HARTFORD, CT – Senate Democrats announced Friday morning two more priority bills aimed at addressing the spiraling cost of healthcare for state businesses and residents.
Senate President Pro Tem Martin Looney, D-New Haven, Senate Majority Leader Bob Duff, D-Norwalk, and Sens. Jorge Cabrera, D-Hamden and Matt Lesser, D-Middletown, introduced Senate Bill 10, An Act Concerning Health Insurance and Patient Protection, and Senate Bill 11, An Act Concerning Prescription Drug Access and Affordability. The Democrats described the bills as among their top-12 legislative priorities for the session.
“One of the concerns that we’ve had is that onerous insurance company burdens, as we know, and the ever-increasing cost of prescription drugs, are really something that are constant worries and a constant aggravation and a source of anxiety for patients,” Looney said at the Legislative Office Building. “We must do our utmost in the General Assembly to contain these where we can.”
Senate Bill 10 contains three major provisions. The first establishes a penalty for any health carrier in Connecticut that doesn’t comply with the legal requirements for mental health and substance use disorder benefit parity. The General Assembly unanimously passed a mental health parity law in 2019, but enforcement of the law has been slow according to the Democrats.
The second provision of the bill prohibits automatic “downcoding” by insurance companies, where insurance companies choose to pay for a lower level of care than what a doctor has ordered. State law requires that before treatment is denied, a doctor of the same specialty must review the course of treatment. The provision would extend mandatory human review to downgrading decisions as well, which are often made by an insurance company’s algorithm or artificial intelligence.
Finally, Senate Bill 10 would place greater restrictions on insurers’ ability to use “step therapies,” where an insurance company requires doctors and patients to try less-expensive, less-effective medical procedures or drugs to address a medical issue before moving on to the next “step” in treatment. State law already bans the use of step therapies for drugs used to treat schizophrenia, major depressive disorder, or bipolar disorder.
“We know that only about one percent of people who are denied a claim or prior authorization will ever fight that denial – but when they do, they’ll win about 75% of the time,” Duff said. “That tells me there’s a lot of room for improvement in the way that health insurance and the people it insures is managed in this state. Hundreds of thousands of people are covered by insurance in Connecticut, and insurance companies employ about 60,000 people in the state. It’s a big business with a direct, personal impact on most everyone.”
Senate Bill 11 focuses more specifically on the costs of prescription drugs. The major provision of the bill addresses pharmacy benefit managers (PBMs), which the Senate Democrats say drive up costs for insurers, pharmacies, and ultimately patients. The bill would seek to establish a fiduciary responsibility of PBMs to ensure they pass along any savings to their plan sponsors.
The bill would additionally authorize state agencies to pool their buying power to bring down the cost of prescription drugs, as well as increase nursing home investment in patient care. Finally, it would expand the definition of emergency services to include a greater range of outpatient services covered under Medicaid.
Lesser said that growing prescription drug costs are impacting everything from families to the state budget.
“The cost increases that we’ve seen are impacting the state’s Medicaid program,” he said. “They’re impacting the state employee costs. They’re impacting retiree costs. If you look across state government, this is one of the biggest things that is impacting our state budget, limiting our ability to spend money on roads, schools, and all of the other things we want to do.”
Cabrera talked about how difficult the healthcare system is to navigate for patients, from getting authorizations to dealing with claims being denied.
Sen. Jorge Cabrera, D-Hamden, discusses how difficult it is for patients to navigate the healthcare system in Connecticut during a news conference Friday, Jan. 25, 2025, at the Legislative Office Building in Hartford. Credit: Jamil Ragland / CTNewsJunkie
“With each passing day, people have a better understanding of the life-changing effects that insurance company decisions can have on them and their families. Connecticut has a responsibility to step in where it can and level the playing field when it comes to these patient/insurance company relationships,” said Cabrera, who co-chairs the Insurance and Real Estate Committee.
Connecticut’s healthcare environment has become more challenging over the past few years. The small group health insurance market was described as being in a “death spiral” after Aetna and Cigna left the market last year.
FILE PHOTO: Sen. Tony Hwang, R-Fairfield, testifies in favor of SB 2, An Act Concerning Artificial Intelligence, Thursday, Feb. 29, 2024, before the General Law Committee at the Legislative Office Building in Hartford. Credit: Jamil Ragland / CTNewsJunkie
Sen. Tony Hwang, a Fairfield Republican and ranking member on the Insurance and Real Estate Committee, said in a statement that he was hopeful that the committee would focus on transparency and accountability this year when deciding what bills should go to public hearings for further action.
“We cannot continue to search year after year for solutions to high healthcare costs and premiums, and instead must allow for all options and opinions to be weighed,” Hwang said. “In fact, our committee leadership fully supported drafting language and public hearing on SB 10 and SB 11. Those ideas and other proposals from the legislature and the Lamont administration are opportunities for us to move forward.”
Hwang also said the committee should consider legislation to promote Association Health Plans to allow small business and nonprofit employees who are not covered by their employer to pool their resources and risk to find coverage as a group.
“This is an affordable, sensical, and logistically sound savings tactic that would help insure thousands of workers across Connecticut,” Hwang said. “Additionally, we must enhance and strengthen benchmarking. I have and will continue to work with the Office of Health Strategy, Governor Lamont, and other stakeholders to bolster the system and make sure the state is committed to lower prices through the benchmarking process. There must also be accountability in this process, and an openness to information like rate increases that tend to lead to the high premiums we see year after year.”
He also stressed that the committee should look at other available mechanisms to lower costs, including reinsurance, certificates of need, and a public option.
“Transparency will open the door to meaningful discussion which will lead to meaningful action,” Hwang said.