> > This week on the Wheelhouse.

> > And health care.

How affordable?

Is insurance under the Affordable Care > > for Connecticut Public on Frankie Graziano.

This is the Wheelhouse.

It's a show that brings politics the people.

We got your weekly dose of politics in Connecticut and beyond right here.

♪ Will they or won't they caught federal health care coverage?

It's a question the Trump administration has dealt with on all the way back to 2016 candidate Trump.

One point, oh, and we all remember concepts of a planned back in 24 right.

We all remember that.

As health care customers still grapple with affordability.

Questions today and studies show that Americans are paying more for health care premiums.

This hour, we'll talk to a local reporter about the cost for people in Connecticut.

But first, we'll dive right into federal health care policy with somebody from a top health policy water kff health news.

Julie Appleby is Kff Health News.

Senior correspondent.

Julie, thank you so much for joining us on the Wheelhouse.

Thanks for having so.

Glad to have you can't wait to talk to here on the show.

Just want to invite folks to give us a call.

We'll take them later on in the show.

88 7 to 0 9, 6, 7, 7, hey, Julie.

We're hearing a lot about the rising costs of health care for people.

Buy coverage through the Affordable Care Act Care Act exchange.

Why is this year such a pivotal moment?

What's changing?

> > You know, it was kind of a double whammy this year.

So first of all, we had about an average 20% increase in the Affordable Care Act premiums.

Okay.

And then also remember in the last year, there was a lot of debate over these things called enhanced subsidies and Congress didn't act to extend them.

So the subsidies, the enhanced part one away.

So people subsidies became less one.

Yeah.

All that stuff People are paying on average about 58% more for their Affordable Care Act coverage this year compared with last year.

So that's that's a big chunk of change for a lot of people.

Before we go further, this is going to be a question for the super uninitiated.

> > So part of me for the really simple question here.

But it does it confuse I guess some people, Obama care, Affordable Care Act, the exact same thing is Obamacare still a thing?

> > Yeah.

You know, a big pickup.

That is the Affordable Care Act and people started calling Obamacare because it did.

> > Pass commerce and he signed it into law during his term.

So they're interchangeable.

People use them either way the end of last year there was a political fight as you were talking about over the future of enhanced premium tax credits that have helped many Affordable Care Act enrollees get coverage and afford it.

The fight COVID a government shutdown longest in U.S.

history.

Remind us what happened ultimately it can people still access.

The subsidies were talking about?

That's a really good question > > Yeah, the subsidies on.

themselves did not go away.

They just became less let's go back in time a little bit.

It was during COVID.

They passed these enhanced subsidies.

They they were always meant to expire, but they were extended once and then they were due to expire at the end of last year in Congress.

All as you mentioned, we saw the shutdown over this debate over whether or not to extend them.

So they still exist.

But the difference now is that.

> > People > > get less and they have to spend more of their own household income toward the premium for the subsidies.

remember the holder of people who actually did get cut off from subsidies.

And those are people who earn more than 4 times the federal poverty rate.

So those folks don't get any subsidies.

And also they're the ones seeing the biggest increase in the amount of what they pay this year.

But everybody else is paying a little bit more because their subs used smaller and because premiums went up.

> > By now, can we gather with the current administration's approach?

Is the Affordable Care Act?

> > You know, there it's Dunham number of things that we've seen.

Congress pass the one big beautiful bill which has some things in there that affected the Affordable Care Act.

> > And then the administration has recently signed a final rule for 2027.

It says for Affordable Care Act incorporates a number of those things.

So what am I talking about?

The administration?

has.

A fraud and improper enrollment.

A big part of their discussion about the Affordable Care Act and some policy folks we can time.

It was later debate.

Some of you know what, what, what?

All that is.

But at any rate they have set some new rules for next year that are going to increase income verification requirements on some people.

It's going it already got rid of what the special enrollment period for low-income people that essentially allowed low income people to kind of sign of year-round.

So they got rid of that.

And there's a number of other things that are in the rule for next year in.

Concluding interestingly.

Higher deductibles in bronze plans and then eventually in these plans call catastrophic plans.

And that's interesting because the administration said that a lower premiums of people are worried about premiums.

But allar polls show that people are also really worried about what are called out of pocket costs.

And, you know, these are the amount you've got to pay.

When you go to the doctor or the hospital, there's an out of pocket maximum for the year and the deductible is part of you got to pay a deductible right before your insurance fully kicks in.

