Most CT Residents Concerned About Loss of Jobs, Access, Care in Aetna-Humana Merger, Poll Shows; Missouri Decision Points to Adverse Impact

The State of Missouri raised a red flag today, waving it directly into the headwind that is the pending merger between health care giants Aetna and Humana.  Missouri’s action came just as a public poll was released in Connecticut by consumer advocates opposing the merger which indicated a general lack of public awareness about the merger plan and substantial concern about potential job losses and adverse health care affordability and choices here if the merger goes forward. The Missouri Insurance Department issued an order banning Aetna and Humana from selling certain types of insurance in the state if the companies’ planned $37 billion merger comes to fruition. The order states that Aetna and Humana should “cease and desist from doing business” throughout Missouri with respect to individual and small group insurance and the group Medicare Advantage market if Aetna’s acquisition of Humana is completed.

In Connecticut, the Connecticut Campaign for Consumer Choice coalition released results of a recent poll which found that most Connecticut voters “didn’t know that the five major national health insurance companies – UnitedHealth, Anthem, Cigna, Aetna, and Humana - are attempting to merge down to three companies from five. The new research found that only 27 percent of respondents were aware of the plans.

After they were given more information about the consequences of the mergers among the five national health insurance providers (Aetna-Humana and CIGNA-Anthem), 71 percent of Connecticut voters were opposed to State Insurance Commissioner Katherine Wade approving the mergers in Connecticut.

Nine in ten state voters (91 percent) think that it’s either very or somewhat important that Commissioner Wade “considers the impact of these mergers on the affordability of insurance premiums and out-of-pocket costs, and their potential to limit health care choices, in her decision making process.” And those surveyed were overwhelmingly concerned that the proposed mergers will lead to job losses in Connecticut.

The Connecticut survey, conducted earlier this month by Public Policy Polling, found that 89 percent of Connecticut voters are either very or somewhat concerned that the proposed mergers will lead to job losses in Connecticut. Additionally, 89 percent of those polled believe it’s either very or somewhat important that the impact of these mergers on job losses in Connecticut be considered by state regulators.

Missouri is the first state regulator to release findings against the proposed deal, announced last year, published reports indicated. The deal is being reviewed by the U.S. Department of Justice, as well as state regulators and antitrust authorities, who are also reviewing competitor Anthem’s plan to buy Cigna Corp. Aetna has filed for regulatory approval in the 20 states where Humana is domiciled and of those, 15 have approved the deal thus far, including Connecticut.  Because of Humana's limited footprint in Connecticut, the review was more form than substance.  The Cigna-Anthem merger, however, is to receive a much fuller review, according to state insurance officials, as Cigna is a state-domiciled company.

Regarding Aetna-Humana, the Missouri Insurance Department “found that in its current, unmodified, form – as to a few specified lines of insurance – that the proposed acquisition would violate the competitive standard set forth in Missouri law, meaning that as to those lines the acquisition would substantially lessen competition in this state.”

The Missouri Insurance Department stressed that the decision “is not a final order. The statute provides that Aetna and Humana may submit a plan to remedy the anticompetitive effect of the merger as to those specified lines.”  If that step is taken, the department “would evaluate the plan and may modify or vacate” the order issued today banning the merged company from certain lines of insurance in the state.

"The Missouri order does not impede the Department of Justice approval process," Aetna said in a statement. "We're disappointed, but expect to have a constructive dialogue with the state to address their concerns."

In addition to the public poll, Connecticut Campaign for Consumer Choice – a coalition that includes the Universal Health Care Foundation, Connecticut Citizen Action Group and Connecticut State Medical Society -  released a letter to Commissioner Wade signed by 17 state legislators calling for multiple public hearings on the merger, intervenor status for interested consumer advocates, and a study that would “analyze the potential impact on cost, access, and the Connecticut economy, including jobs” and warning that if the merger is approved, “the resulting mega-insurer will cover 64 percent of covered lives in Connecticut, with an even greater concentration in some regions of our state.”

The Missouri decision comes following a public hearing held on May 16.  In testimony provided as part of the public record, Consumers Council of Missouri expressed “profound concern,” warning that the merger would result in a “significant reduction in competition (that) will most certainly result in increased cost to consumers,” adding that “the results will be catastrophic and we will have no power to undo it.”

The Missouri Hospital Association, in offering a detailed 21-page analysis, indicated that “Consolidation will affect the ability of hospitals and other health care providers to bargain competitively for contracts containing appropriate fees for medical services. In turn, such providers are less able to invest in the resources to maintain and improve the quality of care. An anticompetitive suppression of healthcare payments will suppress innovation, to the detriment of consumers.”

