Tonya Maurer's boss wants to give her more hours at her part-time job, but the Hebron resident is hesitant. More hours could raise her income and endanger the subsidies that make her health insurance affordable.
"Ultimately, I would have to probably say no to those additional hours because I'm only working those hours in order to pay for health care," Maurer said, echoing the frustration of many Connecticut residents struggling to pay for coverage and navigating a complex system.
"You've got a problem that's bigger than this room that's been brewing for way too long," Maurer told state officials and insurance executives at a public information session on health insurance rates on Wednesday in Hartford.
The rates under discussion -- double-digit price hikes sought by insurers for plans under the state's Affordable Care Act exchange -- only impact about 6% of the state's population, Insurance Commissioner Josh Hershman said at the outset of the session. The state doesn't regulate employer plans or Medicare or Medicaid rates, the vast majority of health insurance coverage in Connecticut.
But the price increases for the ACA plans reflect larger issues driving up medical costs for all residents, he added.
"It's insane and it's not sustainable," Hershman said, describing his own experience with $35,000 in out-of-pocket costs on his family's small-group plan in his previous job. "We need to do better as a collective group."
Anthem, ConnectiCare and UnitedHealthcare have proposed average rate hikes of 16.2% for 2027 for plans in the individual and small group markets that are offered both on and off the Access Health CT exchange.
Higher costs for drugs, increased use of behavioral health services and new state coverage mandates have contributed to the rate increases, insurance executives said at Wednesday's session at the Capitol.
A law signed this year that requires that insurers cover scalp-cooling treatments to preserve hair for cancer patients was singled out by Anthem Sales Director Brandon Rousseau, along with recent coverage mandates around infertility and PANDAS, a neurological ailment in children.
"We recognize the clinical value these services may provide. However, each mandate creates a statutory claims obligation that must be reflected in actuarially sound premiums," Rousseau said.
As costs mount, the savings promised by the use of artificial intelligence in healthcare and the insurance industry have yet to materialize, Connecticut Hospital Association Vice President Mark Schaefer said.
"AI deployment comes at a cost," Schaefer said. "I think it's too soon to tell in this rapidly evolving landscape what the net effect is going to be on cost, but it's an important opportunity that all our health systems and hospitals are pursuing."
Pricey GLP-1 drugs, promised to reduce healthcare spending in the long term on chronic ailments like obesity and diabetes, have also yet to impact insurers' bottom lines.
"They're very popular and they're very expensive. But whether over the long term they'll reduce overall medical costs, we just don't know yet," said Mark Meador, president of ConnectiCare.
State Rep. Tom Delnicki, Republican of South Windsor, pushed back on the insurers' claims that their rising costs required much higher rates.
"I think it's important to take an overview of the companies," Delnicki said, pointing out that Anthem's parent company reported nearly $1.5 billion in profits for the second quarter alone.
Other state lawmakers and Attorney General William Tong urged the Insurance Department to reject the price increases.
"These insurers are, once again, requesting rate increases that exceed other inflationary and general economic growth measures," Tong said in a statement on Wednesday. "To put it bluntly: never-ending insurance rate increases reflect a broken system that does not deliver affordable healthcare for the struggling citizens of Connecticut."
"Deny, Deny, Deny," was the advice of Jan Kritzman of Newington, who spoke passionately about the importance of coverage mandates for patients at risk of breast cancer. A 2020 law that she fought for requires insurers to cover screenings for at-risk women including ultrasounds, MRIs and biopsies.
"This saves a lot of late-stage diagnoses, saves lives, and this is a mandate that ultimately saves insurers a lot of money," Kritzman said. "I hear people like actuaries and CEOs make the same poor excuses for raising premiums, like complaining about mandates. I take that personally."
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This article originally published at 'It's insane': CT patients, officials blast proposed average health insurance rate hikes of 16%.