So the Trump administration has sort of double down on us and what we want to offer these plans to lower premiums.

But we're going to increase.

We're gonna allow insurers to increase the duct that doubles the on the debate over subsidies are lawmakers.

And I guess I'm talking about all lawmakers not just want the majority.

> > And not just federal officials in the Trump administration.

Is there a broader reforms that are being discussed?

Are we having incremental change?

We haven't any chance.

It's something that's transformational.

What your thought there.

> > So I think the broader picture is health care costs in general, not just before double CARE act, right, because we're seeing employer costs go up to.

There was a there was a report out just recently from PWc.

The consulting firm that showed about a 9% increase this year and next year as well in what it costs to cover somebody in their jobs.

And that's Ari, a big chunk of change for most employers if they get averages close to like $27,000 a year for family coverage, an employer plan.

So so when they're looking when when?

Lawmakers and policymakers are looking at solutions to this.

Sometimes they're looking at creating situations that they can control what is being paid.

So health spending So, for example, hospital pass rate.

Hospital costs are a big chunk of what we spend money on us.

Like 31% of health care spending goes to hospitals.

Physician services comes in only 21%.

So there are some places that are looking okay.

Maybe we should cap some hospital piece my my colleagues recently wrote a story that Indiana and they got an interesting program.

It's it's a G O P controlled state and they are actually trying to set some price controls on hospitals.

And we've got to say below a certain limit otherwise they might eventually list their nonprofit status.

And a couple other states are doing things like that.

So there are some things on the margins around cost control that are being discussed.

But it's a that's the biggest difficulty and health care right now is how do control what is spent and this might be a separate issues.

But the hospitals might say to that they're not always getting paid back for the services.

They're rendering.

> > Yeah, that's a that's becoming a bigger issue because as you see with the formal care act, right, average deductibles are going up.

So so an average deductible, one of the biggest amount last year by 37% its.

It's a little over $3,000 and some change.

And then in bronze plan, which is the lowest premium plans.

They average around 7 grand a year and a lot of people don't have 7 grandson around.

So hospitals are increasingly having a hard time collecting the deductibles from people and things like that show, though, we're going to hear a lot about that.

I think in the next year.

So people who are insured but really.

Art, well insured because they don't have the money to pay these out of pocket costs like deductibles and copays.

> > And I want to go into that hardship just a little bit more and underscore that most Americans covered under the ACA, as I understand it, qualify for subsidies.

> > Discounts on the full premiums or at least some help and some federal support there.

But middle income Americans don't right.

Are middle income folks struggling to pay the full premium?

> > Well, you know, a lot of people, I think I saw something from a conservative publication just the other day.

The pair got health Institute.

It says the average, I think person the median person.

He's about $42 towards their premium.

Now that's a median.

So have to people pay more enough.

People pay less.

And these are folks who get subsidies.

So, yes, a lot of people still get subsidies.

And yes, a lot of people still get help paying for those plans.

But the subsidies just cover your premium.

People still have to meet these out of pocket costs and what we saw this year's people shifting to plans that have higher out of pocket cost because their premiums are lower.

So that's probably why was it that yes, substances exist.

People are still getting a lot of help except for that group that over the 400% in the end that this year based on the federal poverty levels that are used to calculate the subsidies is about 62,600 for an individual or about 106,600 for a family of 3.

So if you make one dollar more than that, you're not getting any help when your subsidy your premium.

Also Subsys.

Yes, do help a lot of people that I did some stories earlier this year.

Remember, we had some initial results showing about 1.2 million people.

You are signed up for the ACA this year during open enrollment.

a lot of those folks are folks who didn't some say more and then since then we have seen about 3 million more people not paying their premiums.

So, you know, they were on one rolled and maybe didn't realize the cost or maybe the cost too much in their budget right now.

But but that that was a big jump to 3 million drop.

Policy experts and political folks are kind of arguing over.

What the reasons were for that most of the policy folks say it's because costs went up so much that 58% remember that people are paying on average about 58% more this year.

Some of the administration officials are saying that that drop off is.

Mostly due to fraud control efforts in the Affordable Care Act.

So there's that debate that's ongoing right now.

Let's lock in on the important work that Kff does because it does involve scientific evidence last research guys surveyed.

> > Adults covered by ACA marketplace plans in late 2025.

And again this year, as I understand it, what did you all find?

> > So, yeah, I I can't health news is an operating division of camp up in camp.

