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“One Step Closer To Accountability”

by Paul Bass | Nov 30, 2006 10:05 am

(1) Comment | Commenting has been closed | E-mail the Author

Posted to: Health Care

So rejoiced the state’s health care advocate, Kevin Lembo (pictured), in referene to a judge’s ruling that HMOs must reveal how much of the $700 million they get in taxpayer money goes to run Connecticut’s health-care program for the poor, and how much goes to their own overhead and executive pay.

For more than a year, legal-aid lawyers and a Yale public-health professor have fought to force Anthem, HealthNet and Community Health Network to disclose how it’s spending all that money it receives to run the state’s Medicaid program for 310,000 people in need. With the sometimes-help of the Rell administration (and sometimes not), the advocates convinced the state’s Freedom of Information Commission (FOIC) to order the release of documents showing how the public money was spent. But the companies continued to fight the order, this time in court. They said the information contained proprietary business data and didn’t fall under freedom of information law.

Wednesday, Superior Court Judge George Levine upheld the FOIC’s order. He called “facially and statutorially absurd” the HMOs’ argument that they don’t carry out a “government function” when they get $700 million form the state Department of Social Services’ Medicaid program. Click here to read the judge’s decision.

Besides the principle of the public’s right to know how tax dollars are spent, another pressing issue is raised by this case: Is the health care being delivered? For instance, there have been claims about people being unfairly rejected for prescription drugs to which they’re entitled under the program. Medicaid patients have trouble finding doctors (espeicially dentists) who will see them.This data, if released, can shed light on how people are denied requests for medication, and how much (or too little) doctors are reimbursed for seeing Medicaid patients.

Click here to read legal aid’s release reacting to the ruling.

Kevin Lembo, the advocate on the state payroll hired to look out for consumers’ health-care interest, obatined intervenor status in the case. Following is a statement Lembo release about why Wednesday ruling matters so much:

The court’s decision in this matter is a victory for Connecticut taxpayers and for the future of health care reform in our state.

Without the transparency that flows from this decision, we would never know what percentage of our HMO premium is actually spent on public health care, and what percentage is spent on executive bonuses and overhead.

“The managed care organizations tried to have it both ways “” monopolistic access to public money through public contracts, as well as secrecy in their business practices that put them in violation of state sunshine laws.

“Health care and profit-motivated companies make strange bedfellows.  Without accountability and transparency, however, these business relationships are doomed to failure.

“For too long the most critical information in this program has been kept secret from the public in a way that shields the HMOs from accounting for recipients’ lack of access to care.

“The kind of information that the HMOs have been shielding, is the same information that we as taxpayers and state advocates need in order to speak substantively about real improvements in access to health care for the underinsured and uninsured in our state.”

“We’re now one step closer to ensuring that accountability.

“This is about more than managed care.  It is about accountability for over $700 million of taxpayer money given to private entities to run a critical governmental health insurance program. 
The court’s decision today reestablishes the framework for a healthier Connecticut “” physically and financially.”

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posted by: Cedar Hill Resident on November 30, 2006  1:53pm

It is about time someone was looking into this!! I a single mother was on this. I was lucky that the Fair Haven Clinic is a great place that had all my medical needs under one roof and people that really cared. Even now that I have real insurence I still go there. But…..... the denist thing is the worst. There are no dentist at all taking new people! NONE!! I told them that my teeth were getting bad I could not find a dentist so I went to an emergency apointment at ??? (not saying) and they told me that is would be six months before I could get an apointment but they would give me a perscription for percocet that would last the 6 months??? Oh yeah really smart people. I refused the drugs. To make a long story short I went through kemo and ended up with even worse dental problems and had to call a dozen state reps to get a dentist to help but in the middle of fixing the problems which by this point where really bad (basiclly I think they tell the dentist to not do anything till they need to be pulled they make you wait a year till you need a root canal but do not cover it) the dentist they got me closed his doors for good and I was back to square one.  If I had got the basic dental care in the begining I would not be in the shape I am in now!

So I am happy that the whole thing is being looked over by people that may make it better.

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