OHA Salutes State Action to Protect Diabetics, Address Racial Disparities, and Reform High-Deductible Health Plans

July 24, 2020 -- Hartford, CT -- The Office of the Healthcare Advocate hails the state House of Representatives for passing a bill last night that protects diabetes patients with certain high-deductible health plans from going broke paying for life-essential insulin and other supplies.  The bill if passed by the state Senate and signed into law would limit deductibles and other out-of-pocket expenses for insulin and other diabetes-related supplies and services to $125 per month, for people with state-regulated plans.

High deductible health plans (HDHPs) do almost nothing to reduce overall healthcare spending, as the work of the state’s High Deductible Health Plan Reform Task Force showed earlier this year.  What HDHPs do accomplish is to disguise Connecticut’s healthcare cost crisis by keeping premiums artificially low.  They do this by quietly shifting a major proportion of medical costs, including diabetes drugs and care, onto families who are sick, even if they technically have insurance.  If sick families are left on their own to bear the bulk of medical costs from diabetes and other chronic conditions, the community (and insurance carriers) are protected from ever seeing or dealing with those expenses.

The hidden cost of the high-deductible strategy, of course, is economic stress and even in some cases devastation for families who are dealing with diabetes and other high medical expenses.  Making families pay more for healthcare at the very time they are ill and under stress from diabetes or some other expensive medical condition is unfair, and in one of the wealthiest states in the richest nation on earth, can fairly be said to verge on the barbaric. 

And at this moment, when Connecticut and the rest of the nation is wrestling with the enduring systemic racism exposed by the murder of George Floyd, we must be aware that there is a strong racial justice component here, because diabetes – and its high expenses – disproportionately affects our African-American and Hispanic communities.  This bill will alleviate some of the race-related financial disparities of diabetes in this state for families with state-regulated insurance plans.

OHA salutes the deeply bi-partisan efforts of the General Assembly on this bill, and in particular notes the leadership of Sen. Matt Lesser and Rep. Sean Scanlon, co-chairs of the Insurance & Real Estate Committee.  We urge the Senate to pass it swiftly, and Gov. Lamont to sign it promptly.

While this is a significant step for Connecticut’s diabetics, and a small first step in reforming our current unjust and ineffective high-deductible health insurance business model, more needs to be done.  Specifically:

• This bill is good news because it shifts costs away from diabetic individuals and families, but it does nothing to lower the underlying unjustifiably high costs of insulin and diabetic supplies, which now will be purchased by insurance carriers instead of directly by affected families. The carriers will pass these expenses on to everyone in the form of higher premiums, because spreading catastrophic expenses from one family to a larger community is the purpose of insurance. Until we deal with those underlying high prices, premiums for everyone will go up to pay for this program.
• While this is great news for the diabetes community, it does nothing for families grappling with other expensive chronic conditions. Yes, the high-deductible business model is unfair to families battling diabetes and ineffective in curbing the high underlying cost of diabetic care, but it is equally unfair for families dealing with other chronic diseases and conditions, and equally ineffective in bringing down the costs of those other illnesses. In its next session, the General Assembly should expand this program to all other expensive chronic conditions.
• The General Assembly only has jurisdiction to make this change for the state-regulated segment of Connecticut’s health insurance landscape, which encompasses only about one-third of the health coverage sold in this state. Most people who get their insurance through work have plans regulated at the federal, not state level. The U.S. Congress needs to pass similar legislation protecting people with chronic conditions, including diabetes, from unmanageable out-of-pocket costs.