That is a policy group and they do a lot of polling and they're polling is very interesting is it shows that Americans really are deeply worried about health care costs.

it's right up there right now with gas prices and, you know, we all know it's kind of going on with gas prices.

So something like 64% of folks are very worried about being able to pay their bills and then when they dig down into a day, they look at, you know, who is this resonating with?

Mostly and and not voters overall.

See health care will influence their whether to vote this year end what a vote for.

But when you dig down into the Democrats are more likely to bees hurt by this by something like 72% of them say they are independence, which are going to be a key factor in the midterms, say the 63% of them say health care costs are going to influence their decision to vote.

Among Republicans is about 47% Democrats tend to have an edge on voters minds in terms of which party might do better in controlling health care costs, whereas Republicans have the advantage of which party voters think will solve fraud and waste problems.

So that's why you're going to hear a lot of discussion from the Democrats about health care cost.

A lot of discussion from the Republicans about.

Fraud and waste in government programs which would include the Affordable Care Act.

So you're getting to the affordability problem there without talking specifically, I guess about the Affordable Care Act.

> > Let's talk about other things like employer sponsored insurance or Medicare, other types of coverage they facing the same kind of pressures too.

> > Yeah, we're seeing cars go up kind across the board and again, remember, it's a function of prices and how much is being used?

And when they combined, that's what you get national health spending on.

And it's always been going up.

It's generally going up faster than inflation.

Why is that?

It's, you we have an aging population.

We have a growing labor costs.

We have.

New drugs and treatments.

The new weight-loss trends are a factor in why?

Why are we spending more?

Because we're spending more on some of these strikes, but on top of that, we've also got this year if we're double CARE act, right?

We've got we've got premiums going up partly because those subsidies, one way the insurer said they party raise premiums by about 4 percentage points of that additional increases.

Your because they figured there's going to be fewer people and in their coverage and the people, the dropout tend to be people who are healthy.

So that leaves them with sort of a sick or pools.

So they have to price that intial those costs go up.

We're seeing hospital, Costco, all of these things going out with a function of all of those things that are kind of being rolled into these premiums and then that affects how.

Both employers because employers are paying more and individuals are are seeing what happens with their with their caps to really cut actualize this conversation.

With some background.

And first of all, what generally drives health insurance costs to go up and then help me understand if there's any kind of policy levers that can be pulled to sort of.

> > Address the issue to address the rising costs.

> > Yeah, that's the $64 question.

Ever since I've been covering healthcare, it's been, you know, how do we control these costs?

And we spend about 31% of our health care dollar on hospitals, physician services about 21%.

And then every like a lot of other things.

Medical equipment, home care, administrative costs are not 24%.

So that's kind of your pies will where you pull the levers and so more and more focus is is a lot of focus is on the insurers.

Writer is everybody kind of blames their premiums going up towards those are in those insurers, right?

But what feeds into that or hospital costs drug cost.

So we are seeing some changes.

I mention the effort in Indiana and some other places to kind of cap what worse, what people are paying for.

But hospitals can charge.

Their services.

We've got also know there's some she ation Medicare over drug prices.

We're seeing some other efforts around drug prices a little bit on the margins.

How are we gonna control?

But those prices we pay the most in the world for drugs in the United States.

Compared with other countries.

There's a little bit of discussion about price controls, but that's always been resistant.

So what else?

What else can be sort big-picture national policy level?

People are looking at consolidation as as more more hospitals consolidate and then they by a doctor practices.

They've got to be a negotiating tool with insurers, right?

They can say, look, I've got all the doctors in this area and most of the hospitals.

If you want me in your plan and your debt to pay me more.

and insurers are consolidating and trying to fight back and saying, well, you know, if you want our business, you have to lower your prices.

So so so one area that some policy experts say should be focused is this consolidation that that stuff it involves antitrust and fighting mergers and things like that.

So that's cut one big picture thing.

What are some of the smaller things may be the more Band-Aid type things would be these caps on prices.

How much can you charge?

Can you limit it to 2 times Medicare?

We're seeing some sun states tried that with their state employee programs and then we're seeing some employers try that as well.

Maybe we're only going to pay 2 times Medicare for this taken early there.

But again, it depends how much negotiating power do they have with those hospitals and doctors?

So those are kind of big picture, pop national policy type questions.

You may also want to know what kind of like individuals can do.

And that's a little more limited.

But we could talk about that.

If if you like, yeah, really quickly, if you can.

So, you know, a lot of hey, maybe you can switch to generic drugs.

