Health Care Reform Debated

Critics Say Blueprint Doesn't Go Far Enough

January 9, 2007
By DIANE LEVICK, Courant Staff Writer

Legislative leaders like parts of a health care reform plan unveiled Monday by a Connecticut insurance and business group, but some consumer advocates say it doesn't go far enough - except to protect insurers' interests.

The Connecticut Health Insurance Policy Council's proposals to get more people insured and increase access to care include expanding Medicaid enrollment and reducing its benefits to the level of commercial health plans.

The council also proposed new state subsidies of premiums or tax credits for lower-income people to buy insurance, and suggested omitting some state-mandated benefits from policies to make them affordable for the uninsured.

The state's advocate for managed care members, Kevin Lembo, said he agrees with the council's ideas for promoting healthy living and electronic medical records and increasing Medicaid reimbursement to doctors.

But Lembo, citing insurers' increased profits, said, "I can't find a place where [council members] discuss what the HMOs will give up to control the spiraling cost of health insurance and expand coverage to the uninsured."

"Absent real sacrifice on the part of the HMOs, this attempt at profit preservation is further evidence of why Connecticut needs to take a serious look at more sweeping reform."

The issue shouldn't be the degree of sacrifice by anyone, said Robert Patricelli, council co-chairman and chief executive of Evolution Benefits and Women's Health USA in Avon.

"We've got to get away from trying to think about winners and losers, to the question of what the right policy is for everybody," said Patricelli, noting that the recommendations would increase responsibilities "for virtually everybody in the system."

Democratic and Republican leaders in the General Assembly welcomed the council's report as a positive first step from the private sector and found proposals they like - and some that made them wary.

"I'm very encouraged that the business community is stepping up with some concrete ideas for health care reform" and recognizing that the challenge must involve both the public and private sectors, said Senate President Pro Tempore Donald E. Williams Jr., D-Brooklyn.

The council's consultant, the Lewin Group, estimated the number of uninsured in Connecticut at 298,000, although other estimates go as high as 407,000.

House speaker James A. Amann, D-Milford, said he didn't want to be negative about the council's report and that "we're willing to listen to what they have to say." But he and consumer advocates voiced concern about the council's proposal to omit some state-mandated benefits from policies to make them more affordable for the uninsured. Eliminating Connecticut's requirement that policies cover at least a 48-hour hospital stay after childbirth, for instance, would be "a non-starter," Amann warned, although the council didn't specify which benefits to cut.

"Mandate-lite benefits doesn't do much to give people access to good quality health care," said Beverly Brakeman, director of the labor and community coalition called Citizens for Economic Opportunity, or CEO.

CEO and the AFL-CIO are advocating a single-payer system, something that insurers and employer groups oppose. Single-payer typically means a government negotiating directly with doctors and hospitals to buy their services, although private insurers could be used to administer the program and sell supplemental coverage.

Brakeman said she's glad the insurer-business council recognized that employers have a duty to help fix the health care system, but the plan is "clearly not universal," she said. "If we're going to really push a proposal that would get us to universal health care, this doesn't seem to do it."

Senate Republican Leader Louis C. DeLuca of Woodbury praised several elements in the council's plan, including cutting out some mandated benefits.

"I've been arguing [for] that one for years," DeLuca said. "I'd rather have somebody have some basic insurance than demand they have a Cadillac [plan] and end up with nothing."

He expressed reluctance about the council's suggestion of new subsidies for private insurance, saying the cost can spiral over time, but he said new tax credits might be workable.

DeLuca favored the council's idea about reducing insurance benefits in Medicaid to stretch funding for the program.

But people on Medicaid can't afford to pay part of their medical bills as employer health insurance requires, warned Sheldon Toubman, staff attorney for the New Haven Legal Assistance Association. Reducing Medicaid benefits means the program's members won't get needed care, he said.

The council's plan is "an HMO preservation act; it's ensuring they muscle in by increasing their piece of the pie" without increasing access to care, he said.

Legislators and consumer advocates seem to agree that the state should step up Medicaid reimbursement to doctors to encourage more of them to treat the program's members.

Toubman, though, noted that insurers handle Medicaid and questioned whether they'll actually channel the increased reimbursement to physicians.

Juan A. Figueroa, president of the Universal Health Care Foundation of Connecticut, said the council's report "offers constructive ideas worth considering," but doesn't ensure universal access to health care.

House Republican leader Lawrence F. Cafero Jr. of Norwalk called the report "a very realistic analysis" that "everybody has to contribute to the solution of high health insurance costs."

A copy of the council's report is available online at www.evolutionbenefits.com/report.