HARTFORD – A coalition of healthcare providers, hospitals, physicians, and bipartisan lawmakers are urging legislators to reject a proposal to cap out-of-network payment for hospital inpatient and outpatient services. The proposed policy would have a harmful impact on hospitals, physicians, and Connecticut’s healthcare system, jeopardizing the ability to maintain current levels of patient access to services, the coalition explained at a press conference held today.
The proposal, contained in the Lamont administration’s initial proposed biennial budget released in February, would give more leverage to national health insurance companies over Connecticut’s local hospitals in commercial contract negotiations. The proposal was not included in the Appropriations Committee budget released in April but advanced out of the committee in HB 6871, An Act Limiting Out-of-Network Health Care Costs.
This proposed out-of-network cap policy:
- Could lead to more than $700 million in reduced payments to hospitals, at a time when Connecticut hospitals continue to struggle with negative operating margins
- Will jeopardize a hospital’s ability to maintain current levels of access to services for patients and undermines efforts to rebuild and recover financially from challenges of recent years including a global pandemic, surging inflation, and workforce crisis
- Unfairly favors insurance companies in payer/hospital negotiations
- Ignores the ongoing impact of Medicare and Medicaid underpayment and administrative costs imposed by commercial insurers
- Will have severe and lasting consequences for Connecticut’s physicians, patients, and overall healthcare landscape
Lawmakers Weigh In:
“I share the concerns of many of my medical colleagues that this bill would constrain Connecticut’s hiring and retention of physicians. A system that is already failing its workers due to endless cuts now has the potential to see those impacts worsened, with Connecticut’s health care systems potentially facing the brunt of the fallout,” said Senator Saud Anwar (D-South Windsor), co-chair of the Public Health Committee.
“I think the state of Connecticut really needs to stop deflecting and focus on Medicaid reimbursement rates,” said House Minority Leader Representative Vincent Candelora (R-North Branford), “I think fundamentally we know and can address the problems in healthcare under our control by fixing those rates. By going after different areas of our healthcare system, it’s a house of cards that is going to collapse. I look forward, in a bipartisan way, to working on fixing the real issues that we see with healthcare reimbursement rates.”
“This proposal is not a patient-friendly proposal and will add more challenges for healthcare providers and hospitals. It would make Connecticut an outlier in the nation and inhibit access to care. I stand in strong support of the healthcare providers, hospitals, and physicians urging lawmakers to oppose this bill,” said Senator Heather Somers (R-Groton), ranking member of the Public Health Committee.
“I’m concerned that this proposed legislation will create unintended consequences and could actually increase out-of-pocket costs for self-funded or commercially insured residents, or worse, reduce healthcare accessibility in our state,” said Representative Nicole Klarides-Ditria (R-Beacon Falls), ranking member of Public Health Committee. “Like my colleagues, I’m concerned about this proposal, and I’m concerned that it might force doctors to either stop treating patients or close their practices altogether. I don’t believe this proposal will provide the savings the authors intended.
“In opposing this bill we are standing up strongly for patient care everywhere in Connecticut,” said Senator Jeffery Gordon, MD (R-Woodstock), a practicing physician. “We should not be doing things that make it more challenging to deliver healthcare in our state, we should be doing things to make it better. In opposing this bill, we are calling for a pivot in direction to focus on protecting patient access and helping those providing that care continue to do so, not add more challenges.”
“I have real reservations about the unintended consequences of capping out-of-network rates. It’s essential to ensure that such measures don’t inadvertently strain our hospitals and physicians, especially those serving vulnerable communities. We need to pursue solutions that don’t further threaten access to care or increase costs for patients,” said Senator Derek Slap (D-West Hartford).
Healthcare Providers Weigh In:
“This truly is not a patient-focused policy. It is an insurer-focused policy,” said Jennifer Jackson, CEO of the Connecticut Hospital Association (CHA). “At a time when hospitals and healthcare providers are already struggling, this would jeopardize the ability to protect access and provide high-quality care. This proposal does not strengthen current laws that already protect patients from out-of-network surprise bills. Were such a cap in place, and in-network rates pushed closer to Medicare payments, hospitals would face even greater challenges making it more difficult to meet their missions of caring for communities, patients, and the healthcare workforce. We know that lawmakers understand just how damaging this would be, and we thank them for not including this proposal in the Appropriations Committee’s proposed budget. We ask for their continued support on this issue as budget discussions continue.”
“Payment caps are a gift to health insurance companies and a blow to patients,” said Khuram Ghumman, MD, Connecticut State Medical Society President. “They do nothing to improve care. They will make it harder for patients in Connecticut to find a physician and will push more physicians out of the state. Patients are already frustrated with delays, denials, and limited networks. Giving health insurers even more control will only make things worse. Connecticut should be protecting access to care, not making it harder to get.”