CT Has Nation's 11th Lowest Adult Obesity Rate, Survey Says

One quarter of Connecticut’s adult population is obese, according to data compiled by Gallup, the 11^th lowest rate in the nation.  The state-by-state analysis indicates that at 18.5 percent, Hawaii has the lowest adult obesity rate in the U.S., closely followed by Colorado at 19.8 percent. They are the only two states in which the obesity rate is below 20 percent. On the other end of the spectrum, West Virginia has the highest adult obesity rate, at 37.0 percent. In addition to West Virginia, at least one in three adults are obese in Mississippi, Delaware, Arkansas and Oklahoma. The obesity rate exceeds 30 percent in 18 states.

Of the 18 states with obesity rates of at least 30.0 percent, all but one are located in the South or Midwest. Meanwhile, all 11 states with obesity rates below 25.0 percent are located in the Northeast or West.

These data, from daily interviews conducted January through December 2015 as part of the Gallup-Healthways Well-Being Index, are based on U.S. adults' self-reports of their height and weight, which are then used to calculate Body Mass Index (BMI) scores. Americans who have a BMI of 30 or higher are classified as obese.

The national obesity rate reached a new high of 28.0 percent in 2015, up significantly from 25.5 percent in 2008, when Gallup and Healthways began tracking obesity. Fourteen states had statistically significant increases in their obesity rates from 2008 to 2015, while no state registered a statistically significant decline. Maine, West Virginia, Idaho and Oklahoma experienced the sharpest upticks in obesity.

Gallup calculated the incremental cost of healthcare per year for each state by multiplying the estimated number of obese people in the state's population by the annual incremental $1,573 cost of obesity per person.

In the five most obese states, the annual incremental cost of obesity per 100,000 residents averages $54 million. By contrast, the average cost is $34 million in the five least obese states. In other words, per capita medical costs attributable to obesity are about 1.6 times higher in the five states with the highest obesity rates than in the states with the five lowest rates.  The cost in Connecticut for the obese adult population was estimated at $39 million, for the entire adult population, $1.07 billion.

Public Supports Action to Protect Youth From Weight-Based Bullying

Parental support for enactment of laws and policies to protect youth from weight-based bullying is “present, consistent, and strong,” according to a new study by the Rudd Center for Food Policy and Obesity at the University of Connecticut. All 50 states currently have anti-bullying laws, but only three states – New York, Maine and New Hampshire - include body weight as a characteristic that places youth at risk of being bullied.

Many school districts have anti-bullying policies, yet body weight is often overlooked, stating that “evidence from students, parents and teachers indicates that weight-based bullying is one of the most prevalent forms of peer harassment towards youth in the school setting.”

The study found that support for including weight-based bullying in anti-bullying laws has grown during the past two years, stressing that “the omission of body weight in existing policies has important implications for youth who face weight-based bullying.”

“Parental voices can be influential in mobilizing advocacy efforts, and enacting policy change affecting children’s health,” said Rebecca Puhl, a study author, professor in UConn’s Department of Human Development and Family Studies, and deputy director of the Rudd Center.

The study findings, published in the journal Pediatric Obesity, can inform policy discussions about remedies for weight-based bullying among youth as increasing national attention is being paid to this issue.  The study indicated that “parental support is an influential catalyst motivating political will for policy decisions affecting youth, but has received limited research attention.”

Specific findings of the study include:

• Parental support has been consistently high (at least 81 percent) over the past two years for policies to address weight-based bullying among youth at the school, state, and federal levels.
• Support appears to have increased over the past two years for measures to better protect youth from weight-based bullying through improvements to state anti-bullying laws (87.9 percent – up from 84.7 percent) and through enactment of federal legislation (86 percent – up from 81 percent).
• While previous research has shown that mothers express more support than fathers for similar types of policies, this new study found no gender difference, suggesting that fathers’ support for these measures may be increasing.

“As a next step, it will be important to communicate with policy makers and school officials to identify interest and feasibility of viable policy initiatives,” said Puhl, “and to examine potential avenues for enacting change through law.” Puhl told CT by the Numbers that Connecticut’s law includes “physical appearance” but not body weight. There is, therefore, room to strengthen the state law, she pointed out, because physical appearance is a broad category that can include everything from clothing style to hair color, and body weight could easily slip through the cracks if it is not specifically enumerated.

The study involved online questionnaires of diverse national samples of parents in 2014 and 2015, totaling 1,804 parents over the two years. The research was funded by a donation from Rudd Foundation and a grant from the Robert Wood Johnson Foundation.

