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Will Health Reforms Survive? Legislature Should Let Vetoed Bills Die

MICHAEL J. CRITELLI

July 19, 2009

Two bills designed to expand the availability and affordability of health insurance — passed by the General Assembly this session — would have threatened existing private plans and ignored key institutions such as large employers, hospitals and insurance companies. Gov. M. Jodi Rell sensibly vetoed both. The legislature, which is scheduled to consider veto overrides Monday, should let those bills die and work to refine them while awaiting federal action on health insurance.

I support the objectives of affordable universal health insurance and access to quality health care. The "pooling bill" and the SustiNet bill were significant improvements over previous attempts to achieve these goals. I particularly applaud the SustiNet bill for recognizing that we will not solve the health insurance crisis unless we focus on making people healthier and on improving health care access and delivery through payment reform. Both bills, however, are fatally flawed.

First, while a core goal of health care reform legislation should be to create universal, affordable health insurance, it should be focused on extending coverage to those who are uninsured or underinsured. We do not need public plans that compete head-to-head with the private and employer-sponsored insurance markets that are working well. The HealthFirst Connecticut Authority, on which I served, did not recommend in its report issued in March that those currently enrolled in employer-sponsored plans be able to enroll in a public plan.

As Gov. Rell pointed out in her veto letter to Secretary of the State Susan Bysiewicz, the likely effect of allowing small businesses to enroll in a state plan is that those with a high percentage of older, less healthy workers — who have the highest insurance premiums — are most likely to drop private coverage and participate in the state plan. This would be a costlier result for state taxpayers when they can least afford it.

SustiNet would permit employees of self-insured employers who are earning less than four times the federal poverty level ($43,320 for an individual and $88,200 for a family of four) to enroll in the public plan. The public plan would likely be less expensive for younger, healthy people who would join it and leave their employers' programs.

This migration of young people to the public plan would begin destroying large employer self-insured plans that currently deliver comprehensive, innovative and affordable care. Younger participants in private plan pools now subsidize less healthy plan participants. Without them, self-insured employer plans would be forced to raise their rates and would become too costly for everyone remaining in them.

President Barack Obama has repeatedly said: "If you like your existing plan, you should be able to keep it." Why has the legislature enacted legislation to destroy plans people like to have?

Second, to the degree that either bill contemplated health policy formulation, they have completely shut out major and innovative stakeholders including large self-insured corporations, hospitals and insurance companies.

The Universal Health Care Foundation, which designed SustiNet, understood the need for broad-based representation on a statewide health policy board, but that plan, as enacted by the legislature, has no explicit representation from any of these stakeholders. That is wrong, and it has the effect of preventing some of the largest, most innovative and socially responsible institutions from participating in health policy formulation.

Third, neither bill addresses some of the key causes of rising health insurance costs. Although the legislature and governor did approve a bill requiring annual reviews of proposed health benefit mandates, why is the legislature not tackling all the root causes of rapidly rising health costs?

Finally, given the likelihood of comprehensive federal health care reform legislation, why does Connecticut have to take such a radical and potentially financially ruinous step by adopting the pooling or SustiNet legislation now?

We should await federal legislation and look at how to improve on it. This is the intent of the governor's executive order to establish the Connecticut Care Reform Advisory Board to develop state-level policies in response to reforms being developed at the federal level.

The legislature should fix the flaws in these pieces of legislation rather than trying to get them enacted as is. Although I am passionate about comprehensive health care reform, Connecticut citizens deserve much better plans than these.