut residents are uninsured.

Part of Counihan’s job these days is managing expectations. “It won’t be perfect on Day One,” he said, recalling how the introduction of Medicare’s prescription drug benefit in 2005 ran into many snags although it was ultimately successful.

Compared to the Connector’s launch, Counihan said the public has higher expectations and less patience. “People on the left want to see this fail so they can say, ‘Another reason for a single payer system,’ and people on the right want it to fail so they can say, ‘Big government does not work.’”

Counihan said the online exchange may have fewer features than originally envisioned – for instance, quality ratings of insurance plans -- so it gets done on time. Though he has help from some of nation’s largest consulting firms as well as from his former boss at the Connector, Jon Kingsdale, he knows the buck stops with him.

“It’s a tough, lonely job,” said Counihan. “I’ve never had so much coming at me at the same time.”

He said an Obama administration official recently asked him what he could offer to help, and he replied, “’Give me another year.”

That was not an option.

Anthem Responds To Criticism Over Psychotherapy Reimbursement

Anthem Blue Cross and Blue Shield in Connecticut responded to criticism by doctors groups that the insurer isn’t paying for psychotherapy when it is provided in conjunction with other medical services.

Wallingford-based Anthem, the state’s largest health insurer, said the American Medical Association published significant changes and updates to the procedure codes associated with behavioral health services, which took effect Jan. 1.

These code changes do not set behavioral health provider reimbursement,” Anthem spokeswoman Sarah Yeager said in a prepared statement. “In compliance with federal law, Anthem implemented the code changes and adopted new fees to match to the new codes. Anthem sought to preserve the level of payment that behavioral health providers were receiving before the code changes.”

Anthem was criticized Thursday by three doctor groups — the Connecticut Psychiatric Society, the American Psychiatric Association and the Connecticut State Medical Society — which claim Anthem responded to the annual change in medical-billing codes by covering only visits for an evaluation or management of medical issues, and not psychotherapy as a separate equal category when provided during the same visit.

The most recent version of “current procedural terminology,” or CPT, medical-billing codes take effect Jan. 1 each year, and psychotherapy has been isolated as a separate service in the past, but with different codes.

“These practices are both unethical and illegal,” the American Psychiatric Association’s chief executive Dr. James H. Scully, Jr., said in a prepared statement. “We worked very hard to enact mental health parity laws, and it is now clear that Anthem is seeking a way to avoid compliance. We are not prepared to allow them to skirt their obligations under the law.”

Anthem’s spokeswoman, Yeager, said, “We believe that our provider reimbursement rates for behavioral health services are appropriate, in compliance with applicable laws, and allow our members to continue to have access to mental health services which we recognize are critical to overall health. All applicable behavioral health services, including psychotherapy services, continue to be covered in accordance with our members’ benefit plans.”

Factors To Think About the Next Time You Are Purchasing Insurance

In terms of deciding whether to change personal-lines insurers and which new carrier to choose, price remains the primary —but not the only— factor considered by auto and homeowners’ consumers.

Indeed, when asked about their decision points when placing auto insurance for the Deloitte Research "Voice of the Personal Lines Insurance Consumer" surveys, more than two-thirds of the 1,080 respondents said price was either extremely (54 percent) or very (28 percent) influential the last time they changed carriers. The numbers were similar among the 1,080 homeowners surveyed, although a lower share (45 percent) cited cost as extremely influential, along with 30 percent who said the price was very influential.

Interestingly, among the four age segments surveyed, those 26-34 recorded the largest percentage (71 percent) of those ranking the price of auto coverage as extremely influential but also the lowest percentage (31 percent) among homeowner respondents ranking price as important. This could perhaps be explained by the fact that having the right coverage for a home —most likely a young consumer’s biggest investment— is simply a more important consideration than price.

Another intriguing point is that while respondents cited price in retrospect as the most influential factor in their decision to change personal-lines carriers, when asked prospectively what would influence them, price did not rank nearly as high. Among auto respondents, 58 percent said price would be either extremely (27 percent) or very (31 percent) influential when they next shop for a new policy, compared to about one-third each among homeowners.

Many consumers surveyed indicated they would respond favorably to multipolicy-discount offers. Looking back, four in 10 auto respondents cited the availability of an auto/homeowners’ insurance multipolicy discount as extremely (17 percent) or very (21 percent) influential in their last decision to change carriers. Among homeowners surveyed, the influence of multipolicy discounts was even stronger, with 58 percent citing this factor as extremely (28 percent) or very (30 percent) influential the last time they changed carriers.