Maybe you can choose a plan that that maybe a higher deductible and a lower premium faster if that's your concern.

But if you're having trouble making those deductible payments, choose the choose one with a lower deductible and higher premiums, perhaps most important thing from a lot of the coverage that we do a camp of his, if you have insurance.

Try to stand network.

Really double.

Check that because people pay a lot more when they go out of network.

And those are some things that just individuals can do.

And the other thing that individuals and some employers are doing is trying to look at overall prices and maybe shop around, maybe that MRI, you need.

It's cheaper at one facility to another and some insurers have that on their website.

You can look that up.

There's also some cost tools you can Google online that might show you what are the average price is paid.

And sometimes even specific prices paid at different hospitals and different clinics and some, you know, shopping for those things that you can shop for might be a way to save some money I want to finish out with this.

I think this is very important to feel.

> > Get a feel for how.

What's happening federally federal policy, how that affects you waiting the people do.

We have evidence that rising costs are People use health care are more Americans delaying care.

This given the appointments were avoiding prescriptions because of the price.

What we know.

> > Certainly people tell pollsters they're avoiding that.

And then there's been some studies over time.

But when people have high-deductible health plans, meaning they have to pay a lot of front before they get coverage, they tend to use less coverage now proponents and as they will, maybe they're they're just using, you know, maybe they're being smarter shoppers and maybe they don't really know.

But but a lot of folks, a, you know what, they're skipping care.

This can be a real problem because if you skip Carey, put things off, it could be a lot worse when you finally do seek out care and we're safer.

You sort of physically because you're you're condition may be more vans, but also worse because it's going to cost more to treat.

So I think that that the concern is.

Rising prices keep people from getting care if rising premiums cause more people to become uninsured.

What is going to happen and will it drive up costs for everybody as a result, you've been listening to Julie Appleby, senior correspondent of Kff Julie.

So great to have you on the program.

Thank you for your work.

A camp that thank you.

From Connecticut Public.

This is the Wheelhouse.

I'm Frankie Graziano.

After the break, we go local.

> > How shifts in Obamacare are impacting Connecticut's residents.

Have your health insurance costs conduct.

I sat up acting you and your family.

What are you thinking about that next appointment with an expert prescription?

It was a call.

8, 7, to 0, 9, 6, 7, 7, 8, 8, 7, to 0, 9, 6, 7, 7, There's more Wheelhouse next on Connecticut Public.

♪ ♪ ♪ ♪ ♪ ♪ > > is the Wheelhouse from > > This Connecticut Public Radio.

I'm Frankie Graziano.

Health care costs are eating up a bigger share of many family budgets.

Premiums, deductibles, prescription drugs and out of pocket costs of all become part of a growing affordability.

Conversation here in Connecticut and across the country this hour, we're looking at what Connecticut residents are saying about the cost of care.

Joining me now is Katie Gove, Ala.

Katie is Connecticut Mears, Health Reporter.

Thank you so much for being here for having me.

Thank you for inspiring this conversation.

Kathy Unger Holt is the health care advocate for the state of Connecticut.

Kathy, thank you so much for coming on here today.

Thank you for having me.

So happy to have you both on want folks to call him.

Thank you for listening to the Julie Appleby interview.

I want your follow-ups to what she had to say and what these 2 will have to say to me in short minute here.

Have your health care costs going up.

Are you able to pay your premiums or out-of-pocket costs?

Whatever hit us up.

Comment on our YouTube live stream or give us a call.

8, 8, 7, to 0, 9, 6, 7, 7, It ate 7 to 0, 9, 6, 7, 7, To bring the discussion surrounding the affordable care back to Connecticut.

How are state residents, Katie enrolled in ACA?

Health plans fearing right now?

> > Yes, so I recently did an article asked Access Health CT about the number of people who have failed to make their premium payments in 2026.

And as a result last coverage and that number was 22,000 Connecticut residents and that is about a 75% increase over the number of people who lost coverage last year.

It should not all these people necessarily now are going without coverage.

So access Health does does the survey every year called the levers survey and they talked to people who have rolled off and access health plan.

So they talked about 500 people who had coverage last year and don't have it this year and what they saw was that about 60% of people said that they had enrolled in some of the other coverage, which is great.

But about 40% of people said that they no longer had any coverage at all.

So that we care about that.

22,000 number, because of the 40% of people who now no longer have coverage in your coverage of the topic.

> > I'm ordering because I noticed that you said overall ACA plan enrollment has remained steady.