The study co-authors include Young Suh and Xun Li of the UConn Rudd Center. The Rudd Center for Food Policy & Obesity is a non-profit research and public policy organization devoted to promoting solutions to childhood obesity, poor diet, and weight bias through research and policy.

West Hartford’s Newly Developed Complete Streets Policy is #2 in the Nation for 2015

West Hartford’s Complete Streets policy, adopted in 2015, has been named the second best new policy in the nation by Smart Growth America and the Complete Streets Coalition. The coalition highlighted 16 communities nationwide for their outstanding new policies, among 82 communities that adopted Complete Streets policies during the year.  Nationwide, there are now a total of 899 Complete Streets policies in place in all 50 states, the organization announced this month. A Complete Streets approach creates an integrated transportation system that supports safe travel for people of all ages and abilities. This approach redefines what a transportation network looks like, which goals a public agency sets out to meet, and how communities prioritize their transportation spending. A Complete Streets policy is one of the best ways to set this approach into motion, Smart Growth American emphasized.

The U.S. Surgeon General and Secretary of Transportation both spoke out for more Complete Streets last year and Congress passed a transportation bill that included Complete Streets language for the first time ever.

The Complete Streets laws, resolutions, agency policies, and planning and design documents establish a process for selecting, funding, planning, designing, and building transportation projects that allow safe access for everyone, regardless of age, ability, income or ethnicity, and no matter how they travel.

Across the country, 32 state governments or agencies, 76 regional organizations, and 663 individual municipalities have all adopted such policies to create safer, multimodal transportation networks.

West Hartford’s policy is the result of a process that began in 2009 with the adoption of the Town’s 2009-2019 Plan of Conservation and Development,” according to town Deputy Mayor Shari Cantor.  She said the plan “promote[s] an integrated and balanced “complete street” transportation system which provides the best possible service, mobility convenience and safety while reinforcing a positive social, economic, and environmental influence on West Hartford.

“Utilizing a comprehensive public participatory process, guided by the leadership of the Town Council; the advocacy efforts of various community groups in West Hartford including our Bicycle Advisory Committee, and the work of our Town staff; we were able to develop and adopt this tremendous Complete Streets Policy,” said Mrs. Cantor in response to the national recognition.

Each year, the National Complete Streets Coalition analyzes newly passed Complete Streets policies. The Coalition examines and scores policy language using the guidelines laid out in our ideal policy elements. Ideal policies state a community’s vision for transportation, provide for many types of users, complement community needs, and establish a flexible project delivery approach. Different types of policy statements are included in the Coalition’s review, including legislation, resolutions, executive orders, internal policies, and policies adopted by an elected board.

The Coalition ranks new Complete Streets policies to celebrate the people who developed exceptional policy language and to provide leaders at all levels of government with examples of strong Complete Streets policies.

Sixteen agencies led the nation in creating and adopting comprehensive Complete Streets policies in 2015. Topping the list, with the first-ever score of 100, was Reading, PA, followed by West Hartford, Park Forest, IL and South Bend, IN.  Four of the next seven slots went to communities in Massachusetts:  Longmeadow, Weymouth, Ashland, Natick and Norwell.  The others were Omaha, NE and Incennes, IN.

Of the 663 municipalities with Complete Streets policies, 239 (or 36 percent) are suburban communities. Small towns, often in rural areas, have passed 111 policies, or 17 percent of all municipal policies. On the other end of the spectrum, 12 of the 15 most populous cities in the country have committed to Complete Streets with a policy, according to the organization’s 2015 report. 

“A Complete Streets approach is about helping everyone stay safe on the road—no matter if they’re walking, biking, taking transit, using an assistive device, or driving,” said Emiko Atherton, Director of the National Complete Streets Coalition. “Passing a Complete Streets policy is one of the best actions communities can take toward achieving these goals.”

Connecticut became the 10^th state in the nation to adopt a Complete Streets law, in 2009.  The law mandates “accommodations for all users shall be a routine part of the planning, design, construction and operating activities” of all state highways. Connecticut’s Complete Streets law has evolved, and now (Conn. Gen. Stat. §13-153f) requires pedestrians, cyclists, and transit users to be routinely considered in the planning, designing, construction and operation of all roads.

In 2014, Bike Walk Connecticut released a first-of-its-kind ranking of the state’s cities and towns on how bike- and walk-friendly they are. Simsbury (1), New Haven (2), New Britain (3), Glastonbury (4), and Middletown (5) claimed top honors as the five most bike- and walk-friendly communities.