Many auto respondents noted that the availability of telematics —technology to monitor driving experience in return for a potential break on the price of coverage— might prompt them to change carriers. Indeed, 3 in 10 said getting a discount for installing such a device would be extremely (12 percent) or very (17 percent) influential in their next purchase decision.

However, about 30 percent said they would not agree to install such a device, while another 30 percent said they would. But about 40 percent said their answer would depend on the premium discount being offered. Nearly half of those on the fence said they would expect more than a 20 percent discount to make such electronic monitoring worth their while, while another 22 percent would want a price break of 16-20 percent. About 1 in 5 would install the device for a potential discount of 11-15 percent. Only 1 in 10 would go along for a 6-10 percent discount, and only a handful (2 percent) would agree for less than 6 percent in savings. Age is a factor here as well, with the two older segments surveyed more likely to agree to have a monitoring device installed, while younger respondents were more leery of the idea.

The amount and type of coverage offered was the second most important decision point among respondents the last time they changed carriers, but not nearly as strong a consideration as price, with only 31 percent of auto respondents citing coverage as extremely influential (compared to 54 percent on price). The same pattern held for homeowners (24 percent on coverage versus 45 percent on price).

Reputation and trust were also key factors. Three out of four auto respondents said brand name, reputation for financial strength and the insurer’s rating were important, including 1 in 5 who considered these elements extremely influential when they last changed carriers. The numbers were similar for homeowners.

Brand-name recognition was a very important decision point among both auto and homeowner respondents. About 3 in 4 bought through an exclusive agent because they represented a widely known insurer, two-thirds bought direct because they prefer to do business with a widely known insurer, and about half would be more willing to buy direct if the insurer had a widely known brand.

The importance of brand recognition and perceptions of integrity spotlight the need for more proactive reputational risk-management efforts by insurers in general and the industry as a whole.

One particular area impacting brand reputation is claim service, which was a significant decision point among both samples queried, with about 1 in 3 respondents indicating that poor claims handling was extremely or very influential in their last decision to change carriers.

In terms of which individuals influence personal-lines buyers in their purchase decisions, respondents indicated they were swayed more by recommendations from family, friends and colleagues than from an agent. However, once again age plays a big part, as younger buyers indicated they were much more heavily influenced by their family and acquaintances.

A significant percentage (41 percent) indicated that an affiliation between their bank and their auto insurer would be extremely (18 percent) or very (23 percent) influential in their decision whether to buy coverage. The numbers were similar among homeowner respondents. However, an affiliation with the respondent’s employer did not score nearly as high.

There was a split when it came to the influence of an endorsement from a group or association to which the respondent belongs. This was cited as a major factor among auto-insurance buyers, with half of the respondents notin g t his as either extremely (17 percent) or very (33 percent) influential. Among homeowners, however, this factor was cited by fewer than half that number—20 percent overall, and only by 8 percent as extremely influential.

About 1 in 4 among both samples said a recommendation from their auto dealer or real estate agent would be influential in their insurance-purchase decision, including about 1 in 10 who said these referrals would be extremely influential.

Interestingly, while about 1 in 5 said advertising was either extremely (9 percent) or very (14 percent) influential in deciding where to buy auto insurance, more than half said ads were not very influential (17 percent) or not at all influential (35 percent). The numbers were similar among homeowner respondents.

When asked what would be their three most preferred ways to shop for a new auto policy, "checking a website offering quotes from multiple carriers" scored the biggest response, cited by 41 percent of those surveyed, including 15 percent who said this would be their most preferred channel (respondents could choose multiple options, in order of preference). Next came an independent agent representing multiple insurers at 36 percent (also including 15 percent as most preferred), followed by agents selling exclusively for one carrier at 31 percent (although this option drew the largest percentage of the top preferred choice at 17 percent).

Among homeowner respondents, about 40 percent chose either independent or exclusive agents among their Top 3, with 1 in 5 citing either one as their first choice. Checking a website offering quotes from multiple carriers made the Top 3 among 1 in 3 respondents but was cited as the first choice by only 13 percent.

These responses indicate that while price is a critical element for personal-lines buyers, there are other factors they consider when choosing a carrier, offering insurers a variety of decision points they can leverage to differentiate themselves and thereby retain more customers and boost new business.

