chestervillageCHESTER: Chester Village West set on 55 acres with 105 cottages and apartments was purchased by Masonicare, based in Wallingford, the state’s largest not-for-profit provider of senior healthcare and retirement living from LifeCare Services of Des Moines, Iowa.

“The addition of Chester Village to our organization is a win-win for all,” said Jon-Paul Venoit, President/CEO of Masonicare. “We have extensive experience in the retirement living arena and our cultures are very similar. We are retaining nearly all of their employees, and we expect to invest in some capital improvements on the campus as well.”

Sales terms were not disclosed.

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Washington – As Congress is about to vote on a tax overhaul that will gut the Affordable Care Act’s mandate that most Americans have health insurance, a number of states, including Connecticut, may consider a state-based penalty to encourage people to obtain coverage.

Nearly 60,000 individuals and families in Connecticut paid a federal tax penalty last year because they did not have health insurance coverage in 2015, a penalty imposed by the ACA’s “individual mandate.”

Most of those paying that penalty in Connecticut — about 50,000 tax filers —  reported incomes to the Internal Revenue Service of between $10,000 and $50,000.

The final tax bill that will be voted on this week in Congress would eliminate that mandate in 2019. The result, the Congressional Budget Office said, is the number of uninsured Americans would grow by 4 million people that year and by 13 million by 2027. The CBO also estimates there would be an immediate increase of about 10 percent in premiums because the risk pool that remains would be older and sicker.

“Congressional Republicans made a terrible policy decision in eliminating the healthcare mandate,” said Lt. Gov. Nancy Wyman,  who heads the state healthcare cabinet.

Wyman said elimination of the penalty will “cause healthcare costs to rise for everyone.”

“Connecticut’s bipartisan working group is examining the impact of federal action on our healthcare landscape and considering all options to ensure healthcare is affordable and accessible for residents,” Wyman said.

State Rep. Sean Scanlon, a Democrat on that working group, said the idea of a state-imposed mandate “absolutely has to be on the table,” if Congress approves the GOP tax overhaul, because the end of the federal mandate “would be a very bad thing for the state of Connecticut,” resulting in more uninsured and higher premiums for those who do buy insurance.

Scanlon said that as the chairman of the insurance committee in the state legislature, “I intend to have a conversation about this that includes both parties,” when the General Assembly meets early next year.

“To me, this is a very important topic that we will undoubtedly discuss in February,” he  said.

“Step one has to be if the (federal tax penalties) do go away, is imposing a mandate the right thing to do?” Scanlon said. “And if we answer that ‘yes,’ then the next step is determining what it would look, like.”

Maryland is considering a state mandate that would give those required to pay it the option of using that money to help pay for insurance coverage, which is subsidized for many under the ACA.

In most cases, Maryland officials say, the person under penalty may not have to pay any more money to obtain coverage because of those subsidies, which help pay premiums for those who earn up to 400 percent of the federal poverty level. That’s an income of $47,500 for an individual this year, and $97,200 for a family of four.

Massachusetts never repealed the state mandate it had imposed before Obamacare went into effect. So if Congress approves the tax bill this week, as expected, the state still has its mandate on the books.

California is also considering a state mandate – as well as other options.

At a recent board meeting, Peter Lee, the executive director of Covered California, the state’s ACA marketplace, raised the idea of a state-level individual mandate if the federal one disappeared.

But he also proposed other steps the state could take to keep premiums from rising, including a continuous coverage requirement — requiring people to remain enrolled in health insurance or pay higher premiums later – and automatically enrolling Californians in an insurance plan.

Washington, D.C., is also discussing replacing the federal mandate with its own penalty.

The idea of a state mandate is under discussion in mainly “blue” states with Democratic governors and state legislatures. But it comes at a political cost, as the individual mandate is one of the most unpopular parts of the Affordable Care Act.

Matthew Katz, executive vice president of the Connecticut State Medical Society, said he’d rather the state offer those who might drop coverage if the individual mandate is eliminated “a carrot, not a stick.”

But he said the mandate “is a way to fund and encourage participation in the marketplace,” and without it there will be “a further ballooning of premiums.”

“If the state doesn’t do something, it could be disastrous to the insurance market,” Katz said.

