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Connecticut Activists Prepare Health Care Reform Proposal

brewing debate

DIANE LEVICK

December 09, 2008

A major activist foundation is about to launch the most ambitious proposal yet for health care reform in Connecticut, envisioning a mammoth insurance pool and changes in the way medical care is delivered.

The proposal by Universal Health Care Foundation of Connecticut sets the stage for the 2009 General Assembly, where many reform ideas are expected. The plan also comes as Congress and President-elect Barack Obama begin moving on health care reform.

The proposal by the foundation, an influential advocacy group for expanded health coverage, aims to lower health care costs and make insurance more affordable. But it isn't all new, sharing many concepts with current national proposals and past state attempts.

Its breadth, though, promises to raise a lively debate in the legislative session that starts Jan. 7, and sounds an opening theme: A comprehensive approach to reform is needed, and it must not be eclipsed by the nation's financial crisis.

Health care is a major piece of infrastructure for our economy," said Juan A. Figueroa, president of the foundation. "You can't fix the economy without fixing health care when it's 16 percent of your [gross domestic product]."

States shouldn't just defer to federal reform efforts, he warned.

"Connecticut cannot sit on the sidelines on this issue," Figueroa said. "The fact that we're known as the insurance capital in the country, whatever we say or do ... ought to be part of what gets factored into the national debate."

Competition For Insurers

The foundation's proposal, being previewed on a five-stop road tour that begins today in Torrington, would greatly expand the state employees' health plan. Over six years, the state employees' plan would eventually be opened to individuals, nonprofit groups, municipalities, small employers, and later, to any size employer and would encompass state programs, including Medicaid and the HUSKY health plan.

The expanded pool is aimed at roughly 326,000 uninsured residents and people whose insurance is skimpy or who can no longer afford their employer's coverage. Workers whose health care costs exceed a certain percentage of their income, for instance, would be candidates for the pool, said Janet Davenport, the foundation's vice president for communications.

"Those with cut-rate health plans will have an opportunity to escape high deductibles, rising co-pays and inadequate coverage," Davenport said.

The pool's premiums, co-pays and deductibles would be on a sliding scale according to income, she said.

Taxpayers would bear some of the cost, but the amount remains undetermined.

The pool would compete with the private insurance industry and "would be adding choice to the market," Figueroa said. Because of its size, it would have greater leverage in negotiating purchases, he noted.

Foundation officials envision the pool as self-insured, collecting premiums to fund members' claims and bearing the financial risk. However, the pool could hire insurance companies and other firms to administer the plan, which includes processing claims.

A controversial and somewhat more modest version of expanding the state employees' health plan passed the General Assembly this year but was vetoed by Gov. M. Jodi Rell, who questioned its true cost. The legislation, championed by House Majority Leader Christopher Donovan — the incoming House speaker — would have opened the plan to municipalities, small employers and nonprofits.

Donovan, who vowed to revive the idea, hasn't seen a formal proposal by the foundation but said "the concept is a sound one" and "makes sense."

Details In January

The foundation is still working with experts at MIT and the Urban Institute on what its package would cost and won't discuss that yet or who will pay for it, though a role for taxpayers is unavoidable.

"We all have a stake in this," Figueroa said. "We all need to be part of the solution."

Key details, including the costs, will be released at an event Jan. 13 in Hartford.

Foundation officials say their plan includes ways to control costs and boost the quality of health care. It calls for more use of electronic medical records and increased focus on preventive care, management of chronic conditions and use of a "medical home" model. That means having a primary care doctor and other care providers do a better job of coordinating patient care to improve health and reduce unnecessary spending.

The foundation has been working with business and community groups on its plan, and the broad approach to reform is drawing some praise from the business community.

Christopher P. Bruhl, president and chief executive of the Business Council of Fairfield County, praised the foundation for "moving toward fact-based advocacy." In the past few years, he said, "we're getting to a shared definition of the problem. We have begun to find common ground of fact."

Insurers "are looking forward to working with anybody who has any ideas on reform," said Keith Stover, a lobbyist for the Connecticut Association of Health Plans. He cautioned, though, that putting a lot of people in a pool doesn't automatically lower health care costs.

A national trade group for insurers has proposed national reforms, such as allowing a new health plan that wouldn't have to cover benefits mandated by states, but Stover said he doesn't know yet what his group may do in Connecticut. Still, he says, "There is a real opportunity this session to get something done."

The foundation's proposal is "ambitious because the problem is bad," Figueroa said. "The problems of our health care system are deep."