The cost of healthcare continues to skyrocket, and there is a push in the state capitol to help patients and doctors when it comes to Medicaid, but how?
Department of Social Services Commissioner Andrea Barton Reeves talks about what the governor is proposing.
Mike Hydeck: We want to try to kind of set the stage a little bit before we get into this conversation so people understand what people understand what we're talking about. Let's remind people how Medicaid works. The state and the federal government both pitch in. They share the cost for medical treatments for low income families who couldn't necessarily afford the services by themselves, and if you're a low to middle-income person, you don't die just because you don't have enough money to pay for medical healthcare. One of the interesting things, to qualify for Medicaid, which is HUSKY A, as it's called in Connecticut, a family of four has to make less than $43,000. A family of one, it's about $20,000. So add to that, if that's your income, look at the cost of a one bedroom apartment here in Connecticut. The average is $1,500. A price for a two bedroom is around $2,200. That's if you can even find a place to live. So Medicaid has been a thing of concern in our state for years now. There are some things to try to address is. Across the board increase in our state for Medicaid reimbursement hasn't happened since 2007. There's been piecemeal things to help with certain procedures. How does that need to change? And in your mind, does it need to change?
Andrea Barton Reeves: So it does need to change, thanks for the question. We recently had two studies that were conducted. One is called our Medicaid Landscape Analysis, which just looked at Medicaid overall, how we spend our money. Which programs have strengths and which ones need improvement. And then we also had something called a rate study, which looks specifically at what it is that you're talking about. How much are we paying providers, and where is that gap and how should we fill it? So with both of those studies, we do know that there are specific provider types that really needed to get some improvement in the way in which they were paid. We did that last year in the last session with behavioral health providers. We were able to because we know that there's a behavioral health crisis, especially among young people. So we were able to fill in a lot of those gaps. And then in this year, we're finding that the gaps are really in primary care. And so there's a significant gap all around.
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Mike Hydeck: Primary care means a lot of people.
Andrea Barton Reeves: It does. It means a lot for a lot of people, yeah. And so that's where the gaps are going to be filled again this year. Look, the need will, I think, always outstrip the amount of resources that this or any state has. But to do it in a very thoughtful way, which we did with these studies, and to really target where I think we can close the gap the most and meet the most need, really, is the right way to do it.
Mike Hydeck: So it's more about a targeted approach, once again, not an across the board, sort of thing.
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Andrea Barton Reeves: That's right.
Mike Hydeck: So West Hartford Democrat Representative Jillian Gilchrist said, 'Look, I'm talking to community health centers, and they're saying they're losing $120 on every dental procedure.' Add that up, extrapolated across the year, that's a lot of money. How do you start to fill in those gaps? Community health centers, we're not talking about lobbyists going to Washington for big hospital chains. Community health centers are helping people on the ground in neighborhoods. How do they get addressed?
Andrea Barton Reeves: Yeah, so you're talking about the federally qualified health centers. So there's 16 of those across the state, and the rate study that I referenced certainly acknowledges that there is a gap. So we do have some money that's been allocated in the governor's budget, and the hope is that a portion of that can go to help our federally qualified health centers, along with other primary care providers in that category.
Mike Hydeck: So one of the things the governor is proposing in this budget is increasing the tax on hospitals. So this is a little bit convoluted, but I want to try to explain it. If he increases the tax on hospitals, they pay more taxes. He says that's going to trigger more funding from the federal government. Which can help the balance sheet for both the state and the hospitals. However, this did happen in 2016 under Malloy, when he was the governor, and he clawed back some of that money. So the hospitals didn't get the money they were promised. Now, reasonably, the hospital is a little skeptical that we're going to try this balance sheet bingo once again. How do you feel about that?
Andrea Barton Reeves: Yeah. How I feel about that is that this governor, right, who has entered into an agreement where there's been a 2% increase that's been built into the hospital settlement agreement over those years, and no one has reneged on that agreement. That money has gone in, and the hospitals have seen that. Yes, and you're right, there has been an agreement, or, you know, some discussion about having more money put in, in what we call the user fee, and then using that difference to pay the hospitals. I obviously am an appointee of Governor Lamont, and I am very much a fan, of course. Never been in, you know, in a circumstance where he has made a promise to this particular group, and not met that promise. So I don't see any reason why that would be any would be any different today.
Mike Hydeck: So assuaging the hospitals is going to take some work, if they don't believe it right now, right?
Andrea Barton Reeves: Well, of course. That's true for any group, but, you know, I think they definitely recognize that hospitals are an important partner. Obviously, we all want hospitals to do well and to make sure that they're available when we need them. But we also know that hospitals have received overall about $3.3 billion over the last five years in additional funding. So it's not just Medicaid funding. It's also what we call supplemental payments, payments in order for us to train graduate students and other kinds of payments that go to hospitals that are in more rural areas, that have a different kind of what we call a payer mix. So there has been significant investment in hospitals over time, and we continue to work with them, you know, to make sure that those investments bear fruit in terms of providing good service for all the people in the state.