Earlier this year, the University of Connecticut released a study that shows how shared space, a design concept that encourages all users to share street space, can provide much greater vehicular capacity than conventional intersections and increases pedestrian convenience. The study found that by redesigning streets and intersections as human-scaled places and incorporating shared space concepts, communities of all sizes have successfully encouraged active transportation, stimulated their local economies, reduced accident severity, and lessened their environmental impacts. The study compared actual user delays at six shared space intersections to expected user delays using standard U.S. traffic modeling software.  The state Department of Transportation issued a policy document in 2014 consistent with the law.

The criteria used in the Complete Streets evaluation include:

1. Vision: The policy establishes a motivating vision for why the community wants Complete Streets: to improve safety, promote better health, make overall travel more efficient, improve the convenience of choices, or for other reasons.
2. All users and modes: The policy specifies that “all modes” includes walking, bicycling, riding public transportation, driving trucks, buses and automobiles and “all users” includes people of all ages and abilities.
3. All projects and phases: All types of transportation projects are subject to the policy, including design, planning, construction, maintenance, and operations of new and existing streets and facilities.
4. Clear, accountable exceptions: Any exceptions to the policy are specified and approved by a high-level official.
5. Network: The policy recognizes the need to create a comprehensive, integrated and connected network for all modes and encourages street connectivity.
6. Jurisdiction: All other agencies that govern transportation activities can clearly understand the policy’s application and may be involved in the process as appropriate.
7. Design: The policy recommends use of the latest and best design criteria and guidelines, while recognizing the need for design flexibility to balance user needs in context.
8. Context sensitivity: The current and planned context—buildings, land use, transportation, and community needs—is considered in when planning and designing transportation solutions.
9. Performance measures: The policy includes performance standards with measurable outcomes.
10. Implementation steps: Specific next steps for implementing the policy are described.

The National Complete Streets Coalition, a program of Smart Growth America, is a non-profit, non-partisan alliance of public interest organizations and transportation professionals committed to the development and implementation of Complete Streets policies and practices. A nationwide movement launched by the Coalition in 2004, Complete Streets is the integration of people and place in the planning, design, construction, operation, and maintenance of transportation networks.

CT Ranks As 7th Greenest State in the Nation, Analysis Says

Earth Day 2016 – celebrated on April 22 – will be observed in communities throughout Connecticut this weekend, against the backdrop of a new state-by-state analysis that ranks Connecticut as the 7^th “greenest” state in the nation. WalletHub’s analysts compared the 50 states across three key dimensions: 1) Environmental Quality, 2) Eco-Friendly Behaviors and 3) Climate-Change Contributions, including 17 key metrics that “speak to the health of the current environment as well as the environmental impact of people’s daily habits.”

Topping the list were Vermont, Washington, Massachusetts, Oregon, Minnesota, Maine, Connecticut, New York, New Hampshire and New Jersey.  The data set ranges from “Total Municipal Solid Waste per Capita” to “Energy Efficiency Score” to “Carbon Dioxide Emissions per Capita.”

Connecticut’s highest ranking in the individual categories was in Water Quality, where the state ranked first.  Other top finished include Energy-Efficiency (6^th), Carbon Dioxide Emissions per Capita (6^th), and Gasoline Consumption per Capita (12^th).

The state ranked in the middle-of-the-pack in Percent of the Population Not Driving to Work (22^nd), Air Quality (24^th) and Percentage of Recycled Municipal Solid Waste (25^th).

In the three overall categories, Connecticut ranked 2^nd in Climate Change Contributions, 5^th in Environmental Quality, and 23^rd in Eco-Friendly Behavior.

At the bottom of the WalletHub ranking were Oklahoma, Nebraska, West Virginia, Montana, North Dakota and Wyoming.

Gary Ginsberg Receives Public Communications Award from the Society of Toxicology

Dr. Gary Ginsberg, a Senior Toxicologist with the Connecticut Department of Public Health (DPH) has been awarded the “Public Communications Award” by the Society of Toxicology, an international organization dedicated to enhancing the impact and relevance of toxicology. Dr. Ginsberg was recognized by the organization for his efforts in explaining complex toxicology issues to the public, with the conference program noting that “Dr. Ginsberg is able to consolidate vast amounts of science into easily digestible useful information to help protect consumers from potentially hazardous situations.”

At DPH, Dr. Ginsberg regularly prepares educational material for citizens on emerging contaminant issues, such as arsenic in pressure treated wood, the hazards to children from mothballs, and chemicals in children’s products and toys.  He has represented DPH in the media on numerous topics ranging from mercury in fish to chemical spill emergencies. He has also appeared on television shows such as the Dr. Oz Show and had his own radio program covering environmental issues of the day.