How is that when more than 22,000 people lost their coverage in Connecticut.

Great questions.

So, you know, as the years going on, access health continues to get enrollees.

You know, people change jobs live into the state.

> > Have an opportunity to enroll in a plan.

So that means they are continuing to see people enroll in plans, which is a good thing.

But again.

I think that.

Initial number of people who have who have rolled off plans who now no longer have coverage is still the group that policymakers are concerned > > You heard us talk earlier about.

with Julie about enhanced premium tax credits and then lapsing last year.

That was a large driving force in the United States.

Government's shut down earlier this year.

Of course, the longest in history.

But the officials did step in to try to lessen the blow for Connecticut residents.

Right?

Katie?

> > Yeah, that's right.

And Connecticut was one of only a handful of states that did this.

So Governor Lamont set aside 115 million dollars that went towards helping some of those people who lost enhanced subsidies.

Get that help back.

So for the poor assist folks who lost who losses, enhanced subsidies people making between a 10200% of the federal poverty level.

That money went towards replacing everything they lost from the federal government.

So they see no change and then you heard in the last segment, people making over 4 times the federal poverty level lost all their help.

So the states that if you're making between 4 and 5 times of the federal poverty level, we're going to replace half of what he lost.

So, you know, that is a help that the state gave and only think about 10 states provided some sort of support.

So.

Connecticut was definitely a leader there.

So I guess it's good to live in Connecticut and good to work in Connecticut.

I guess Kathy.

> > a turn to you now and dig into trends you're seeing in your office.

But first of all, for anybody who is in for for would you tell us what you do and why it might be hard at this time.

Thank you.

> > Yes, am.

The health care advocate for the state of Connecticut.

And I run the office of the Health Care Advocate, which is a state agency.

We help people with all things health insurance.

So that includes helping people find health insurance.

Choose the best health insurance for them.

If they have options.

Looking at educating people about their health insurance plans being able to understand with their coverage is and what it pays.

Every health insurance.

Plan is different.

And the criteria that used by the different health insurance plans is also different.

And we help people with any kind of obstacles to using their health insurance.

So that includes being denied prior authorization or being denied a bill or claimed.

So we have attorneys nurses, paralegals, other experts in our office that will help people for free.

All residents of the state of Connecticut to make sure that their health insurance is paying when it should.

And then we use our experience with about 6,000 consumers every year to look at the patterns and trends that are happening in health care and what we can do from a policy level.

What we can recommend to our state legislators and the governor to fix some of the problems that we're seeing on a systemic level.

Your job also put you on the board of Access Health, right?

That's correct.

So help us understand how many people would be on the ACA marketplace plans in Connecticut.

> > And then if you could somehow contextualize that versus insurance plans, the rest of the way in Connecticut.

Sure.

> > So there are about 150,000 individuals in the state of Connecticut just to put that into context, that's about 5% of our population.

And then before the Affordable Care Act, that was 5% of people who didn't have access to any type of health insurance.

Any time you can increase the pool of people who are insured.

It makes it less expensive for everyone else.

The other a very important thing that happened with the Affordable Care Act was prior to the Affordable Care Act.

People were waiting to get health care.

They were coming on to programs like Medicare, much sicker and after the experience that we've had with the Affordable Care Act, we see and how much it's relieved the pressure on the Medicare program and so many people are coming onto Medicare much healthier than they otherwise would have > > So you're saying that been.

there is a positive aspect to getting this kind of insurance.

You're saying that it does make Americans healthier.

Yes, absolutely.

Let's go beyond the zba for a bit, though, because obviously, as you said, there's only 5%.

So there is more to talk about here.

Anecdotally, what are you hearing say?

No, you're saying people are calling you and I'm familiar with your work as a stunt work with one of your predecessors before.

So what kind anecdotes can you tell us about?

Well, certainly the biggest issue is that people > > have been calling more panic.

Much more in despair about their health care and telling us, well, I have insurance.

Why do I get a bill?

Why is this bill?

So high?

So we're hearing a lot of issues of of people just almost giving up almost feeling like they have no control and people will say to us, you know, I'm just one car accident.

One House fire, one diagnosis of cancer away from being completely ruined.

it's it's it's a terrible place to be.

We're also hearing just generally about the types of issues where the insurance companies are using artificial intelligence.

More to deny claims into examine prior authorization.

So we're having to intervene on their behalf.

And we know we only see a tip of the iceberg.

