The biggest health care stories from the decade
by Lynne Ide
The start of a new decade prompted me to reflect on what happened in health care in the past decade. My first thought was: Not enough!
After all, Connecticut health reform advocates ended the first decade of the millennium on a high with the 2009 passage of the SustiNet law. The landmark law, which was never fully implemented, put our state on the map with the creation of a public option.
Enter the biggest health care story of the decade – passage of the federal Affordable Care Act (ACA) in March 2010. The ACA law swept in the biggest changes in health care policy since Medicare and Medicaid were enacted.
The ACA has eclipsed virtually all state reform – sidelining implementation of SustiNet, for example.
In short, the ACA was health reform “American style” as it preserved the roles of the monied interests – insurers, health systems and Pharma. It aimed to do three key things:
- Expand health coverage options to millions (via broad expansion of Medicaid, and plans offered via health insurance exchanges – with subsidies to help qualified people afford to buy the plans)
- Protect people from health plans that don’t meet their needs (such as requiring plans to cover pre-existing conditions, and ten “essential” benefits – emergency room care, pre-natal care, hospital care, screenings, etc.)
- Invest in a health system that promotes wellness (with no copays for check-ups and most screenings, and use of electronic medical records)
In Connecticut, many residents (and the state budget via federal Medicaid dollars) have benefitted from the ACA. Here are just a few examples:
- Preexisting conditions protections for anyone under 65.
- Medicaid (called HUSKY in Connecticut) expanded to 300,000 residents
- Close to $2 billion of federal funding for Access Health CT subsidies
The past decade threw the ACA into the political wringer – led by the push and pull of partisan efforts to dismantle, repeal and undermine the law.
The ACA has survived, largely because many people enjoy its benefits and the courts have protected it. Connecticut has taken action to codify the ACA consumer protections in state law.
At the end of the decade, the ACA took another hit with the Texas v US case – which could result in the entire law being unraveled. Stay tuned to see what 2020 holds for the ACA.
The second big health care story of the decade – consolidation that built conglomerates and drove up the cost of our health care.
That sounds dramatic. It is – and it all happened largely under the radar of the average person and the state and federal oversight entities. It felt like we all woke up one day and realized what was happening – and by then it was almost too late for advocates and regulators to stop.
Consolidation has happened in two key sectors:
- The hospital and health care industry. Connecticut once had over 28 nonprofit, independent hospitals – now all but seven are part of larger networks dominated by Hartford HealthCare and Yale New Haven Health Systems. Not to mention that most independent medical practices and clinics are now also owned by the big systems.
- The insurance industry. Nationally, insurance companies have been in merger mania. And now, its spreading to the other sorts of hybrid mergers – such as the Aetna-CVS deal.
Evidence shows that these mergers limit consumer choice, drive up the cost of health care, and do not necessarily improve the quality of care.
The third big health care story of the decade – health care costs too much and people can’t afford it.
Reforms at the state and federal level have done little to curb the cost of health care. In fact, reports and consumer polls show that health care affordability is the biggest health care worry for people across the spectrum.
The spiraling cost of prescription drugs has risen to the top in public opinion polls. States and Congress have taken on the issue with mixed success – as the well-heeled Pharma industry is quick to challenge reform efforts in legislative halls and courtrooms.
The stress of out-of-pocket costs – such as co-pays, deductibles and surprise medical bills – make regular headline news. People from all walks of life are opting not to seek care for fear of being stuck with a medical bill they cannot afford.
Connecticut has passed several laws to take on surprise medical bills, out-of-network charges and prescription drug costs.
Currently, advocates are waiting on recommendations from a High Deductible Health Plan Task Force – and we are the first state to develop a Health Care Affordability Standard, which once adopted can help legislators and regulators measure the impact of policy on families across the state.
Will YOU be part of this decade’s big health care story?
Health care is a hot issue. Will the monied interests continue to call the shots – or will the interests of everyday people come first?
We need people like you to work with us to put health care front and center in the 2020 elections. Raise your voice for real change that helps keep us healthy, gives us more value for our money, and delivers peace of mind to our families.