The organization’s annual conference, attended by 6,500 toxicologists and 350 exhibitors from across the country, and held in New Orleans last month, honored Ginsberg, who has been employed by DPH for over 20 years and regularly communicates with the legislature, local health departments, the general public and other state agencies on a wide variety of toxic exposure issues.

The recognition comes as Connecticut and the nation mark National Public Health Week, April 4-10.

Conference organizers pointed out that “his dedication to toxicology is evident though his tireless endeavors to educate the public and other health care professionals with accurate and practical knowledge.”  Also noted were his regular contributions to a Yale University blog on toxicology issues, and his website, www.whatstoxic.org, as well as writing on toxicology issues in state and national publications. Dr. Ginsberg evaluates human exposures to chemicals present in the air, water, soil, food, and in the workplace, and provides risk assessment expertise to state agencies in standard setting and site remediation projects.

Dr. Ginsberg was featured in a recent “Wastebusters” video produced by the CT Department of Energy and Environmental Protection and CT DPH on the importance of selecting green cleaning products in schools and homes.  He has drafted numerous fact sheets on chemical hazards in consumer products, such as sun screen and chemicals in hand sanitizers. In 2006, Dr. Ginsberg co-authored a book called “What’s Toxic What’s Not” (Berkeley Books, 2006).

“We are extremely proud of Dr. Ginsberg and congratulate him on this prestigious and well deserved award,” said Ellen Blaschinski, DPH’s Regulatory Services Branch Chief.  “His expertise in toxic exposures and ability to consolidate vast amounts of science into easily digestible, useful information helps protect and inform Connecticut’s citizens.”

A resident of East Granby, Dr. Ginsberg received his PhD from UConn in 1986. In addition to working at DPH, Dr. Ginsberg is an assistant clinical professor at the UConn School of Community Medicine, an adjunct faculty member at Yale University and has served on a number of US EPA advisory committees and on the National Academy of Sciences.

The Society of Toxicology is a professional and scholarly organization of scientists from academic institutions, government, and industry representing the great variety of scientists who practice toxicology in the US and abroad. The Society’s mission is to create a safer and healthier world by advancing the science and increasing the impact of toxicology.

https://youtu.be/l1MIcvoWGMo

Paid Family Medical Leave Has Broad Support in CT, Survey Shows

Eighty-two percent of registered Connecticut voters age 45-plus and a similar majority of voters age 25-plus, 83 percent, support a paid family medical leave plan now being considered by the state legislature, according to a recent survey by AARP Research. The large majority is also present across the ideological spectrum, with 94 percent of registered Democrats, 79 percent of independents and 68 percent of Republicans indicating their support for state paid family medical leave to support Connecticut workers and family caregivers.

One-thousand state voters age 25-plus were asked two questions about the paid family medical initiative, whether they supported such a plan, and whether they would support political candidates who did.

Among the 83 percent over age 45 who said they supported a paid family medical leave plan, 65 percent indicted they strongly supported such a plan, which would give employees an opportunity to contribute to and utilize a limited amount of paid leave from work to care for themselves or a loved one who is recovering from a serious medical condition.

“Connecticut voters overwhelmingly support paid family leave for workers,” said Nora Duncan, AARP CT state director. “We urge lawmakers to give serious consideration to passage of SB 221, An Act Concerning Paid Family and Medical Leave, in the remaining weeks of the 2016 legislative session. Voters are clearly interested in this policy and will make it a part of their considerations at the ballot box this fall.”

Asked if they would support a candidate for state elections who worked to implement a paid family leave plan that included working caregivers, 74 percent indicated their support, with half saying they would strongly support such a candidate. 

SB 221 would create a statewide system of paid family and medical leave for workers needing time off to care for themselves, an ill loved one or a new baby. The system that’s being suggested would be fully funded by employees with no employer contribution. According to The Institute for Women’s Policy Research, the cost to Connecticut employees would be very low at just about one half of one percent of someone’s income.

Nearly half (46 percent) of registered voters in Connecticut ages 45-plus say they are currently providing or have provided unpaid caregiving to an adult loved one.  Among them, two in three (63 percent) say they have been employed either full or part time while providing that care, the survey found.

Versions of paid family medical leave laws have been approved in California, New Jersey, Rhode Island and Washington.  California's law took effect in 2004, New Jersey's in 2009 and Rhode Island's in 2014.  Washington's has yet to take effect.

