Connecticut, Massachusetts, New York and Federal

By Phil Boyle HCG Services

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State of Connecticut◦ Proposed Legislation

State of Massachusetts◦ Existing Health Reform Issues

State of New York◦ New Law that is raising costs NOW

Federal Government Issues◦ New National Laws◦ Future of health insurance

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An Act Establishing The Connecticut HealthCare Partnership (HB 6582)◦ This bill requires the Comptroller to convert the

State employees health insurance plan to a self-insured arrangement for benefit periods effective July 1, 2009.◦ Other entities such as Not-for Profits and Private

Small Businesses would be brought on by January 2010.◦ Ultimately the State Controller and SEBAC would

determine who comes into this plan.3

A bill establishing the Sustinet (HB6600). Some items regarding Sustinet:◦ No actual plan in place as of this date.◦ No carriers are participating as of this date.◦ No funding in place as of this date.◦ The plan is estimated to cost the state $1 billion

dollars, if approved.◦ The committee just voted to push the start date back

to 2011.

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◦ Commonwealth Care is a subsidized health insurance plan. (Chapter 58 of the Acts of 2006)◦ It is administered by “The Connector” .◦ In February 2008, the Boston Globe reported that

Commonwealth Care covered 169,000 people at a cost of $618 million for the fiscal year. ◦ By June 2011 enrollment is projected to grow to

342,000 people at an annual expense of $1.35 billion.◦ In March 2008, the Boston Globe reported that

health care costs were rising at an annual rate of 10% and the state budget deficit was $1.3 billion.

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◦ As of January 1, 2009 – Massachusetts residents were required to have health insurance that meets the Commonwealth Health Insurance Connector Authority Minimum Creditable Coverage (MCC) standards. ◦ MCC requires a broad range of benefits and restricts

the size and type of cost sharing for in-network core services.◦ If you don’t have an MCC type plan in place as of

January 1, 2009 a person would face a tax penalty.

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◦ New York State Rate Adjustment effective July 1, 2009◦ As a result of increased surcharges and the state budget,

carriers are adjusting their premium rates from 2% - 4% now. ◦ The Big Issue is that these increases may effect groups

who had health insurance from January 1, 2009. Some of those groups will be seeing increases of 4%-8%. ◦ We are aware of one municipality which, due to the

premium increases that they were not anticipating, now have to find $100,000 which was not budgeted for in their annual planning.

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◦ Three New Laws went into effect from late 2008 to early 2009: New FMLA rules went into effect November 2008.

There are up to 11 important revisions. CMS (Centers for Medicare & Medicaid Services) – A

New Federal Law became effective January 1, 2009 which requires insurers to provide CMS with health insurance benefit entitlement information. This includes providing Social Security Identification Numbers on it’s members as part of the Medicare secondary payer reporting requirements.

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Cobra Benefits under the American Recovery and Reinvestment Act (ARRA)◦ Qualified Beneficiaries who experience “Involuntary

Termination” of employment, backdated from September 1, 2008 to now and going forward until December 31, 2009, are - ◦ If they are eligible:◦ Able to have the United States government cover

65% of their cobra expense for up to 9 months (certain restrictions apply)◦ Most states with Mini-Cobra also followed the

Federal guidelines.9

The future of health insurance on a federal level: ◦ The US government will push for a health care

reform plan beginning in Fall 2009. ◦ The US government is planning to use the

Massachusetts Connector model. ◦ The US government will set something in place either

by a Party Majority Vote or a technicality in the rules of engagement.

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- Health Insurance is complicated – there is a need for people who understand all aspects of health insurance.

- Everyone agrees something needs to be done about the growing cost of health care in the future.

- The next few months will provide an interesting ride for those involved in health insurance as government will get more involved on some degree in providing or overseeing health insurance both on a local and national level.

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Thank you for your time and attention. Phil Boyle, Partner, Vice President HCG Services, LLC

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