Mike Smith considers himself lucky. When, at 21, he discovered a golf ball-sized tumor on his neck, he had health coverage and a support system to back him up.
“I was lucky because it was only stage 2A when I was diagnosed,” said Smith, now 35. “I was lucky that my mom had a job that offered good quality health insurance. Otherwise, I’d still be crawling on the nearly millions of dollars in medical care needed to keep me alive. But we must not leave the health and financial fate of our family, friends and neighbors to chance.
Smith called on state insurance department officials to reject the 20.4% average increase that insurance companies are seeking for 2023 individual health plans in Connecticut.
“The rates for health insurance have increased. But unlike a pickup truck or an SUV, you can’t reduce your health care costs and save gas,” he said. “When health insurance costs become too high, you deprive yourself of it. We can, we must and we must do better.
“If we ask the hard questions, we can fix this system so that survival that results in a difficult medical diagnosis, both physically and financially, doesn’t rely solely on luck.”
Smith was one of dozens of residents and elected and appointed officials who addressed the Department of Insurance on Monday, asking its leaders to reject a request from insurance companies to raise health policy rates for the next year.
In addition to the substantial average increase in individual plans, insurers selling policies on and off Connecticut’s Affordable Care Act Exchange are seeking an average increase of 14.8% on small group plans.
Requests are significantly higher than what insurers were looking for last year for 2022 health policies. In 2021, carriers requested an average increase of 8.6% on individual plans and 12.9% on small group shots.
“I’ve treated tens of thousands of ER patients…which hopefully means I’ve improved the health of tens of thousands of people. I know I probably saved the lives of hundreds of people. And unfortunately, by doing this, I also ruined the financial health of hundreds or thousands of people,” Phil Brewer, an emergency physician who has been practicing for 40 years, testified on Monday. “I have said several times that I love what I do. But unfortunately, because of what I do, many of my patients end up going bankrupt. I have strong opposition to these rate hikes.
Three insurers sell fonts Connecticut Affordable Care Act Exchange: Anthem Health Plans, CTCare Benefits Inc., and ConnectiCare Insurance Company Inc.
Anthem requested an average increase of 8.6% for individual policies that cover 27,698 people. The proposed changes range from a decrease of 1.8% to an increase of 16.1%, depending on the plan.
The company also sought an average upside of 3.6% on small group policies that cover 19,271 residents. Suggested changes range from a decrease of 1.2% to an increase of 26.3%.
CTCare Benefits requested an average increase of 24.1% on individual plans which cover 75,003 people. The proposed changes range from an increase of 18.7% to 33.2%, depending on the policy.
He also looked for an average increase of 22.9% on small group plans that cover 3,476 residents (increases range from 20% to 28.9%).
ConnectiCare Insurance, which only sells individual policies on the exchange, asked for an average increase of 25.2% for plans covering 8,782 people. The suggested increases range from 17.1% to 32.2%.
Several other companies, including Cigna and Aetna, sell plans over-the-counter.
Representatives from only two insurers – ConnectiCare and Cigna – attended and spoke at the public hearing monday at the Palace of the Legislative Assembly. An insurance department spokesman said only those two companies were invited because they had the highest rate demands of any carrier. Cigna is targeting an average increase of 19.6% for its off-exchange small group plans. ConnectiCare Insurance asked for an average hike of 29.3% on its over-the-counter small group policies.
Sarah Souza, director of small group actuarial for Cigna, said even with the proposed increases for the 2023 plans, the company’s premiums would be lower than the market average.
“For Silver plans, which are the most popular among small employers, we have the lowest plan in six of the eight rating zones representing the vast majority of small employer locations,” she said. .
“The percentage increases are all relative to the base figure. As such, while we may have among the highest proposed increases, we continue to have among the lowest actual premium charges when all is said and done,” added Wendy Sherry, Vice President Cigna’s U.S. commercial markets.
ConnectiCare attributed its proposed increases to rising medical and pharmaceutical costs, as well as delayed care due to the pandemic.
Karen Moran, president of ConnectiCare, said Monday that the company suffered more than $65 million in losses in the individual market over the past year because rate increases failed to keep up with increased use of medical services and the cost of prescription drugs, among other expenses.
“For an insurance program to be viable, rates must be sufficient to cover the payment of claims and the administrative costs of running the program. Over the past year, the total insurance premiums we have received are far less than the cost of care we have actually funded,” she said. “Previously approved premiums by the insurance department were significantly lower than what we needed to meet members’ needs. … The most important driver of our tariff increase proposal is to restore tariffs to an adequate level.
“[Another] a significant factor in the required premium is the medical trend, which is the increased cost of reimbursement for health care providers,” Moran said. “Utilization of medical and pharmaceutical services exceeds pre-pandemic levels in 2022 and is expected to continue largely due to the needs of the people we serve.
“In short, we haven’t asked for more than we absolutely need to stay on the exchange.”
But residents and elected officials said many will not be able to afford coverage if the proposed rate increases take effect.
“I recently heard from a senior who explained that she was making the choice to go without food, health care, or prescriptions,” said Rep. Robin Comey, D-Branford. “I know these hikes will make insurance even more out of reach for so many people – young adults, seniors and young families.
“Many people I have spoken to plan to postpone their care at the expense of their long-term health and well-being. … Our goal as a state should be to insure as many people as possible, regardless of age, zip code, or racial and ethnic disparity.
Representative Holly Cheeseman, R-East Lyme, recounted her own ordeal buying insurance.
“If it was six years ago, I would be sitting here as a member of the public when my husband died and my son and I had to take out individual policies. … I remember having a dog bite and deciding that it was better to put butterfly strips on it than to go to the emergency room because I would have paid all that,” she said. . “So I think we need to remember the price our residents are paying, their families are paying, and small businesses are paying.”
Attorney General William Tong asked insurance company representatives whether they conduct an analysis of whether customers can pay their premiums before asking for a raise.
“From an actuarial perspective, that’s not a consideration when we set rates,” responded Neil Kelsey, ConnectiCare’s vice president and chief actuary. “Our rates cannot be excessive, [they must be] non-discriminatory and must be adequate. These are the three stipulations or thresholds to which the actuarial analysis must conform.
Moran added that “it’s the competitive market that really helps determine if our rates are affordable.”
Tong said Connecticut families are “suffering”.
“They’re pressed all over the place,” he said. “Prices for gasoline, heating oil, natural gas and electricity are still on the rise. We paid 13% more for groceries last month than a year ago. …Rent, housing, all the way up. And so it’s clear that Connecticut residents — individual market individuals, small groups, small businesses — can’t afford increases as high as 20.4% on average.
Actuaries in the insurance department are currently reviewing the requested increases. They will look at trends in unit cost (total expenses incurred by the business), service usage, and expected severity of claims in the process.
After review, the department may approve the entire requested increase, reject it, or change it to a different number. Final changes are expected to be released in late August or early September.
Open registration for Health Policies 2023 begins November 1.