Indiana Insurance Department to Hold Hearing on Anthem Acquisition of CIGNA on April 29

The Indiana Insurance Department will consider the proposed acquisition of Bloomfield-headquartered CIGNA Health Care by Indianapolis-based Anthem, Inc. at a public hearing on Friday, April 29 in Indianapolis. “Any member of the public interested in the proposed acquisition of control may attend the hearing,” indicates a public notice of the hearing. In addition, “Any policyholder of Cigna HealthCare of Indiana, Inc., or other person whose interests may be affected by the proposed acquisition of control shall have the right to appear and become party to the proceeding.”

Officials indicated that written testimony could be mailed in lieu of an in-person appearance, and would be considered. Members of the public may make written submissions  without appearing in person at the hearing. Length of submissions should not exceed 5 pages, double-spaced. Officials indiated that submissions should be sent to John Murphy, outside counsel to the Commissioner in this matter, by close of business on April 26, 2016. Contact information is: John T. Murphy, ICE MILLER LLP, One American Square, Indianapolis, IN  46282, (317) 236-2292, john.murphy@icemiller.com  [this information was updated on 4/19]

Consumer Groups, State Comptroller Call for Full Review

Among those aligned in opposition to the acquisition is the American Medical Association, noting that the deal would make the combined firm the nation’s largest insurer by membership and also give the company a tremendous amount of leverage when negotiating with providers.  In a press release, AMA President Steven J. Stack, MD, said such proposed mergers threaten to reduce competition and choice. “To give commercial health insurers virtually unlimited power to exert control over an issue as significant and sensitive to patient health care is bad for patients and not good or the nation’s health care system.”

Anthem and CIGNA suggested that the deal will create new efficiencies that will make the healthcare market function more efficiently.  A website, www.betterhealthcaretogether.com, has been established to highlight the companies commitment to “drive health care innovation.”

Last month, a coalition of consumer and medical organizations in Connecticut called for greater public input into the Connecticut Insurance Department’s review of the proposed Anthem-CIGNA  mega-merger, expressing concerns about the potential “negative impact on both the cost and quality of care in Connecticut” of that acquisition and the proposed Aetna-Humana merger. The groups – Universal Health Care Foundation, Connecticut Citizen Action Group and the Connecticut State Medical Society – formed the “Connecticut Campaign for Consumer Choice” coalition and urged state Insurance Commissioner Katherine Wade to “ensure an open, transparent hearing process in Connecticut, where policy holders, physicians and other interested parties are given maximum opportunity to share their views.” The coalition has been conducting public information sessions, including one in Mansfield this week, to provide state residents with information on "what the proposed health care mergers will mean for Connecticut consumers."

A week ago, State Comptroller Kevin Lembo, in a letter to the Department, urged an open and thorough review in order to address significant concerns raised by health care consumers and providers.  Lembo expressed his support for the efforts of the Connecticut Campaign for Consumer Choice, noting that a merger between Anthem and Cigna would increase the Connecticut health insurance concentration over 40 percent.   Lembo indicated that only Georgia is expected to experience a more significant increase in market concentration.

CIGNA Questions Anthem; Feds Question CIGNA

A week ago, Modern Healthcare, a web publication focused on healthcare business news, raised questions about the absence of detail in the year since Anthem disclosed “what was by far the largest data breach in healthcare history.  The cyberattack—in which hackers stole the names, birth dates, Social Security numbers, home addresses and other personal information of 78.8 million current and former members and employees – caused consumers to question “whether Anthem and other healthcare organizations could manage the volumes of data they had,” according to the news report. 

The publication also questioned whether state regulators would consider not only the breach, but CIGNA’s reaction to it at the time:

“Trust with customers and providers is critical in our industry, and Anthem has yet to demonstrate a path towards restoring this trust,” CIGNA CEO David Cordani and former Board Chairman Isaiah Harris Jr. wrote in a June 21, 2015 letter: “We need to understand the litigation and potential liabilities, operational impact and long-term damage to Anthem's franchise as a result of this unprecedented data breach, as well as the governance and controls that resulted in this system failure.”  It was estimated that in Connecticut, about 1.7 million people were affected.

In January, published reports indicated that U.S. regulators temporarily banned CIGNA-HealthSpring from offering certain Medicare plans to new patients after a probe uncovered issues with current offerings, citing that CIGNA’s deficiencies “Create a Serious Threat to Enrollee Health and Safety.”  CIGNA disclosed that the U.S. Centers for Medicare and Medicaid Services (CMS) had suspended the company from enrolling new customers or marketing plans for CIGNA Medicare Advantage and Standalone Prescription Drug Plan Contracts. CIGNA acquired HealthSpring in 2012.