Making lemonade from lemons

Stan Dorn, a senior fellow at Families USA, a health care advocacy group, said different types of people will drop coverage if the federal mandate is gone.

Not only will young people and young families with modest incomes who are struggling to purchase coverage on the individual market drop coverage, but some people who are now covered under employer policies may elect to drop out of those plans so they don’t have to pay their match.

Also, a number of people who are eligible for Medicaid, the joint federal state program for those with low incomes, may be uninsured.

“The individual mandate act as a ‘nudge’ for many people who don’t realize they qualify for Medicaid,” Dorn said.

The CBO said the end of the mandate and the increase in the number of uninsured would save the federal government about $338 billion over the next decade in subsidies and Medicaid costs it no longer has to pay for. The savings are earmarked by GOP authors of the tax overhaul to offset the cost of some of their plan’s tax cuts.

Dorn said he expects insurers — who want the young, healthy people most likely to drop coverage to stay in the market — to press states to “fill the gap” if the individual mandate is gone, and consider state tax penalties to boost coverage.

“But this is all at an early stage,” Dorn said. “Discussions are just getting underway.”

Still,  he predicts “some states will make lemonade out of lemons.”

“They will step up to the plate to help their residents,” Dorn said.

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Access Health CEO Jim Wadleigh
Kyle Constable / CTMirror.org

HARTFORD: With about three weeks left in open enrollment, Access Health CT CEO Jim Wadleigh estimates the health insurance exchange will end the enrollment period with about the same number of customers it had at the end of last year’s signup.

Wadleigh said he anticipates 105,000 to 110,000 will be enrolled when the shortened open enrollment ends Dec. 22. As of this week, Wadleigh said, about 101,000 were enrolled.

“I believe that we’ve done a better job getting the word out through social media,” Wadleigh said. “I see our enrollment fairs have had more attendees, the walk-in centers have also had more attendees, and our wait times are less.”

In general, Access Health allows people to have their coverage automatically renewed if they remain eligible for the same type of coverage they have now.

Last week, about 78,500 were automatically re-enrolled. About 12,500 customers couldn’t be automatically enrolled for various reasons (such as their plan no longer exists or they are no longer eligible for subsidies).

As of this week, about 1,000 of the 12,500 had signed up for coverage. The remaining 11,500 are counted in the 101,000 enrollees because Wadleigh expects most of them to eventually sign up for insurance.

If they don’t re-enroll, they will lose coverage at the end of the year.

About 10,600 new customers have enrolled for 2018 and a little more than 4,000 people who were enrolled this year opted out for 2018.

The two insurers that participate on the exchange are Anthem and ConnectiCare, which offer a variety of plans.

Access Health officials decided to close the exchange’s two storefront offices in New Haven and New Britain and to open 10 less-costly enrollment centers across the state, where people can walk-in for help.

The centers are in Bridgeport, Danbury, East Hartford, Hartford, Milford, New Britain, New Haven, Norwich, Stamford and Waterbury. Access Health officials have seen the largest traffic at the Danbury and Stamford sites, Wadleigh said.

About 2,800 people have visited the ten sites and nearly 116,600 have called the call center.

“From my perspective, our decision was the right decision to spread out further across the state,” he said.

Access Health officials also scheduled five weekend enrollment fairs, with three still upcoming in New London, Hamden and Willimantic.

Medicaid chief: Feds are willing to approve work requirements


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Seema Verma, head of the Centers for Medicare & Medicaid Services, indicated Tuesday that allowing states to have Medicaid work requirements is part of her plan to help give states more flexibility. (Phil Galewitz / KHN)

 

The Trump administration has signaled its willingness to allow states to impose work requirements on some adult Medicaid enrollees, a long-sought goal for conservatives that is strongly opposed by Democrats and advocates for the poor.

“Let me be clear to everyone in this room: We will approve proposals that promote” employment or volunteer work, Seema Verma, the head of the Centers for Medicare & Medicaid Services (CMS) said in a speech to the nation’s state Medicaid directors.

Such a decision would be a major departure from federal policy, and critics said it would lead to a court fight. President Barack Obama’s administration ruled repeatedly that work requirements were inconsistent with Medicaid’s mission of providing medical assistance to low-income people.

