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One Pill Makes You Small

Someone feed the governor's head: Charter Oak health plan and HUSKY don't mix

Andy Bromage

November 27, 2008

Someone get Jodi Rell a doctor. The governor, it seems, has come down with a bad case of denial, tinged with a touch of political paranoia.

For months, the Rell administration has turned a deaf ear to critics of her Charter Oak Health Plan who say the state-subsidized program left poor families on Medicaid in danger of losing their doctors.

That stubbornness turned to pettiness last week when the Rell administration struck back at its critics with demands to see every e-mail, phone message and letter they had concerning her signature health care plan. Commissioner of Social Services Michael Starkowski filed a freedom of information request seeking the documents from two state officials, including Attorney General Richard Blumenthal, and three Democratic lawmakers, going back to 2007.

The implication of Rell's scavenger hunt is clear: Health care advocates and Democrats are in cahoots to sink the governor's hallmark health care initiative, probably because they want universal health care.

The targeted legislators shot back with all due outrage.

"These requests ... smack of an attempt to chill lawful, legislative oversight through harassment and intimidation," reads the letter signed by Rep. Peter Villano of Hamden and Sens. Toni Harp of New Haven and Jonathan Harris of West Hartford. "That this attempt will be unsuccessful does not mitigate its infirmity."

HUSKY, the state's Medicaid program, was steadily stabilizing until the state combined it with the new bare-bones Charter Oak insurance plan this year and contracted three new HMOs to manage them.

Charter Oak is aimed at middle-class people who earn too much to qualify for state-assisted care but too little to afford out-of-pocket insurance, and offers no-frills insurance for $259 a month or less.

Because HUSKY and Charter Oak were combined, participating doctors had to accept both kinds of insurance. The rates Charter Oak pays to doctors are pathetic (a specialist can earn as little as $2.48 for an office visit) and it puts doctors in charge of collecting co-pays from delinquent patients. A few doctors and hospitals have joined but many more have stayed away, saying they couldn't afford to work for Charter Oak rates even if they wanted to. That put 345,000 HUSKY patients on the path to new health plans without enough doctors to care for them until the state agreed to delay the transition date.

Everyone gets that it's a problem. The doctors who aren't signing up. The state's attorney general, health care advocates and child advocates who want Charter Oak and HUSKY de-linked. The five Democrats in Connecticut's congressional delegation who want a moratorium on HUSKY enrollment. Even the federal agency overseeing Medicaid, who said it wouldn't allow anyone into plans with too few doctors.

Everyone except Rell. Asked by a reporter last week if Charter Oak was "crashing and burning," Rell replied, "The Charter Oak program is alive and well."

What Charter Oak plan is the governor talking about? The one that after six months has just 2,300 people enrolled in it, only a quarter of what it was designed to accommodate? The one whose network still doesn't include the only hospital in Middlesex County and has just a handful of physicians signed up in the state's rural counties?

Finally feeling the pressure, Rell relented last week and said HUSKY and Charter Oak would be de-linked: Participating doctors would no longer be required to accept both. Just as quickly, though, her administration did an about-face after the attorney general said that would require re-bidding the state contract. Doctors will have to sign up for both plans, but not at the same time. Just exactly when they will and how that will work remains to be seen.

To Rell, the problem isn't a half-baked health care policy that helps a handful of middle-class people at the expense of a half-million poor ones. It's simply how negative her critics are about it.

"In recent days, there has been a flurry of statements, press releases and public comments on all sides that have been too negative in tone," the governor wrote in a letter inviting the targets of her inquiry to a Charter Oak peace talk this week, including Health Care Advocate Kevin Lembo and Child Advocate Jeanne Milstein.

"I believe it is time — indeed, past time — for all of us to turn our energies toward ensuring this much-needed program achieves its full potential to benefit the citizens of Connecticut," the governor wrote.

Health care advocates have been pleading for months with Rell to uncouple HUSKY from Charter Oak, only to be told they need to be patient. Doctors will sign up, the advocates were told, they just need time to understand the plan.

Six months later, the new networks of doctors are still spotty and the date to default HUSKY enrollees into one of the three plans has been pushed back to February.

"This disaster could have been entirely avoided if the governor had heeded the persistent call from the dozens of public and private organizations," says Sheldon Toubman, a New Haven legal aid lawyer who's been a stalwart advocate for uninsured families and who is referenced by name in the Rell administration's records request.

"It is a tragedy that the governor disregarded these consistent warnings and went ahead with her ill-conceived combined plan."¦