In an enforcement letter, CMS accused CIGNA of "widespread and systemic failures," including the denial of health care coverage and prescription drugs to patients who should have received them. The actions "create a serious threat to enrollee health and safety," said CMS, which required CIGNA to appoint an independent monitor to audit its handling of the matter.

“Cigna has had a longstanding history of non-compliance with CMS requirements. Cigna has received numerous notices of non-compliance, warning letters, and corrective action plans from CMS over the past several years. A number of these notices were for the same violations discovered during the audit, demonstrating that Cigna has not corrected issues of non-compliance,” said the 12-page enforcement letter from the Director of the Medicare Parts C and D Oversight and Enforcement Group.

CIGNA, First in Connecticut

Nearly five years ago, in July 2011, CIGNA announced it was to receive $50 million in economic benefits from the Connecticut Department of Economic and Community Development with the promise of adding at least 200 jobs the following two years, which would increase the company’s employment in the state to more than 4,000.  CIGNA also declared Bloomfield its corporate headquarters in the United States, replacing Philadelphia which had been the company’s corporate headquarters since 1982.

CIGNA was the first company to receive economic incentives under Governor Dannel Malloy’s “First Five” program, which was designed to spur job growth and support Connecticut businesses in becoming more competitive in the global marketplace. “CIGNA is proof that these tools work and that Connecticut is open for business,” Malloy said at the time.

“Through this partnership with the Governor and the state, we are building upon our long history in Connecticut,” added CIGNA Chief Executive Officer David Cordani.

Anthem's application states it has "no current plans or proposals to reduce in any material respect the number of employees employed by the Cigna companies."  The $54 billion merger would increase Anthem's membership from 38 million to 53 million members nationwide.

Approval in Florida, Concerns in California

“There are no meaningful adverse impacts resulting from the acquisition,” Florida’s Insurance Commissioner said last week in approving the acquisition in his state. “The companies, individually or in combination, are an important part of, but not a dominant factor in, the Florida market, and their combination does not noticeably increase the market concentration across the broadly measured market on a statewide basis.”

In California, the combined membership of Anthem Blue Cross and Cigna would make it the largest insurer in the state with more than 8 million members.  At a public hearing in California last month convened by that state’s Insurance Department, consumer advocates and the AMA opposed the acquisition.

"This merger would create the nation's largest insurer, which could have a significant impact on California's consumers, businesses, and the healthcare marketplace," said California’s Insurance Commissioner. "I am considering what is best for consumers and the overall marketplace. Anthem and Cigna bear the burden of demonstrating this proposed merger is in the best interest of California consumers and the health-care marketplace."

Shareholders of Anthem and Cigna voted overwhelmingly in favor of the merger plan late last year, and regulators in 26 states where the companies operate are at various stages of considering the acquisition.  Attorneys General in a number of those states, including Connecticut, are looking into the proposed acquisition on anti-trust grounds, and the U.S. Department of Justice has the final authority to approve the deal, published reports indicate.

The news site Business Insurance reported soon after the acquisition was announced that “viewed in tandem with rival Aetna Inc.'s recent $37 billion merger agreement with Humana Inc.— as well as St. Louis-based health insurer Centene Corp.'s proposed acquisition of Woodland Hills, California-based Health Net Inc. for $6.3 billion — experts said regulators may be more stringent in examining the Anthem/Cigna deal's potential to dampen health insurer competition.”

CT Medical Examining Board Website Ranked 15th in US

If you’re looking for information about your doctor, you may find yourself searching the website of the state medical board.  In states across the country, those are the agencies that license physicians and also discipline them for offenses including sexual misconduct, substance abuse, and negligent care. But the accuracy and completeness of the information you find varies from state to state, according to a new analysis from Consumer Reports, which ranked the Connecticut Medical Examining Board as 15^th in the nation for the information readily available to the public from the agency website.

Consumer Reports Safe Patient Project partnered with the nonprofit Informed Patient Institute to evaluate the websites of state medical boards in all 50 states. They found that most are difficult to navigate and the information on them varies widely.

Overall scores were based on eight categories:  Search Capabilities, Complaint and Board Information, Identifying Doctor Information, Board Disciplinary Actions, Hospital Disciplinary Actions, Federal Disciplinary Actions, Malpractice Payouts and Convictions.

Connecticut, with an overall score of 58, was rated good in four categories, very good in two, and excellent in one category.  Only one category was given a poor rating.

The highest rated state medical board websites were in California (84), New York (79), Massachusetts (78), Illinois (76), North Carolina (76), Virginia (72), New Jersey (70), Florida (70) and Texas (68).

