The Register Citizen (Torrington, CT)
Insurers balk at health reform
Low-cost insulin, telehealth at issue
Members of the Insurance and Real Estate Committee heard hours of testimony on two bills that would provide low-income state residents access to critical medical care including low-cost insulin and continued telehealth visits until June of 2021.
One in four Americans is rationing insulin — a dangerous practice that could lead to death — and the coronavirus pandemic has changed the way healthcare is delivered through audio telemedicine that can reach the poor who don’t have access to much technology, state Sen. Matthew Lesser, D-Middletown, said at a public hearing Tuesday.
But industry representatives from the state’s six largest healthcare insurers are bucking both pieces of legislation, saying the bills need further review and could create “unintended consequences.”
The Connecticut Association of Health Plans, which represents Aetna, Anthem, Cigna, ConnectiCare, Harvard Pilgrim and United Healthcare, opposes significant portions of the insulin bill on the grounds that “capping copays, unfortunately doesn’t do anything to address the actual cost of the drugs and the supplies.”
“At the end of the day, we are al
ways trying to make healthcare more affordable,” said Susan Halpin, executive director of the association.
Advocates appealed to legislators for the insulin price caps with heartfelt stories of their experiences.
Kristen Whitney-Daniels was spending her entire income — $2,400 a month—on insulin until she was able to access a government program through a community health center. She now pays $14 a month. But Whitney-Daniels, the chapter director for #Insulin4all understands that there are scores of state residents who don’t qualify and who need help receiving the life-saving diabetes medication.
Whitney-Daniels testified seeking adjustments to LCO 3601, which would cap insulin costs at $25 a month for state-regulated insurance plans including Medicaid. At community health centers, it would cap the cost of insulin supplies and allow patients to receive an emergency 30-day supply of insulin without a prescription. The bill would save lives, she said. But it doesn’t go far enough to protect enough people.
“The cap only applies to 28 percent of residents,” she said. “There are 5.4 million Americas without health insurance right now.”
But it’s a start, said Danny Houdeshell, whose son, Kevin, died in early 2014. Kevin Houdeshell was well liked and respected by his co-workers at T.G.I Fridays in Ohio. To this day, his parents hear stories about their son’s kindness, he said.
Kevin Houdeshell ran out of insulin during the New Year holiday in 2014. His doctor was unavailable to write a prescription that would have allowed the 36year-old to easily get his medication. Kevin thought he had the flu, his father told the committee by video as he was sitting in his car. What was actually happening was that his organs were shutting down due to the lack of insulin, Danny Houdeshell said.
“No person should die because he could not get a refill because his doctor was unavailable,” Danny Houdeshell said.
Connecticut would be the 20th state to pass some form of “Kevin’s Law,” named after Kevin Houdeshell, which allows a pharmacist to dispense an emergency supply of insulin without a current prescription, said Committee Co-chair Sean Scanlon, D-Guilford.
“Your son’s loss is not being forgotten in any way,” Scanlon said. “All of us are proud to have you speak today.”
The committee had begun work on the insulin bill before the coronavirus pandemic shut down the legislature. Lawmakers agreed to take up the bill and the telehealth bill during a special legislative session slated to start Thursday.
Halpin, at the health insurers’ association, agreed there is a cost crisis. But, the association believes the focus should be on the underlying actual drug price charged not on the copays which, if capped, she said will only exacerbate the situation by removing any leverage health plans have to negotiate lower prices with the drug manufacturers.
The association also opposes the bill that would extend telehealth services to be reimbursed the same as in-person visits until June 30, 2021. Gov. Ned Lamont expanded telehealth services by executive order early in the pandemic.
Halpin noted that health insurance carriers have voluntarily extended provider payment parity since the inception of the pandemic, but that they disagree with the wisdom of codifying the provision in statute. While agreeing that telehealth is a critical service, she suggested that more data is needed to determine whether paying parity for telehealth adds value or has the unintended consequence of raising premiums.
The bill would expand the types of medical services that patients can utilize and allow healthcare providers to receive the same fee for service for telehealth as in-person office visits beyond the executive order, which expires in September.
Telehealth during the pandemic has been key for underserved populations, said Mark Masselli, founder and CEO of Middletownbased
Community Health Center, which provides low-cost health services to 130,000 residents statewide at numerous locations.
“We should not let poverty be a barrier for patients,” Masselli said.
Low-income residents who do not have access to technology such as smartphones or tablets have been able to access treatment through telephone calls, he said. States on the west coast have successfully used telehealth for years while in the Northeast, the service is in its infancy, Masselli said.
“We can’t lose this major innovation now, it would be disastrous,” Masselli said.
“Anecdotally there are positives and negatives,” Halpin said.
Sen. Saud Anwar, D-South Windsor, a physician who has provided healthcare to coronavirus patients, questioned the association’s response to the telehealth legislation.
“One way to delay something is to say we need more data,” Anwar said. “The other way is to say there are unintended consequences.”