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SustiNet Offers Better Care, Savings

Juan A. Figueroa

April 10, 2011

Connecticut consumers used to have a quality, non-profit insurance choice. It was affordable. It provided good coverage. It was a big plus for consumers. It was called Blue Cross Blue Shield. But it no longer exists as the not-for-profit, mutual company it was.

Connecticut's insurance market is now dominated by a few large for-profit insurance companies that must meet Wall Street expectations.

This year, we have a real opportunity to improve the marketplace for consumers and save taxpayer money by coordinating the state's fragmented, parochial health care spending into a thoughtful system that reduces waste and improves health outcomes — the implementation of the SustiNet plan.

SustiNet is the culmination of several years of hard work by hundreds of health care experts, stakeholder organizations and public officials. It takes into account the current economic climate and fiscal viability of implementation and strikes a balance between a modest, up-front investment and significant anticipated savings (about $58 million a year).

We have been advised by one of the nation's leading health economists, Jonathan Gruber of the Massachusetts Institute of Technology and a Medicaid and federal reform expert, Stan Dorn of the Urban Institute.

Articles written about SustiNet in the past week have focused on estimated costs in 2014 related to a provision in the SustiNet bill known as the "Basic Health Program," which is an option states can choose under federal reform to cover low-income families. The estimated cost for this program contradicts earlier calculations that this option would bring the state about $50 million more in federal revenue than the state spends.

This is a discrepancy that warrants a closer look. And there is certainly time to address it.

The cost of doing nothing and continuing the path of fragmented, under-supervised health care is not an option. Currently, in Washington, there are proposals to gut Medicare and Medicaid, our country's most fundamental health care safety net for seniors and poor Americans, and put these vulnerable populations into private insurance. There are no caps on what private insurance can charge.

In the language of the insurance industry, the costs of services we receive are called "losses." In the good days of non-profit Blue Cross Blue Shield, before for-profit insurance companies came to dominate the healthcare industry, the amount that insurance companies charged for non-medical expenses, such as administration, was about 10 percent of premium dollars. Today that percentage has doubled or tripled.

In a recent New York Times article, experts were beginning to question whether or not privatizing public services achieves savings. That same scrutiny should apply to our decision to pay for-profit entities to provide this vital public service — insuring the health and well-being of Connecticut citizens.

The bottom line is that if we do not get our health care costs under control now, we will continue to see large deficits in years to come. Federal reform offers us many opportunities to transform our health care system and rein in costs — including support for the innovations articulated in SustiNet, such as medical homes, electronic medical records and incentives for evidence-based care.

We would argue that investing $4 million now to put us in a position to save nearly $60 million annually in the coming years is a good investment.

That's why the health reform debate is alive and the support for SustiNet is gaining momentum. It is a bold health reform bill based on sound health care policy. We understand the challenges ahead in reaching an agreement that addresses concerns. SustiNet is the right thing to do, however, and now is the right time to do it. It is a plus for our state. We cannot afford to miss the opportunities of health care reform.

Juan A. Figueroa is president of the nonprofit Universal Health Care Foundation based in Meriden.