The Federation of State Medical Boards, which represents the boards and facilitates communication among them, acknowledges that variation is a potential issue. “Consistency is certainly a worthy goal,” Lisa Robin, chief advocacy officer for the organization told Consumer Reports. “Looking at the disciplinary trends to make improvements in the system … we would always encourage that.” Still, she also says that, “the rate of discipline alone is probably not a good picture of really what the boards do and how well they’re able to protect patients in their state.”

But, as Consumer Reports’ analysis found, those state boards fall short in other measures, too. In fact, in many instances, physicians who have been severely disciplined continue to practice while their offenses remain relatively hidden, buried deep on the boards' websites or unavailable entirely online.

The Connecticut Medical Examining Board website includes a listing of disciplinary actions taken by the Connecticut Medical Examining Board or the Connecticut Department of Public Health but notes that “information is not intended for licensure verification purposes.”  Actions taken – ranging from reprimands to civil penalties to license suspension or revocation are listed.  Board meeting minutes are also available on the site, as well as procedures for individuals to file complaints.

Gender Identity in Schools Among Topics at Connecticut School Health Issues Conference

The keynote address “When Boys Will be Girls: Getting A Grip on Gender” will greet attendees – school nurses and school health officials from across Connecticut - attending the 38^th Annual School Health Conference on Thursday in Cromwell. “Critical Issues in School Health 2016,” a two-day conference, will have expert presentations on issues ranging from absenteeism to infectious diseases, food allergies to mental health.  But no issue has grown in attention and interest recently than how to respond to LGBT students in the school setting.

The conference is coordinated by the Connecticut chapter of the American Academy of Pediatrics with the assistance of the Association of School Nurses of Connecticut.  

The keynote will be given by Robin McHaelen, MSW, founder and executive director of True Colors, a Hartford-based non-profit organization that works with social service agencies, schools, organizations, and within communities to ensure that the needs of sexual and gender minority youth are both recognized and competently met. McHaelen is co-author of several books and articles on LGBT youth concerns, and has a national reputation as a thought leader in LGBT youth concerns, programs and interventions.

In her presentation, titled “When Pink and Blue Are Not Enough,” McHaelen offers suggestions on working with LGBT students, and seeks to increase “understanding, knowledge and cultural competency regarding LGBT students,” while identifying issues of “risk, challenge and strengths specific to LGBT youth.”  She also will point to “opportunities for intervention that will ensure appropriate care within a safe, affirming environment.”

Among the recommendations:  offer gender-neutral bathroom options, always use the patients’ chosen name and chosen gender pronouns, and “recognize that there are additional stressors (and that there may be significant feat on the part of) transgender patients.” 

McHaelen will be offering a similar presentation at the New England School Nurse Conference, to be held in late April in Mystic, hosted by the Association of School Nurses of Connecticut.  The president of the Association is Suzanne Levasseur, Supervisor of Health Services for the Westport Public Schools.  The New England affiliates include Massachusetts, Vermont, New Hampshire and Maine.  The conference theme is “Waves of Change, Oceans of Opportunity.”

Lesbian, gay, bisexual, and transgender students are the targets of bullying, harrassment, and disproportionately high discipline rates at school, researchers have pointed out. But without consistently collected, reliable, large-scale sources of data, it's difficult to track the extent of those problems or the effectiveness of proposed solutions, a group of researchers at Indiana University said in a briefing paper released this week.

Expanding existing federal surveys on youth safety and well-being to include more questions about gender identity and sexual orientation could provide a clearer picture, according to the researchers, noting that “if you don’t measure it, you can’t improve it.”  They suggest addressing the data gap by adding discipline and harassment items to existing health surveys that currently include measures of sexual orientation and gender identity, such as the Youth Risk Behavior Survey, collected by the Centers for Disease Control and Prevention.

“Although these measures provide more specific information about sexual orientation and in some cases gender identity, they do not provide sufficient information about the specific negative outcomes experienced by LGBT students,” the research paper points out.  They conclude: “the availability of data documenting the experiences of LGBT students is a civil rights concern, and the expansion of data collection efforts to include sexual orientation and gender identity is a critical next step in ensuring the rights of LGBT and all students to participation and protection in school.”

The mission of the Association of School Nurses of Connecticut is to support, assist and enhance the practice of professional school nurses in their development and implementation of comprehensive school health services that promotes students' health and academic success.  The Connecticut Chapter of the American Academy of Pediatrics has over 600 active members committed to both improving the health and safety of Connecticut's children and supporting those who provide care to these children.