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Health care advocate previews upcoming insurance changes

Health care advocate Victoria Veltri

Health care advocate Victoria Veltri

Anyone wondering about the cost of health care in Connecticut might consider the following:

  • Twelve cents of every dollar in Connecticut is spent on health care.
  • One of every eight people employed in Connecticut is employed in the health care industry.
  • Private insurance covers 2.4 million in the state, but there are more than 344,500 uninsured and they live primarily in New Haven, Hartford and Fairfield counties.
  • From 2000 to 2009, the costs of family premiums in Connecticut rose 96% while whole family incomes rose only 13%.
  • Connecticut has the fourth highest level of health care expenditures in the nation at $8,654 per capita, behind the District of Columbia, Massachusetts and Alaska.
  • The state has the highest level of Medicaid costs at $9,577 per enrollee.

These are just some of the statistics offered by Victoria Veltri as an overview of the impact health care costs have on the lives of Connecticut residents when she addressed the neighboring Wilton League of Women Voters at its annual meeting last month.

Ms. Veltri is the state health care advocate. She explained what her office does and how the Affordable Healthcare Act will affect people here.

The 12-year-old office “helps people navigate the system and helps people denied by insurance,” she said. “We educate consumers on their health care rights and assist with denials and appeals.”

The office also works to reduce waste, acts as an industry watchdog, and presents data to the legislature and tries to make changes, she added.

“We try to make it our mission to benefit everyone in this state,” she said. “If the state overall is going to be healthy … the residents have to be healthy.”

Right now, she said, insurance companies can still deny policies to people with pre-existing conditions such as high blood pressure, high cholesterol, or who have made even one visit to a mental health professional. In some cases, she said, “they may give you a policy but not cover the condition.”

That will not be the case beginning in 2014, under the Affordable Care Act, she said. In addition, policy caps will be lifted and deductibles will be limited to $2,000 per year for individuals and $4,000 per year for family plans.

Also by 2014, everyone must purchase health insurance or face a $695 annual fine. There are some exceptions for low-income people, she said.

Exchanges

The Affordable Care Act, also known as Obamacare, will usher in insurance exchanges. Connecticut is one of only 14 states planning to offer an exchange — Access Health CT — which is an online marketplace where consumers may shop for insurance policies. Ms. Veltri likened the exchange to travel websites such as Expedia or Travelocity that consolidate information and prices into one place. There, consumers may compare policies offered by companies such as Aetna, Anthem, ConnectiCare and others.

Individuals or families who do not have insurance through an employer and who meet income limits may receive federal assistance in purchasing a plan.

For example, a family of four earning up to $92,000 a year would qualify for help in purchasing a policy.

Plans on the exchange must meet minimum requirements of offering essential health services, as well as behavioral health services.

The Office of the Health Advocate will monitor networks to make sure providers will take in the influx of new patients, Ms. Veltri said. It will also partner with the exchange to help enroll people in their community.

“There will be 300 or more assisters to help people sign up,” Ms. Veltri said. Participants may also sign up online.

Individuals covered by an employer plan or their own private plan that meets the minimum threshold of coverage will experience no change, she said. Those plans will be grandfathered into the program and they will be exempt from some of the new regulations like deductible limits.

Medicaid

In 2014, the income level for those eligible for Medicaid will rise to $1,200 per month and the federal government will pay 100% of costs for all new Medicaid enrollees. The federal government will continue to pay 100% for three years and Connecticut will have to pay 10% beginning in 2017.

During the question-and-answer period, Ms. Veltri was asked if Connecticut is one of only 14 states offering an exchange on its own — some states are partnering with the federal government and some are not participating — what does that mean about the plan nationally?

“The bad news is, 14 states are on their own,” she said. “The good news is, 14 states are on their own. We’re getting a ton of attention and getting what we need to succeed. We need to succeed,” she said.

“We are in a very good position to get people enrolled. What will take longer is driving down prices,” she continued. “If 14 of us can make it, that’s a big win.”

For information on the Office of Health Advocate, visit ct.gov/oha.

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