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Debate Begins On Health Care Plan

Rinker Buck

February 15, 2011

What is expected to be a long and bitter battle over the creation of Connecticut's own health care reform began in earnest Monday at a crowded legislative hearing in Hartford.

The hearing over three health care reform bills drew a broad array of Connecticut interest groups, from doctors who passionately pleaded for reform to small, inner-city pharmacists who said their businesses would be ruined by the proposed changes.

The hearing, jointly conducted by the public health, insurance and human services committees, was on legislation that would implement the state's proposed SustiNet plan, which would allow cities and towns to buy into the state's health care coverage and would save the state an estimated $66.5 million a year by consolidating purchases of prescription drugs for state employees and Medicaid recipients.

House Speaker Christopher Donovan, D-Meriden, appeared at the hearing with Hartford Mayor Pedro E. Segarra, to stress the advantages that Connecticut cities would realize by pooling health care costs with the state. Segarra said rate increases from private insurers were growing so quickly that annual health care costs for Hartford's municipal workers were approaching 20 percent of the city's total budget.

"Health care pooling works," Segarra said. "The city of Hartford is currently looking to join the state prescription pool and expects it could save $1.8 million in annual employee prescription costs. Adding new members to the state plan would result in an estimated savings of $6 million a year for the state."

Several doctors also appeared at the hearing, arguing that under the SustiNet plan, more comprehensive eligibility for Medicaid patients and affordable premiums for residents who are not now insured would save the state money in unnecessary hospital costs.

Dr. Julie Rosenbaum, a primary care physician who teaches at Yale Medical School and practices at Waterbury Hospital, described a recent case that she said was typical of the conditions she sees in Waterbury. A machinist she treated for a chronic lung and heart condition recently lost his job and health insurance, and, to save money, he had stopped taking the medications she had prescribed. As a result, his health deteriorated to the point where he required an 8-day hospitalization that cost $15,000.

Under the SusitNet plan, Rosenbaum said, the machinist's care probably would have been covered by enhanced eligibility requirements, and because of the proposed creation of "medical homes" that would reward doctors for better tracking of chronically ill patients, he would not have fallen through the cracks.

The bill that would join state employees and Medicaid recipients in the same purchasing pool for prescription drugs came under particularly strong criticism from small pharmacies. Their trade association, the Connecticut Pharmacists Association, predicts that the lower reimbursements paid to pharmacies would reduce their profit margins on the average drug prescription from 15 percent today to 6 percent after July 1.

Laks Pudipeddi, who opened a pharmacy in Bridgeport in 2008, said many of his 17 employees would lose their jobs under the lower reimbursement rates the plan would provide.

"My vision was that in an urban setting, where there is now a pharmacy desert, we would deliver great prescription drug care and delivery service for a needy Medicaid population," Pudipeddi said. "But if this bill passes, it will probably drive me out of business and hurt the patients who rely on me."

State Comptroller Kevin Lembo, who helped design both the SustiNet and prescription drug legislation last year as the state health care advocate, said the state deliberately set the dispensing fee paid to pharmacies for each prescription at the $2.90 Medicaid rate, which will direct an extra $13 million into pharmacies. He said that the legislature could also consider a waiver for inner-city pharmacies over new reimbursement rates.

"Access to care is our No. 1 priority here, and this prescription drug proposal is just that, a proposal," Lembo said. "The legislature now has to address all the difficult points, and this is one of them. Should we save money for all Connecticut taxpayers or preserve the existing structure just to support this small group of pharmacists? I'm confident we can address that in a fair way."