It's a very small, pattern of what is happening in health care.

Did it delays that the insurance companies are putting forth.

And I are very concerning to a lot of people.

> > Any positives, though, in terms of actually being able to talk to a real person like yourself or anybody work with Kuz.

I think about that now prior authorization process that initiate a lot of people to their health insurance.

I would imagine whether they're trying to get on a GOP, one of the trying to get some kind of medicine.

That's when some other kind of medicine.

That's when I'm sure they get initiated to it.

So and then you talk about AI in the way that these health insurance companies are.

That's been a big topic of conversation in America.

Corso anybody happy to talk to a real person within your within your office there on Sure.

> > So one of the things that we know statistically only about one percent of people who are denied.

Prior authorization or payment of a service appeal that denial.

So we are encouraging everyone to examine the the explanation of benefits statement they get from the insurance company, the bill they get from the doctor where the hospital and to give us a call.

If if they don't understand why they've been denied because 70 to 80% of the time our office can get that denial overturned.

By talking to the insurance company or negotiating with the provider.

Can you talk to me, Katie, about Medicaid lets the situation that > > we're in right now because I think that the new rules for Medicaid in terms of work requirements go effect, go into effect 6 months from > > Yeah, that's right.

Before now.

answer, just want to say the work that your office does is just so incredible.

And I think, you know, I spent a lot of time talking to policymakers, but Kathy and her team are really, you know, they're hearing directly from people.

It's almost like what we should be paying attention to 3 months from now.

And so we're paying attention to right now.

So I mean that office and work you'll do is just incredible.

And yet, so yeah, read a and so yes, we are getting new Medicaid rules in January and what's going to happen is that.

People are now for the first time ever going to have to prove that they meet what's called the community engagement requirement.

So this is for people in Husky Diesel.

These adult low-income adults with no children they're going to have to prove that they either, you know, work go to school, do violent for 80 hours a month.

And and in order for them to qualify for their Medicaid or they have to prove that something is preventing them from meeting those requirements.

And then there.

They don't have to prove that so and another big change that's coming is right now.

People get it critical pre-determined or recessed for whether they're still eligible eligible for Medicaid.

One time of year.

And now that's going to go up to 2 times a year, starting in January and basically what all that means.

Is a bunch more paperwork for people.

And so what studies have found when certain states to put work requirements into place is not that people no longer.

It turns out people no longer qualify for their coverage but that they have a harder time proving they qualify and lose coverage as a result.

And even before January, we're going to see a smaller populations access to them and their Medicaid.

So in October, people who currently qualify for Medicaid with certain immigration status is like refugees asylees people with temporary protected status.

They're no longer going to qualify for Medicaid.

So the big changes are coming in January.

But we do have smaller, but very significant change coming in October as well.

You worked in the health care space as I understand it, Kathy, for 40 years now.

That's correct.

So when we zoom out, can you shed some light on how the healthcare space has changed?

> > Over the past few decades and how we got here because it sounds like.

The goal of the Affordable Care Act and at least what lawmakers worked out was to get more people insured or to get healthier by the time they needed Medicaid.

So help us understand.

Yeah, thank you.

> > And to to kick to Katie's Point, let me just add that one of the penalties that also comes Medicaid is if if you no longer qualify for Medicaid, you can't qualify for care under the Affordable Care Act that's one of the provisions in the bill.

So that makes it even more concerning.

Just to talk about a little bit about my history and health care I will come back too far.

But my family was very involved in service industry, teachers and nurses, and I decided that I wanted to do something similar.

So I went into health care management at the time.

The University of Connecticut had a program health care management.

They no longer have that program because it's treating health care is treated much more like a business now.

And it is a service industry.

So 40 years ago you would see all the hospitals coordinating with each other, collaborating with each other, making sure that people at a local level could get the care that they needed.

And then if you needed something more significant than you would go to one of the regional leaders that would have more complicated would be able to serve more complicated issues.

We are currently losing so many local services through the consolidations that have been happening in Connecticut.

And, you know, is Julie talked about on the earlier segment.

There's so much to be done about what what has been happening.

With the health care and how it it's leading us to where we are at right now where everything is fractured.

You have insurance companies that are making their money.

You have hospitals that have consolidated and frankly they have eaten up all of the mission oriented service delivery aspects.

So it's been it's been a big change.

Sounds really bleak to be honest with you.

And that's the > > we're glad to hear the honesty because people need to know what's happening.

But I mentioned how you work in the health care space for 40 years.

