Face the Facts: State lawmakers battle over bill meant to curb rising healthcare costs

Sen. Saud Anwar (D-South Windsor), who is also physician, explains his concerns with a proposal to cap out-of-network charges. He went so far as to call it a “disaster.” The plan, proposed by the governor, is intended to limit skyrocketing health care costs. But opponents say it will end up harming patients and providers in the long run.

Mike Hydeck: The soaring cost of health care is at the center of a serious debate between the governor and lawmakers right now. Some say a bill meant to save patients money may do the exact opposite. In fact, my next guest calls House Bill 6871 a disaster. Senator Saud Anwar is here. He's the chair of the Public Health Committee, Vice Chair of Insurance and Real Estate. Welcome back. Good to see you. We appreciate it. So this bill would cap how much out of network doctors can charge. Why do you say this is a disaster, as you put it?

Saud Anwar: Sure, first and foremost, I know that our governor is committed to trying to reduce the cost of health care, so I have been supportive of so many of his bills in the last six years. He's doing very good work to try and protect our citizens. This particular bill has some problems. If you look at what it's going to do to the health care system, that's where the issue is. This is going to reduce the health care system's ability, or loss of money in the $700 million range. So here's how it works out, and I'll break it down. First of all, we know that there are nine hospitals that are in trouble, existential threat, from where I see them.

Mike Hydeck: In trouble of going out of business, already?

Saud Anwar: Going out of business, yes. So that's nine hospitals in our state. That is almost, if you look at the coverage, half the state's population would be affected. But we also need to recognize that the Medicaid payments, that is about 35% to 40% of all of the health care systems funding that they're getting, Medicaid payments are about 57% of what Medicare paid in the year 2007.

Mike Hydeck: So Medicaid is where the state and the federal government combined to pay for the…

Saud Anwar: State only. So Medicaid is state, but the amount of money in the Medicaid is so low that there's no other industry that you would actually say that pay me 57% of what you were paying in 2007.

Mike Hydeck: Right, so if you were went in for a broken leg and they said normally it would be $1,000, you're gonna pay half that.

Saud Anwar: Yeah, if at all. That's one part, and then the Medicare payment is another big part of it, and the federal government, that's a major challenge there as well. They have not increased their payments either. So now that's the bulk of it. Now people are left with like 15, 20, 30% of the remaining amount. Now, with the knowledge of the Medicaid being reduced by the federal government, that is every day we are hearing that we are going to reduce $800 billion worth of Medicaid.

Mike Hydeck: That's not, that's not written in stone yet. That's what people are projecting at this point.

Saud Anwar: But if that happens, we know the children's hospital will close, because that's 60% Medicaid. The two childrens hospitals, Yale as well as Hartford. So that's a disaster, right there too.

Mike Hydeck: As that's even before this bill we're talking about. That's having to do with the federal government.

Saud Anwar: Yes. Okay, so now, with that backdrop, now you're actually saying that if the insurance companies walks away from the table, which they will if this bill passes, then the hospitals, which are barely surviving, they will go under, and that the cost is going to be $700 million, we will see immediately many hospitals will go underwater.

Mike Hydeck: So when you brought this up, called it a disaster, there was bipartisan, everybody was singing from the same hymnal at that point. Republicans, Democrats, all the heads of the committees. So let's play devil's advocate for a second. The governor mentioned a hypothetical situation. He says, you go in for a surgery. Now all of asudden, you're done with the surgery, you're home, and you find, as you look at your bills, the anesthesiologist is out of network, so now your anesthesiology bill goes way up. That's what he was trying to combat here. If this is not the way to do it, this bill, how do we do that?

Saud Anwar: Sure, I think with respect to the surprise bill, there are federal laws and there are state laws. They're already in place, so the governor does not need to worry about that part. The surprise bill acts are in place. But with respect to the fact that the two parties need to come together to the table, we should not, as a government, actually help one over the other. What this bill does is it is actually it is actually selecting the winner, and the winner is going to be the insurance industry. And the insurance industry financially is doing far better than the healthcare industry. If you look at the numbers of what's going on with the healthcare, at least the hospital and the physician groups in the state of Connecticut, they're going through a lot of financial challenges, as opposed to the insurance industry. So we have a responsibility to not pick winners and let them decide amongst each other based on their capacity and what the market requires. So that's the one of the parts.

Mike Hydeck: So if I'm a regular person and I get one of those bills, I don't know that there's a law protecting me. There needs to be, how do I know that if I look at a bill and I'm going to be threatened by a creditor saying, Look, you need to pay this even though it was an unexpected bill, how does a patient actually work with something like that?

Saud Anwar: So that's where the insurance companies are probably not being fair, because they are trying to have somebody else pay for it. The insurance companies are supposed to pay for it because they are the ones who have been taking the premium from the individuals. So that's part of the confusion that gets created.

Mike Hydeck: But you're also on the Insurance Committee. That means you could hold them accountable. So what do we do?

Saud Anwar: So that's where the issue is, that we need to bring them to the table, and we need to talk to these individuals. But there's a broader question, and I think that's what we have to have more conversation about. The broader question is, what the governor is trying to do is to reduce the cost, and I'm 100% with him on that part. And I think the ways to do that is to actually have more health care before the patient gets too sick. So we have actually an illness based health care system, rather than a wellness based health care system. We need to invest more into the wellness part of it. Preventive care. And that's and then try to control the cost and the pharmaceutical arena. The cost of medicine is out of control. The cost of inpatient care is out of control, and that's where the opportunity is, and that's where we'll have to work together.

Mike Hydeck: Unfortunately, I could talk about this all day. I have to leave it there. There's so many more questions I have. I hope you'll come back. Senator Anwar, we appreciate it.