State Representative Mitch Bolinsky (R-106) and Sean King, a staff attorney at the Connecticut Office of the Healthcare Advocate (OHA) could only listen — and in some cases, shake their heads — as several of the dozen or so attendees at a Forum on Health Care Costs at the C.H. Booth Library March 4 related their frustrations and healthcare horror stories.

“How can consumers push back?” asked one attendee. “We’re getting hammered!”

Another facing renewal on a single payer healthcare policy confirmed that this year, co-pays and deductibles on her existing plan are increasing, forcing her to consider a less expensive policy that would nonetheless increase her annual premium $300.

But perhaps the most disturbing story was related by a couple who came to the forum. The man related that his wife is currently able to obtain a critical prescription on her employer’s health plan for just a $5 co-pay.

“But if she leaves the company, it goes up to $4,000 a month,” he said.

“I can’t retire,” his wife added.

Unfortunately, the lawmaker and lawyer could not offer much in terms of relief or even provide solid answers to some questions because, as Mr King admitted, the OHA is not a policy-making agency.

“We’re there to advocate for consumers and policies,” the OHA attorney said. “But we’re not the regulators.”

How The OHA Works

Mr King opened the hour-long forum by explaining how the OHA works on behalf of state residents and agencies before he and Rep Bolinsky opened the floor for questions and comments.

Moving through a 20-minute Powerpoint presentation, he reminded attendees they could contact the OHA at 866-466-4446 if they:

*Are not sure who to call to help with a healthcare enrollment or coverage situation;

*Need specific explanations about a benefit, program, or coverage definition;

*Want an assessment of the plans offered in Connecticut;

*Want to review their rights and responsibilities as a healthcare plan member;

*Want to better understand the referral and pre-authorization procedures required by a plan, or;

*Need assistance with a health plan’s internal and external appeals processes.

The OHA attorney said he and his colleagues are dedicated not only to serving and assisting Connecticut’s healthcare consumers, but also ensuring products and services available are adequate. This effort requires a multifaceted approach, including direct consumer advocacy and education, inter-agency coordination of benefits, and a voice in the legislative process.

In trying to define why the costs of healthcare are outpacing increases in average earnings by 213 percent, Mr King said health insurance carriers continue passing excess costs on to consumers.

“Health insurance companies must charge enough in rates to ensure they can pay all their claims,” he said. “As costs rise, more of that expense gets passed on as well.”

The OHA attorney added that health carriers must expend at least 80 percent of their premiums for claims, leaving about 17 percent for overhead and about three percent remaining for profit.

Several audience members wondered if the recent escalations of mergers are giving hospitals and specialty providers greater economies of scale that deliver financial advantages while they are also marking up costs for tests, procedures, supplies, and collateral services.

“That market power is fighting insurance companies and keeping them from lowering rates,” he said. Some health plans are even creating tiered provider groups in plan, he added, “to drive payers to even lower cost providers.”

Price List Wanted

Another audience member at the forum wondered why there is no centralized cost list so he could price out a planned procedure and its related services.

Mr King replied that while the state Office of Healthcare Access offers cost and price information based on medical procedure codes, any slight change or added element during a planned procedure could still result in “costs beyond expectations.”

“The system is set up to confound you,” Rep Bolinsky admitted, not hiding his own frustration. “They just want to wear you out so you go away.”

The lawmaker said 2019 will mark the third session he has tried to get some type of reliable resource for consumers to shop costs for certain common medical procedures and services online. But the thousands of codes hospitals and medical practices use, Rep Bolinsky said, make it virtually impossible to create a consumer-oriented guide.

Reminding guests to the forum that he would take concerns he was hearing March 4 back to his colleagues and Governor Ned Lamont himself, Rep Bolinsky noted that “our new governor is open to new ideas.”

As he welcomed residents to the early evening forum, Rep Bolinsky apologized on behalf of State Rep JP Sredzinsky (R-122) and Senator Tony Hwang (R-28), who were both scheduled to attend but were diverted — in Rep Sredzinsky’s case, by demands at his job as an emergency communications director in Stratford.

In closing, Rep Bolinsky said in many cases, he and his colleagues in the legislature could only refer constituents to various state resources like the OHA for specific assistance.

“Then we have to hand off to them,” he said, urging those constituents to “come back and let us know” when and if they do not get the answers they need.