A big fan of our show is also a former health care worker.

Betty Jenkins Donahue, a retired nurse.

She reached out to us actually through our election survey, which you can all feel out right now in advance of the midterms at CT Public Dot org slash election CT public DOT org slash election in a recent interview, she told me she's dedicated advocacy on the healthcare front despite her being on husband's insurance and not need to get any more.

She's from Allentown, Small town in southeastern Connecticut.

You don't know where that is.

That's on the northern edge of new London County.

That borders Rhode Island.

> > I love it town where there is no public transportation.

I live in a town with a closed fist health care provider is 20.

I mean, it's OK.

We have a 25 minute.

I'd at least a 25 minute ride to our closest hospital and the hospital, which I go to is 30 its money.

We have no pharmacy in town.

We have to get interesting.

Can't.

So I think our state and local represent it is also meet to be.

Encouraged and by the state transportation in Pearl Community's needs to be addressed.

> > That he said that she wants lawmakers to commit to health care access, including transportation to and from or provider and continue to provide support for health care insurance like ACA, like Medicaid.

She said she's already heard from the CEO of a local community health center that they may have to cut services because there may be fewer payers with all the federal health care policy changes.

Theres are basically insurance groups and other entities that reimburse providers.

Betty also said that health care reform comes down to political action in her view.

> > I don't feel.

Currently.

Our current administration to work improving health care insurance and access I do feel, however, that federally representatives, are committed to improving health care.

And I think we continue to be to continue to put pressure on our federal representatives to keep the heat.

I mean, the current administration.

> > A big shout out to Betty and her husband out there in Volant out.

Thank you for continuing to listen.

The show big radio hug out to you all and participating because when we talk about when we talk about civics, you want people to talk.

You want people to share their thoughts.

She's retired nurse who lives in volant out.

As I said, any comment, Katie or Kathy and what you said about access to health care in her small town or about the idea of advocating for health care access during this campaign season above other issues.

> > transportation is the biggest reason why people don't access health care.

And studies have shown that over the years.

And so there are a number of the community organizations that operate out of the Norwich area that will provide the transportation.

So I would suggest that in that folks that are.

In that situation where transportation is an issue.

Look into that because there are some things that are being addressed through that.

This is the Wheelhouse from Connecticut Public.

> > I'm Frankie Graziano.

After the break, we're going continue our conversation about health care, affordability, Connecticut.

> > Including what residents are telling the office of the Health Care advocate.

Questions on what you heard so far.

Hit us up on our YouTube stream.

Give us a call.

8, 8, 8, 7, to 0, 9, 6, 7, 7, 8, 8, 7, to 0, 9, 6, 7, > > Listen to the We'll ask 7, Connecticut Public.

♪ ♪ ♪ ♪ ♪ ♪ This is the Wheelhouse from Connecticut Public Radio.

I'm Frankie Graziano for many Connecticut residents.

The cost of health care isn't just a personal concern.

It might be political.

As candidates make their case to voters this election season where this health care fit into that conversation and water people across the state hoping to hear.

Still with us, Cady go Vallow health reporter for the Connecticut Mirror and Kathy Unger, Holt, Connecticut's health care advocate Katie peer into the crystal ball here.

Folks want to give us call, by the way, it's 7 to 0, 9, 6, 7, 7, but the quick because we're almost done Katie, let's peer into that crystal ball.

I was talking about you follow this year's state legislative session in Hartford.

So you're aware the support advocates and health care consumers are asking for what topics do expect the state legislature to talk about particular with those rules coming into effect where the able to capture some those requirements are terms of the people that might go off of it with the money that they got a couple of years ago with us.

The need to do more work to think peering into the crystal Ball member.

Get anyone in > > I I expect that as you know, there's what the journalists and there's so much about these Medicaid rules that state policymakers still don't understand.

So for example, there's a term called medical frailty if you can prove you, you have medical frailty, you would be exempt from those work requirements.

> > But federal government put out rules.

I think last month that took State Department, social services by complete surprise.

And it's actually going to require a ton more paperwork to prove that people are exempt through that medical frailty.

And so, you know, DSS has said there is no state that is prepared to do right now.

What the federal government is required them to do so my guess is that as some of these changes rollout in January, we will hear from state agencies and state legislators who are talking to their constituents about 2 address.

Some of the problems that come up.

And I think another thing we're going to be hearing a lot about.

If the governor wins reelection campaign is the Connecticut option.

