More Costs, Costs, (Health Insurance) Costs

The legislature is considering yet another bill that would drive up the cost of health insurance in Connecticut. 

SB 599 requires insurance companies to immediately authorize and pay for all prescription drugs during certain appeals procedures. 

It’s important to understand that under federal law, an existing prescription—something an individual is already taking—must receive immediate authorization and payment during an appeal process. 

But this bill takes it a step further by also requiring the immediate authorization and payment for any new drugs that go through an appeal process. 

The distinction between existing medications and new prescriptions is important for many reasons, including patients’ safety. Prescription medications are also significant cost-drivers in the healthcare system, and careful review of their use is essential to controlling costs.  

SB 599 is not only a new health benefit mandate–which contributes to higher premiums–but it also undermines the procedures insurance companies have in place to help control the skyrocketing costs of prescription drugs. 

Absent those controls, SB 599 will directly lead to higher premiums and by extension, make it more difficult for employers to help their employees afford health insurance. 

Decreased Access

The link between higher cost and less access is undeniable, yet several measures to increase cost, such as this one, are still under consideration. If the legislature continues down this path, health insurance will be too expensive for employers and employees. Consequently, the type of coverage available to purchase will be irrelevant if no one can afford to buy it.

New Mandates = State Dollars

The state budget will be directly impacted by any new health benefit mandates, such as the one in SB 599. Under the federal Affordable Care Act, the state will have to pick up the tab for new benefit mandates for the subsidized population. 

For individuals receiving a subsidy to purchase health insurance from the state exchange, that means the federal government will pay only for the existing benefit mandates (coverage for certain specialized procedures and treatments)–leaving the state on the hook for any new mandates. 

The Time to Act Is Now

If increased access to health insurance is the state’s goal, then the conversation about cost must change. 

Bills such as SB 599 must be analyzed with their significant cost impact on the forefront of everyone’s mind–not simply considered an unintended consequence. 

Health insurance sticker shock is coming in a few short months, and the legislature has an opportunity to help consumers right now. New health benefit mandates must be rejected.  

For more information, contact CBIA’s Jennifer Herz at 860.244.1921 or jennifer.herz@cbia.com.