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A Fresh Call For Health Insurance Reform

ARIELLE LEVIN BECKER

January 13, 2009

It wasn't that Debbie Hunsinger didn't know about the lump in her breast. She did. And it wasn't that she didn't care about her health. Back when she had health insurance, she never missed a physical.

But a divorce left her without health coverage, and although she owned a deli in South Meriden, Hunsinger couldn't afford health insurance. She couldn't afford to see a doctor, either, so she decided not to deal with the lump. At the time, it was pretty small.

But by the time she finally got it checked out, about six months later at a free screening, it wasn't small.

And the cancer had spread to her lymph nodes and right arm.

If the cancer had been caught earlier, if she hadn't been one of the more than 300,000 people in Connecticut without health insurance, Hunsinger, 47, figures she might be healthy and back at work by now. Instead, she's facing dozens more rounds of chemotherapy and radiation and an uncertain prognosis.

Hunsinger thinks something must change. "I would hate to have anybody have to go through this just because they don't have health insurance," she said.

Her struggle is one of the reasons advocates say that it is finally time to make broad changes — an effort that will get a jump-start today in Hartford when the Universal Health Care Foundation of Connecticut unveils its proposal calling for major changes in the health system and a plan that the group says could insure 98 percent of state residents by 2014.

It is the first of many proposals — both state and federal — expected to be aired in what many people say is the year for health reform.

State legislators expect to address the issue in the current session, and the topic is expected to be a top priority for President-elect Barack Obama. Already, members of Obama's health care advisory team have been gathering input through meetings on health care reform, including one at the UConn Health Center last week.

It won't be an easy year, though. The prospect of new state spending or major federal reform might face tough obstacles as state legislators grapple with a projected $6 billion biennial budget gap and the Obama administration confronts an economy in shambles.

But advocates for reform say that the economic crisis and growing unemployment, with more Americans at risk of losing their health insurance, makes this precisely the time to tackle health reform.

"Fixing health care is about fixing the economy, that's sort of the bottom line," said Juan A. Figueroa, president of the Universal Health Care Foundation.

Figueroa said that the foundation's plan would put Connecticut in a strong position as the federal government addresses health reform, allowing the state to shape the national debate and be ready to tap into any resources that the federal government makes available for health reform.

The proposal calls for a new health program, called SustiNet after the Latin word for "sustains," that would extend health insurance to anyone who wants it while emphasizing preventive care and other changes.

The plan, which would begin enrollment in 2011, would create a gigantic health insurance pool by combining the existing pool of state employees and retirees with people now covered under state assistance programs.

The pool would also be open to the public, starting with those without access to employer-sponsored insurance, those whose employer-sponsored insurance is inadequate or unaffordable, and employees of small businesses, nonprofit groups and municipalities.

Ultimately, any employer in the state could use the state's pool instead of their own insurance. Employers who wish to participate would pay in as they would any other health insurance plan.

Mid-size and large employers would not, however, be able to simply drop coverage and allow the state to pay the cost of their employees' care. Employers with payrolls above $318,000 that do not offer insurance or provide adequate coverage to their employees would be required to help pay the cost of the program.

The plan is for the pool to compete with, not replace, private insurance plans. The proposal would not require everyone to be covered, but would automatically enroll people without insurance unless they opt out of the plan.

The foundation believes that the size of the pool will lead to lower costs — a critical element of the plan. According to the foundation, the plan would save individuals and employers $1.7 billion by 2014, although it would require the state to spend an additional $950 million in 2014, the year that the plan is expected to be fully operating.

That figure includes the cost of subsidizing coverage for previously uninsured people and increasing the notoriously low payments that doctors receive for seeing HUSKY and Medicaid patients.

The concept of expanding the state's employee insurance pool isn't entirely new. A proposal last year to open that pool to municipalities and small businesses passed the General Assembly, with strong support from Democratic leadership. But Gov. M. Jodi Rell vetoed the bill.

Figueroa said that the foundation's proposal offers a far more comprehensive approach and that he hopes Rell and other state officials will be supportive.

"This is a time not to be weak-kneed about these issues," he said. "This is a time to exercise strong leadership."

The foundation's figures for 2014 are based on several assumptions, including:

•$570 million in premiums paid by individuals covered by the plan; premiums would be charged on a sliding scale, based on people's ability to pay.

•$80 million in "shared responsibility payments" from employers with payrolls over $318,000 that don't provide insurance coverage to their employees.

•$240 million in revenue from companies whose employees join SustiNet because their company-sponsored plan is inadequate.

•An additional $800 million in federal funding by expanding the federally subsidized HUSKY program.