Doug Maine CTLatinoNews.com
Between 7,000 and 10,000 low-income parents, and many of their children, are likely to become uninsured as a result of Gov. Dannel P. Malloy’s proposal — part of the 2016-17 state budget – to eliminate HUSKY A (Medicaid) eligibility from the parents of children enrolled in HUSKY A, and pregnant women, with incomes above 138 percent of the federal poverty level.
Those are among the conclusions of a policy analysis commissioned by the Connecticut Health Foundation (CT Health) and conducted by the University of Massachusetts Medical School Center for Health Law and Economics.
The engine driving these, and other proposed cuts to Connecticut’s health and social safety-nets is the state’s current-year deficit, which stands at $191 million, according to a recent estimate by the nonpartisan Office of Fiscal Analysis, which was reported by CTMirror.org on March 25.
Under the governor’s proposal, affected HUSKY parents with incomes between 138 and 201 percent of the FPL, and pregnant women earning between 138 and 263 of the FPL, would be instead be eligible to purchase federally subsidized private insurance through the state’s health insurance marketplace, Access Health CT.
Even with the subsidy, the CT Health report said that annual costs for low-income parents would increase by an average of $1,900 per year, leading at least 20-30 percent of the 34,000 working parents who lose HUSKY benefits to go without insurance.
According to report co-author Rachel Gershon, an associate with the Center for Health Law and Economics at the University of Massachusetts Medical School, “we expect there to be more people who are uninsured, who have uncompensated care at hospitals and delayed care,” if the proposed changes are adopted. “And because of the delayed care, we expect to see a less healthy population among those folks who are cut,” she said.
The report notes that, “subsidized coverage through Access Health CT offers much thinner mental health and substance abuse benefits. Dental coverage would have to be purchased through an additional stand-alone plan.”
For pregnant women, reduced access and higher expenses for care could lead to delaying prenatal care, with life-long health effects for their children and higher health care costs down the road, the CT Health report said. Also, an uninsured woman who learns she is pregnant would have to wait until the open enrollment period before she could obtain insurance coverage through Access Health CT.
Even some parents who do purchase insurance will likely delay needed care due to the out-of-pocket costs, such as copays and deductibles, that are part of the Access Health CT plans.
Not only would many parents become uninsured, but recent history in other states suggests that many of their children would end up uninsured as well, even though they may still be eligible for the HUSKY or CHIP programs, in which minors up to to age 18 qualify up to a higher FPL level.
That’s what happened in Maine after the income-eligibility standard for its Medicaid program was reduced in 2013; in the seven months after the change took effect, there was a 13 percent decline in the number of children enrolled in the state’s program, according to the CT Health report.
The report also cites a 2006 study by the Center on Budget and Policy Priorities, which found that parental coverage in public insurance programs was associated with children’s greater participation in public programs, less uninterrupted coverage of children and better access to care. “Researchers suggest that parents may not be aware that their children are eligible, or may be thwarted by complicated enrollment and redetermination procedures. There is greater convenience and greater incentive for parents to enroll their children and keep them enrolled if a single visit or a single form leads to coverage for the entire family,” CT Health said.
“A step in the wrong direction”
Health advocates for low-income families, including Jane McNichol, executive director of the Legal Assistance Resource Center of Connecticut, are disappointed that the state could be undoing its recent gains extending coverage to low-income families. “We have been doing a good job increasing coverage in taking advantage of the Affordable Care Act. This is a step in the wrong direction, and that’s a mistake,” she said.
“Connecticut has really made a lot of positive changes over the last decade or more to increase access to healthcare.” Sharon Langer, advocacy director for Connecticut Voices for Children, said. “This would be a step backward.”
Many of the improvements have come through the expansion of the HUSKY healthcare program. An important step was aligning children’s coverage to that of their parents in 2007, she said.
The governor’s budget proposes “widespread and deep cuts,” to programs that target children and the needy, Langer said. “A third of the budget goes, arguably, to children, but half of the (proposed) cuts are from children.”
“The legislature has a very difficult job to do, but we feel very strongly that they need to look at both sides of the ledger, to look at those programs, that it’s unfair to balance the budget on the backs of kids,” Langer said. Legislators wouldn’t even consider such cuts if the state weren’t in such dire financial straits, she said.
McNichol said she is concerned about other proposals, such one to cut Medicaid provider rates. Any cut is likely to result in fewer doctors and other providers treating lower-income patients, she said.
Asked whether members of the General Assembly are paying much attention to these issues, McNichol said, “our sense is that legislators understand the implications of this and are concerned,” but the size of the deficit and their obligation to produce a balanced budget are formidable obstacles.
Holding out hope, McNichol said, “I do think politicians like to be associated with good government, and sometimes that means you need more revenue.”
Cutting deficit vs. human impact
State Senator Terry Gerratana (D-New Britain), who co-chairs the General Assembly’s Public Health Committee and sits on the Appropriations Committee, said legislators have seen estimates from the governor’s budget office that moving people from HUSKY A into Access Health CT would save the state about $44.6 million in the 2016 fiscal year and $82 million in 2017.
“As legislators, we certainly have to look at the people we’re talking about,” Gerratana said. A single adult whose earnings are at about 138 percent of the FPL, or $16,000, could have to pay a premium of as much as $600 through Access Health CT. Those with incomes between 151 and 200 percent of the FPL could see their premium go up to as much as $1,800, which would have to be paid out-of-pocket before the federal subsidy would kick in, she said.
“For the real people that are involved, that (premium payment) would be very onerous for them,” Gerratana said, adding that she is concerned about those affected losing access to healthcare. “This is a lot of money; this is certainly a disincentive to getting healthcare.”
The plans available through Access Health CT have different ratings, or levels, and are not as comprehensive as the coverage under the HUSKY program, she said. “It would really shift the burden onto individuals, and it’s very concerning that individuals would not be able to pay.”
These and other budget items will continue to be discussed, probably until late in the legislative session, and possibly beyond, Gerratana said. “It’s a very tough year, and we have to carefully look at the policy that goes behind the money.”
“Even with these cuts, we’re over our spending cap by $50 million,” Gerratana said. “This isn’t an easy year, but this isn’t good policy.”
The Connecticut Health Foundation’s full report, “How Proposed HUSKY Cuts will Harm Low-Income Families,” can be found at cthealth.org.