HG OxyContin size640x480NEW HAVEN: The city has joined the parade of states and cities suing the privately owned Stamford, Connecticut based Purdue Pharma and other pharmaceutical companies over their marketing of opioids, such as Purdue’s, oxycontin.

Other companies being sued include Johnson & Johnson [NYSE: JNJ], Insys Therapeutics [Nasdaq: INSY] Chandler, AZ, Endo Pharmaceuticals [Nasdaq: ENDP] of Dublin, Ireland and Teva Pharmaceuticals [NYSE: TEVA], Petach Tikva, Israel.

The city is also suing claiming that the drug companies and drug distributors McKesson Corp. of Stuggart, Germany and Cardinal Health [NYSE: CAH], Dublin, Ohio have marketed the prescription drugs through deception.

Marijuana leafAUGUSTA: Not everyone is willing to toke up for some taxes. Like Connecticut legislators, Maine’s Governor Paul LePage was not willing to allow Marijuana to be legalized in his state. He followed through on his threat to veto legislation that would have allowed the process to create a “regulated marijuana market” .

A statewide referendum in October 2016 had voters approving the Cannabis and a bill was supported overwhelmingly in Maine’s House and Senate, set out the rule for taxes and the rules for cultivation, processing, and retail establishments.

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UPDATE FROM REUTERS>

By Mitchell Young


WOONSOCKET, RI: Aetna [NYSE: AET] CEO Mark Bertolini probably won’t be enjoying the commanding view of the New York City skyline from his New York headquarters, next year.

CVS Health Corp. [NYSE: CVS} wants his company and they are reportedly willing to put up the bucks to take it, $200 per share, more than $66 billion.

Aetna shares rose more than 11%, [$18.48] this morning , to $178.60, on the speculation of the deal and the $200 price tag. Shares of Aetna have traded as low as $104 within the past year.

Aetna has approximately $64 billion in revenues and $2.2 billion in annual profits. CVS generates more than $5.5 billion in profits from $170 billion plus in sales and has a $74 billion market value. Aetna before the speculation had a market value of $65 billion. Reports are, that based on the similarity in market value size, the merger will likely include, stock and cash to fund the payday.

While most of us know CVS, originally Consumer Value Stores from their ubiquitous “drug stores,” the company makes much of its money as one of the nation’s largest Pharmacy Benefits Managers [PBM]. Ironically the profits that PBMs generate and that is providing the "quan" to fuel the takeover, are themselves under scrutiny by insurers, major employers and healthcare regulators as excessive.


CVS’s PBM negotiates drug benefits for health insurance plans and employers, and is seen as taking an aggressive stance in price negotiations with drug makers. Consumer advocates however, have questioned, whether PBMs themselves rather than consumers are seeing the benefit of this market power.

USA Today reported in 2014, that “while all the cutting goes on in health care, one of the biggest and least understood players [PBMS] are getting bigger and richer.”

A merger with Aetna could provide even more leverage in its price negotiations with drug makers, but could underscore as well, that the profits CVS’s PBM make as an intermediary should also be on the chopping block, as industry price pressures continue.

Aetna at 164 years has been based in Hartford for all that time. Apparently, the company is being driven into an early retirement by the Obama administration's scuttling of their merger with competing health plan Humana in 2016.

While the details have emerged about the possible deal, a final agreement is neither assured or likely to come this week.

The discussions have gone on for a few months and are reported to be primarily between CVS Chief Executive Officer Larry Merlo and Aetna's Bertolini. Neither company has commented, but that is likely to change with the pricing information now in the market.

While Obama administration officials probably wouldn’t admit it, several “writers” behind the Affordable Care Act have said they were seeking consolidation of the healthcare industry, as a means to reduce costs. The proposed consolidation of Anthem and Cigna, and Aetna, Humana that resulted however, created a backlash from the public and many healthcare providers and the merger was eventually rejected by the Obama administration.

Connecticut's U.S. Senator Richard Blumenthal was among the biggest critics of the Aetna, Humana merger. Three months after the deal was nixed, Bertolini announced his decision to move Aetna’s headquarters to New York.

