Debra Dauphinais, owner of Bicycles East, a bicycle shop in Glastonbury, said she hasn’t been able to find a health insurance plan that she can afford for her four employees.
She said she’s tried both private plans and plans on AccessHealthCT, the state insurance exchange. She’s switched between plans. Nothing is affordable.
“People are paying, or have paid up to $10,000 a year in premiums and still have a $6,500 a year deductible,” said Dauphinais. “So after people pay their premiums, they don’t actually obtain healthcare because they don’t have the money left to do that.”
Dauphinais said that her employees tell her that they don’t go to the doctor because they can’t afford it. And that extends to her as well. Dauphinais said that despite her and her husband together paying over $18,000 in premiums, she still had a $1,300 deductible. Knowing the cost of going to the doctor, she lived with leg pain for eight months rather than get an appointment.
“Basically, we paid $18,000 for no healthcare,” said Dauphinais.
Dauphinais was part of a group standing outside the legislative office building in Hartford this morning in protest of proposed rate increases from the state’s largest insurers.
Anthem is requesting a 10 percent rate increase for individuals and 15 percent increase for small businesses. Together, the company covers about 61,500 people across the state.
Connecticare, which covers about 78,000 people both on and off the exchange, is asking for rate increases of between 12.7 percent and 17.5 percent. Cigna, which covers about 20,600 people, is asking for a 23 percent rate increase.
During a hearing in Hartford on Monday, Mark Meador, the president of ConnectiCare, said that the cost of hospital care and prescription drugs was a major factor in their request. The state has tried to cap hospital cost increases at three percent this year, but Meador said that in contract negotiations with hospitals, some of the hospital systems were asking for three times that amount.
“Some hospital systems are getting larger and larger, buying up other hospitals and physician practice. The hospital system consolidation in our state has made it more difficult for us to negotiate reimbursement rates on behalf of our members and our customers,” said Meador.
Director of the Office of Healthcare Strategy Dierdre Gifford noted that the amount of money that insurers paid the different hospitals in Connecticut varied widely — the lowest-paid hospital in Connecticut receives 170 percent what Medicaid pays, and the highest-paid hospital receives 310 percent what Medicaid pays.
She also said that the location of the hospitals or the quality ratings the hospital received did not seem to have any relationship to how much the insurers paid each hospital.
The Connecticut Hospital Association said in a statement that they had continued to offer accessible care despite the challenges of inflation, workforce shortages, sicker patients and underpayments from Medicare and Medicaid.
“As the governor says, it will take everyone working together to slow the rate of healthcare cost growth and we welcome other industry colleagues, including in the health insurance industry, to join in that work. Addressing the rise in commercial health insurance cost growth also requires state partners to address the significant underpayment by Medicaid for healthcare services, which puts significant pressure on commercial health insurance costs,” the association told lawmakers.
Brandon Rousseau, sales director for Anthem, said that the rate increases were connected to an ongoing increase in people seeking healthcare after the COVID pandemic, particularly for services like joint replacements and colonoscopies. He also said there was an increase in the number of people needing treatment at substance-abuse clinics and going into therapy.
Insurers also pointed to the increased cost of prescription drugs, a combination of increased use of these drugs and rising costs. Zachary Moon, actuarial director for Cigna, pointed to the high cost and risk of drugs like Ozempic and Rybelsis, which cost nearly $1,000 for a one-month supply. These drugs are designed to treat diabetes, but have been used off-label for weight loss.
According to data presented by the Office of Healthcare Strategy, healthcare premiums cost families an average of about $24,000 in 2021. By comparison, the cost of childcare was $16,000.
Data showed that Connecticut has the 5th highest healthcare costs in the country, and that between 2020 and 2021, Connecticut’s commercial healthcare costs increased nearly 19 percent, despite the state’s goal to cap increases at 3.4 percent. In comparison, Rhode Island’s healthcare costs increased 9.7 percent over the same period.
Rousseau urged for a move to “value-based care” where hospital systems or doctors are paid based on the quality of medical care that they provide.
Healthcare Advocate Ted Doolittle said that he believed the hospital systems should be required to answer for the reason that costs have gone up so much. But he said the insurers needed to take responsibility for other parts of the increases.
Attorney General William Tong called the rate increases a “self-fulfilling prophecy” where the insurers set the premiums and hospitals adjusted their costs to meet the amount that the insurers would pay.
And legislators decried what they said were “excessive” and “unsustainable” increases and the lack of a clear formula to how insurers arrived at those numbers.
State Sen. Tony Hwang, R-Fairfield, said that he wished there was a way to look at the entirety of the companies’ finances, noting that high-level executives were highly compensated.
“I simply wish that we had … more of an opportunity to delve into your business operations as a whole,” said Hwang.
State Sen. Jorge Cabrera, D-Hamden, said during a press conference that he was thinking about bills that the legislature could bring up next year to better regulate health insurance rates.
“I’m no health expert, but — my God,” said Cabrera. “I was just dumbfounded by the incredible lack of forthcomingness and transparency.”
The Department of Insurance will make their final determination on the rates for 2024 in September.