Healthcare professionals from 20 different organizations spoke against SB 6871, a provision originally brought forward by Gov. Ned Lamont that would place caps on out-of-network insurance costs, during a May 7 press conference. Speakers emphasized that workers from across healthcare were united in opposition to the bill, which they said would lead to the closure of medical practices, increase wait times, and limit patient access to care if passed.

A bipartisan group of legislators also spoke in opposition to the bill.

The proposal would cap out-of-network costs for insurance plans entered into or renewed after January 1, 2027, at 240 percent of the costs of Medicare reimbursement rates for the geographic area where services were provided. It also prohibits healthcare providers from charging or collecting over the cost sharing amount for a patient’s insurance plan.

It would also give the Office of Health Strategy (OHS) authority to set in- and out-of-network hospital service costs and require physicians to collect and provide OHS with information necessary to do so. OHS would also have the authority to issue a civil penalty of up to $1,000 for anyone who exceeds the cap.

Despite strong opposition to the measure by doctors, hospitals, and other healthcare professionals, the bill was advanced out of both the Committee on Insurance and Real Estate and the Committee on Appropriations. The bill has an anticipated $1.1 million price tag for fiscal year 2027, as OHS will need to hire five workers in order to meet requirements outlined in the bill.

But healthcare professionals are warning that the overall cost of the bill could be far greater.

Dr. Anthony Yoder, an assistant professor of medicine at the University of Connecticut (UConn) and internal medicine doctor, said that the bill if passed would have “severe and lasting consequences” for physicians, especially for small practices. Yoder also said that Connecticut already struggled to retain physicians and the bill’s proposed cap would harm hospitals, physicians, and the medical system.

Many other healthcare professionals who spoke at the press conference echoed similar concerns.

Sen. Saud Anwar, D-South Windsor, who is a physician, said the bill “in its current form” would impact the sustainability of the state’s healthcare system and would result in the closure of hospitals and medical practices.

Anwar also later stated that the state should not be involved in picking winners and losers, and the bill selects insurance as a winner. He said that if Medicaid reimbursement rates were higher it would cause “the level of panic to be a little less.”

House Minority Leader Vincent Candelora, R-North Branford, also mentioned Medicaid reimbursement rates, stating that the state “needs to stop deflecting” on the issue and focus on Medicaid rates. He said that going after different areas of the healthcare system was a “house of cards that’s going to collapse.”

Dr. Daniel Frees, an emergency physician at Hartford Hospital, said the bill would reduce access to care, risk emergency departments closing, and would potentially undo landmark legislation passed by the state with the intention of keeping costs for out-of-network costs in check.

Connecticut passed a “no surprises act” in 2015. The federal government passed a similar bill in 2022. The legislation is intended to prevent individuals with insurance plans from receiving surprise out-of-network bills for things like emergency room visits and limit charges to no more than in-network cost-sharing rates.

Several healthcare professionals who spoke also expressed concern that the bill would jeopardize physicians’ abilities to negotiate reimbursement rates.

Orthopedic surgeon Dr. Dante Brittis, said his practice and many others have been presented with “take it or leave it” contract renewals from insurance companies over the past year. Brittis said that, without an option to work out-of-network because of artificial caps the bill would create, physicians’ ability to negotiate increases, even just to keep up with the cost of inflation, would be obliterated. He added the effect would further limit in-network reimbursements and “only strengthens the bully in the room.”

Deremius Williams, the senior vice president of payer strategy and innovation at Yale New Haven Health, said she was “very concerned” with the state’s attempt to legislate reimbursements via the bill. She said the bill would place “significant undue strain” on negotiations between hospitals and physicians and insurance companies, leading to network disruption, limited networks, and destabilization of the healthcare system, opposite to the bill’s intent. Williams requested that the bill be tabled and stakeholder input be sought. She said any solution must “address underfunding of government reimbursement.”

Ryan Englander, a medical student at UConn, also offered the perspective of incoming doctors.

Englander, who said he’d just started his third year medical rotations, said physicians are already struggling with long wait times and patient overloads due to current physician shortages. He said that about one-third of patients had mentioned months long wait times for appointments and said if the bill passes, the problem will get worse.

Englander also said that he would like to remain in Connecticut, but if doctors don’t have support or the ability to negotiate fair prices for their services, hospitals and practices will close, and newly graduated doctors will have nowhere to go in Connecticut.

The bill is currently sitting on the House of Representatives’ calendar.

Republish This Story

Republish our articles for free, online or in print, under a Creative Commons license.