So that is something that he and his administration have been talking a lot about studying the way to create a plan that any Connecticut resident can enroll in and Sean Scanlon, the comptroller, who's a does a lot of healthcare work with the governor has committed legislation next year.

So in 2027, that doesn't mean that Connecticut option will come in 2027, but we will see legislation that tells us how the state is thinking about designing that plan.

So those are the this is a 2 conversations that I think most interested in the expect will happen next session.

> > What you don't do in the summer, Kathy is head over to the Capitol and provide testimony in a public hearing.

So that's something he might do in the winter.

And as we have the next legislative session, what might you be preparing to ask of lawmakers or something that you asked last session that didn't get done, that you still need here.

What do you what do you think?

> > So we have a number of proposals from the office of the Health Care Advocate.

Again, based on our experience with consumers, we need more standardization in insurance.

There's so many types of insurance if we could get some rules around clinical standardization so that every policy doesn't require different set of circumstances for each different type of of illness or injury.

That's a big thing.

There's a lot of churn and health care and what that means is people tend to gravitate to other health insurance plans over time.

On average people have 20 to 30 different types of health insurance over their lifetime.

One of the things we'd like to see is if you've been approved for a procedure under one type of insurance when January first comes that approval goes with you.

You don't lose that approval.

It have to get it from a new insurance company.

There's a lot of inefficiency in healthcare.

One of the things we'd like to see is this constant requests for prior authorization for people who have parents that have shown that they're not going to change their health issues are not going to change every month.

You're having to get prior are some things that that that there are people we help.

There's been a just recently a 19 year-old in a 39 year-old who have significant.

Disabilities whose condition never changes every 6 months.

They have to show their insurance company that it hasn't changed.

And every 6 months they get denied and then they come to us at the office of the health Care advocate.

We fix it and wait another 6 months.

So if we can eliminate some of those types of inefficiencies and standardization problems in health care, and then we can move some of these cases forward a lot easier.

> > Early in the show, Julie Appleby from Kff Health News offered some advice for people who can no longer afford health insurance through the Affordable Care Act Exchange.

What what else can you offer listeners?

> > So one of the things I would say is look at your your total cost of health care.

Speaking of not having a crystal ball, we don't necessarily know what our health care needs are.

But if you do, if you have a chronic impairment or an illness and you know, you want to see particular doctors make sure they're in your network.

Don't just look at the premium cost.

Consider the entire cost of health care if you know you're going to need pharmaceutical assistance and other types of of care, then make sure that it's covered and definitely take advantage of all of the things that come before a deductible.

So if you're entitled to a wellness exam, go to that wellness exam.

What you don't know can hurt you.

So you want to attack as many of the issues that you have to deal with in your health care as quickly as possible.

Up front.

What we also do a lot of work in my office with medical debt and helping people to understand how to reduce medical debt, how to avoid medical debt.

And we're developing some new screening tools now that will help people to be able to get hospital financial assistance where they can get free or discounted hospital care if they qualify.

> > So there's a lot of buzz terms we talked about here as we finish up the show and there's a lot of things like prior authorizations and all kinds of issues to navigate.

Where can people go to get help where they can certainly come to our office?

> > The reaches well, we have a we have great website, but a lot of resources on a lot of self-help information, but also information about how to contact us.

So our Web site is the office of the Health Care advocate in the state of Connecticut.

It's kind of an odd address.

But if you Google that, then you'll find us.

You've been listening to Kathy Unger home.

She's a health care advocate for the state of Connecticut.

Kathy, thank you so much for being here.

Thank you.

> > And my friend, Katie, Go Valla, Connecticut Mears, Health reporter.

Katie, thank you so much for joining us.

Thanks for having and thank you for the inspiration for the show.

And before we go, folks, I got a reminder for you about our election survey, which listeners can fill out ahead of the midterms to inspire what we cover a Connecticut Public like commentary we got for Betty Jenkins down who's a good friend of mine.

We want to hear from you up.

Find the survey at CT Public Dot Org slash election again, that CD public Dot org slash election.

Today show produced by Chloe.

When thank you to our interns, Amanda Adams and Katie Service for helping out as well was edited by Eric Coston.

Our technical producers dealing race.

I want to thank Tess terrible or show talk show unit visuals and operations team here.

Connecticut Public.

Folks download the Wheelhouse anytime on your favorite part.

Yes app.

I'm Frankie Graziano.

This is the Wheelhouse.

Thank you for listening.

♪ ♪