How to Catch Texting Drivers?

Connecticut and Massachusetts Get $550K Grant to Find Ways:

The National Highway Traffic Safety Administration (NHTSA), part of the U.S. Transportation Department, said this month it is providing $550,000 to Connecticut and Massachusetts to help them devise anti-texting enforcement techniques and programs.

Each state will receive $275,000 to develop and train police officers on better methods for spotting drivers who are texting, and also to develop media techniques that alert the public to the perils of texting and driving.

“We have come a long way in our fight against distracted driving, but there is still much work to be done,” said U.S. Transportation Secretary Ray LaHood. “Texting behind the wheel is especially dangerous, which is why we’re working with states like Connecticut and Massachusetts to address this important safety issue.”

Authorities say that 39 states currently have laws on the books that specifically ban texting and 10 states have laws that prohibit the use of handheld cell phones while driving.

Not Easy to Detect Texting Behind the Wheel

But despite such laws, prior demonstration programs conducted in Hartford, Conn., and Syracuse, N.Y., found that it is more challenging to detect a driver texting behind the wheel compared to drivers talking on a handheld device.

The vast majority of tickets issued under those programs were for handheld phone use — only about five percent of the citations issued across both communities were for texting violations, according to officials.

“While it is relatively easier for law enforcement to determine illegal handheld cell phone use by observing the position of the phone at the driver’s ear, the dangerous practice of texting while driving is often not as obvious,” said NHTSA Administrator David Strickland.

“These two new demonstration programs will help identify real-world protocols and practices to better detect if a person is texting while driving.”

Watching From Overpasses

The demonstration grants call for Connecticut and Massachusetts to develop anti-texting enforcement protocols and techniques — such as using stationary patrols, spotters on overpasses on elevated roadways and roving patrols — to test their effectiveness in four successive waves of high-visibility enforcement activities over a 24-month period.

The results of these demonstrations will be documented for the benefit of other states which are facing the same challenges.

Own a gun? Time to buy violence liability insurance, California Democrats say:

Democratic lawmakers proposed legislation Tuesday that would require California gun owners to buy liability insurance to cover damages or injuries caused by their weapons.

Similar bills have been introduced in other states after the Newtown, Conn., school massacre. They include Connecticut, Maryland, Massachusetts, Pennsylvania and New York.

I was moved, like many others, being the father of two young children, by the Sandy Hook incident and looking for constructive ways to manage gun violence here in California as well as the rest of the country," said Assemblyman Philip Ting of San Francisco, who introduced AB231 along with Assemblyman Jimmy Gomez of Los Angeles. "There's basically a cost that is born by the taxpayers when accidents occur. ... I don't think that taxpayers should be footing those bills."

Ting equated the idea to requiring vehicle owners to buy auto insurance. Gomez said it would encourage gun owners to take firearms safety classes and keep their guns locked up to get lower insurance rates.

No state has enacted the requirement despite repeated previous attempts, said Jon Griffin, a policy analyst with the National Conference of State Legislatures.

Bills have been offered unsuccessfully in Massachusetts and New York since at least 2003, when the conference began keeping track, he said. Similar bills were proposed in Illinois in 2009 and in Pennsylvania last year. Lawmakers are introducing the bills this year in even more states after the recent shootings.

Some proposals would require buyers to show proof of insurance before they could purchase a weapon. The proposal in California would apply to anyone owning a weapon, Ting said, though the bill's details are still being worked out.

Sam Paredes, executive director of Gun Owners of California, said most gun owners already act responsibly and can be sued for damages if they don't.

He said the proposal is part of an ongoing attempt to "price gun owners out of existence," particularly the law-abiding poor who live in crime-ridden areas and need protection the most. Criminals would ignore the law, he said.

Moreover, he questioned whether it is constitutional to require someone to buy insurance to exercise a constitutional right.

"If they don't address it in committee, I'll guarantee they'll have to address it in court," Paredes said.

Ting said he and Gomez plan to work with gun owners and opponents to craft a constitutional bill. It will not require insurance companies to offer gun insurance, but will encourage them to enter the market.

He noted that the National Rifle Association itself already offers its members the chance to buy liability insurance, despite its opposition to requiring gun owners to buy such policies.

Ting also introduced AB232, which would give a state income-tax credit of up to $1,000 to anyone who turns in a firearm to a local gun buyback program. The amount of the credit would be determined based on the value of the weapon.