“House Bill 6871 will significantly jeopardize the financial viability of physician practices already operating on thin margins in Connecticut, particularly small, independent practices,” said Dr. Anthony Yoder, Chair of Health & Public Policy for the CT Chapter of the American College of Physicians. “The American College of Physicians has long advocated that reimbursement for covered services should be fair and adequate to reduce barriers to care by enhancing participation of physicians. Using Medicare rates as the comparator to which out of network reimbursement is calculated runs completely counter to this goal.”
“Current law provides fair payment for out-of-network emergency care. Passage of HB 6871 would drastically reduce patient access to specialists in the emergency department.” said Dan Freess, MD, Connecticut College of Emergency Physicians.
“My practice is 100% breast reconstruction for women with breast cancer or at elevated risk. The perforator flap reconstruction I perform has many advantages over implant reconstruction. I have been able to help many women in CT, who were disfigured and suffering following their treatment. If this bill passes, I will have to stop doing these highly specialized breast reconstruction cases in CT because I would not be able to support my small practice where I employ single moms who are the sole providers for their families. I would need to shift all my patients to NY for reconstruction,” said Julie Vasile, MD, Secretary, the CT Society of Plastic Surgeons.
“House Bill 6871’s proposed cap on out-of-network payments threatens the viability of many surgical practices and, with it, patients’ timely access to lifesaving care,” said Royd Fukumoto, MD, FACS, President, Connecticut Chapter of the American College of Surgeons. “Pegging reimbursement to a fraction of Medicare rates will make it financially unsustainable to treat complex cases—especially emergencies—forcing specialists out of our communities. Connecticut can lower healthcare costs without sacrificing the skilled surgical workforce our patients depend on, and we urge lawmakers to pursue solutions that protect both affordability and access.”
“The Connecticut State Society of Anesthesiologists unequivocally opposes HB 6871,” said John Satterfield, MD, Legislative Chair, Connecticut State Society of Anesthesiologists (CSSA). “This bill will incentivize health insurers to firstly, not negotiate in good faith and secondly, allow insurers to drive Connecticut physicians out of network unless they accept unreasonable insurer rates. Access to patient care will undoubtedly be hindered and we will face even greater difficulty in attracting physicians to Connecticut. Sadly patients will suffer.”
“We are already struggling with a severe physician shortage, ranking 44th in the nation for physician workforce density-15 of our state’s 169 towns have no primary care physicians at all,” said Dr. Atique Mirza, President of the Hartford County Medical Association. “The proposal in HB 6871 will further exacerbate this crisis, reducing access to healthcare for our most vulnerable citizens. By giving insurance companies even more leverage to reduce reimbursement rates for physicians and hospitals, HB 6871 will force many healthcare providers to consolidate or close, leaving our patients with even fewer options for care, and undermining the quality and accessibility of healthcare in our state.”
“This proposed policy is a gift to insurance companies and a punishment to highly-sought physician specialists and their patients,” said Dr. Ray Lorenzoni, Pediatric and Fetal Cardiologist, Fairfield County Medical Association (FCMA), “It creates arbitrary caps that jeopardize patient access and choice for specialized care, undervalues physician expertise, and threatens the viability of medical practices already strained by a decade of pay cuts to physician reimbursement. There is only so much bombardment your doctor can take. Please oppose.”
“HB 6871 allows large insurance companies to set payment rates and eliminates the economic incentive for an insurer to negotiate a contract with a provider. We must not allow insurance companies to unilaterally determine the value of healthcare services, and certainly not those of our lower cost providers. Medicare, often a provider’s lowest paying insurance carrier, was never meant to be a model for reimbursement and does not cover many services that are provided in ASCs. The impact of this legislation on healthcare in Connecticut would be devastating,” said Amanda Gunthel, President of the CT Association of Ambulatory Surgery Centers.
Those opposing out-of-network caps include:
- The Connecticut Hospital Association
- Connecticut State Society of Anesthesiologists
- Connecticut Association of Ambulatory Surgery Centers
- Connecticut College of Emergency Physicians
- Connecticut State Medical Society
- CT Society of Plastic Surgeons
- Hartford County Medical Association (HCMA)
- Fairfield County Medical Association (FCMA)
- Connecticut Society of Eye Physicians (Eye M.D.s)
- CT Dermatology & Dermatologic Surgery Society
- Connecticut Urology Society
- Connecticut Orthopaedic Society
- Connecticut Chapter, American College of Physicians
- Connecticut Chapter, American College of Surgeons
- CT Association of Physicians of Pakistani descent of North America
- CT ENT Society
- CT Academy of Family Physicians
- Eastern Connecticut Medical Association
- American College of Obstetrician Gynecologists-Connecticut (ACOG CT)
- Radiological Society of Connecticut
Read the coalition letter detailing these concerns here.
Watch the press conference here.