One thing to watch is whether CVS, with its low-cost retail culture will keep its headquarters in Woonsocket, rather than move to the Big Apple.

bigstock 173513822HARTFORD: Connecticut Chamber of Commerce executives and their health insurance marketing partner the Chamber Insurance Trust announced they are responding to the healthcare cost crisis by overhauling their benefit programs to address the escalating costs to Connecticut businesses.

There are more than 65 Chambers of Commerce in Connecticut serving ten of thousands of members across the state, they operate six existing regional Chamber Benefits Centers across Connecticut.

The Chambers are producing informational events throughout the state and selected members are being designated as Chamber Healthcare Navigators. The Middlesex Chamber is hosting an event on October 11, Danbury October 18 and Norwalk and the Fairfield Coast Chambers on October 19. The New Haven Chamber is organzing a business healthcare summit to be held at Long Wharf Theater later in the month, date to be announced.

The first meeting was held on September 6, at the Manchester Chamber of Commerce, Candice Corcione, Executive Director of the Tolland County Chamber helped organize the multi-chamber event.

Corcione, said, “businesses in our 13 communities are practically shouting from the rooftops, about the increasing healthcare costs. As a Chamber executive my number one responsibility is to help our region’s companies address their problems.

Sometimes we’re advocating for them at the State Capitol or organizing events to help get more business, but the rising costs of healthcare have become a priority.”

Chamber execs cited The Kaiser Family Foundation report that the cost per employee in Connecticut averaged more than $6,545 in 2016, the fifth highest in the Continental US, trailing, only New York, Massachusetts, Rhode Island and New Hampshire.

The Connecticut Department of Insurance has authorized rate increases for 2018 of as much as 31.7% for the individual market. Anthem Blue Cross/ Blue Shield, Connecticut’s largest insurer, was authorized to increase rates that average more than 25%, for the majority of their small business and non-profit market.

Nearly all of Connecticut’s major health insurers have posted double digit rate increases.

To gather more direct information from companies the Chamber executives said they are launching The Connecticut Healthcare Response Survey, to get “extensive business feedback and data from every corner and company segment across Connecticut.”

JoAnn Ryan, president of Connecticut’s Chambers of Commerce Leadership Council, and president of the Northwest Chamber of Commerce, in Torrington said, “from Danbury to Danielson, members are telling Chamber leaders that increasing healthcare costs are strangling their businesses.

We’re hearing that its causing many to forgo investment, reduce or hold back new employment and to seek outsourcing solutions, typically out of state or overseas.”

Ryan added, “the Chambers have used our combined member power, working with our healthcare marketing partner the Chamber Insurance Trust [CIT] of Orange, run by Steve Glick to provide access to quality and affordable health plans for more than two decades.

Steve and Sally Glick owners of the Chamber Insurance Trust have been recognized by Business New Haven as its Innovators of the Year and Small Businesspersons of the Year.

CIT’s CEO Steve Glick said, “most of the media and political attention has been about the Affordable Care Act and the individual market. While we can argue the cause, there is no doubt about what is happening in the marketplace and what the increases mean to Connecticut companies.”

Glick added, “There are policies that the Federal and State governments can do to help, we are not waiting. We’re innovating, we’ve researched, negotiated with providers and are creating new and exclusive solutions offered only through Connecticut’s Chambers.

Glick added, “the idea of managing your healthcare costs, once a year at rate renewal, is over for most companies, especially those with 10-20 employees and Connecticut’s middle market companies. The bottom line solution is long term cost control, transparency, and shared risk with other quality companies.

The only way a middle-market company can contain healthcare costs is by taking control of the expenses, Companies need to pay less for the insurance plan’s administration, marketing and profits, they need to reduce claims through management and wellness, better manage the drug benefit and a have a health plan designed for their unique company.

Aaron Glick, Executive Vice President and in-house Counsel for CIT explained that CIT and the Chambers are focusing on Connecticut’s middle market companies saying, “we all know about Connecticut’s problems with several big headquarters companies, but the state was recently ranked #17 in middle market companies in the country. These firms are the drivers, innovators and sustainable companies, that are the future. Healthcare costs have moved to the top of the list of management issues.”

Disclosure: Second Wind Media Ltd. Publisher of Business New Haven and Conntact.com performs some marketing support functions for the Chamber Insurance Trust.