Connecticut health insurers paid out an extra $1.8 billion last year [The Hour, Norwalk, Conn.]

Oct. 22—Connecticut insurance carriers spent 20 percent more to cover the administrative cost of medical claims in the second year of the COVID-19 pandemic, according to the newest state "report card" on insurance carriers, as people scheduled doctor's visits after getting vaccinated against infection.

The Connecticut Insurance Department provides an annual update each October of insurance carrier enrollment and expenses outside of medical care, averaged separately across indemnity and HMO plans. Multiplying average claims administration costs against total membership across carriers and plans, last year's health insurance claims expenses in Connecticut added up to nearly $10.8 billion, compared to just under $9 billion in 2020.

The Connecticut Insurance Department's consumer report card does not include data from "captive" insurers, plans through which medical bills are underwritten by large employers directly rather than through a carrier's insurance pool.

Elevance Health subsidiary Anthem is the dominant carrier in Connecticut, one of two along with ConnectiCare to add members last year to push its market share to 54 percent of all policies. The two carriers are the lone participants in the Access Health CT public exchange for health insurance that was created with funding from the Affordable Care Act as a way for people to get coverage if an employer does not provide it.

The Connecticut Insurance Department released the consumer report card about two weeks in advance of the November 1 kickoff to open enrollment, when many employers allow members under their plans to change their health coverage. Open enrollment for the Access Health CT public exchange begins on that day as well.

The Connecticut Insurance Department recently approved Access Health CT rate increases for Anthem that average 6.8 percent, with ConnectiCare's Access Health CT plan averaging a 15 percent increase. While the department also approves rates for small business groups, it does not do so for large groups and captive insurers on the assumption they wield the heft to line up quotes at competitive rates.

On Wednesday, an Elevance executive discussed Anthem's medical claims trends against the context of the COVID-19 pandemic, during which emergency wards were overrun for extended stretches, but regular doctor's visits plummeted before rebounding last year. Overnight hospital remain lower than before the pandemic, according to John Gallina, chief financial officer of Elevance.

"The overall cost structure of the health system is still a bit higher than what it would've been had COVID never occurred," Gallina said Wednesday, speaking on a conference call. "We're seeing outpatient a bit higher and inpatient a bit lower, helping offset to have a more normalized trend."

Bloomfield-based Cigna had roughly 330,000 members for a 17 percent market share last year in its home state, with Hartford-based Aetna and parent company CVS at about 300,000 people for 15 percent of the market. ConnectiCare, a Farmington-based subsidiary of EmblemHealth, had just over 150,000 members, and UnitedHealth and its Oxford Health Plans division combined for 110,000 members.

Connecticut employers are losing one option after Point32Health elected to pull out of the Connecticut market for commercial insurance, with its Harvard Pilgrim insurance membership having peaked three years ago at nearly 40,000 people. The Massachusetts-based nonprofit plans to continues to offer Medicare Advantage coverage through its CarePartners of Connecticut affiliate.

Jayme Stevenson, a Darien Republican who is running for the 4th Congressional District seat against incumbent U.S. Rep. Jim Hines, D-Greenwich, wants people to be able to purchase insurance from carriers regulated in other states as a way to improve prices and coverage.

"That would infuse the system with a little bit more competition which ultimately raises the quality of services and brings down prices," Stevenson said in a debate last week sponsored by Connecticut Public and the League of Women Voters of Connecticut.

On a conference call last week, the CEO of UnitedHealth Group said overall inflation is having an impact on health insurance rates, on top of the rebound in medical visits and procedures more than two years after the onset of COVID-19.

"There is a blend of possibly a little bit of COVID-effect in the system; but cost-of-living effects — things like inflation, things like capacity constraints in the system as the labor market tightens — have affected different parts of the system at different moments," said UnitedHealth CEO Andrew Witty. "There's some unavoidable pressures in the macro environment, that everybody is well aware of."

Alex.Soule@scni.com; @casoulman

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