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It's Law, But Is SustiNet Fiscally Sustainable?

Many Pieces In Framework, Except How To Cover Yearly Cost That Could Hit $1 Billion

CHRISTOPHER KEATING and ARIELLE LEVIN BECKER

July 22, 2009

The plan could cost as much as $1 billion a year, and the state legislature has no plan to pay for it.

But even though many questions remain, advocates are overjoyed with the legislature's override of Republican Gov. M. Jodi Rell's veto of the SustiNet health care bill. Supporters say Monday's action puts Connecticut on a path to universal health coverage and finding a way to contain costs while improving health.

Juan A. Figueroa, president of the Universal Health Care Foundation of Connecticut, which crafted the plan, said the state is at the forefront of a key issue, poised to shape national debate on health reform and capture any federal money that becomes available.

"To our knowledge, there is no other place in the country that has legislation enacted in law that has this kind of a comprehensive framework," Figueroa said.

Figueroa and other supporters of the plan waged a years-long battle to pull off the veto override against a popular governor.

"We're in the insurance capital of the country, and governor's vetoes don't get overridden often," Figueroa said.

The SustiNet plan will likely move out of the spotlight for the next 17 months as a nine-member board crafts a plan due to the legislature by January 2011. The plan is expected to be open to those without insurance beginning in 2012.

More than 300,000 state residents currently have no health insurance.

By law, the SustiNet board will be charged with establishing a plan designed to provide health insurance to uninsured residents, increase the range of insurance options available to individuals and employers, slow the growth of costs, improve health of state residents, and improve quality and access to health care.

At the same time, task forces will be established to examine major health problems — obesity, tobacco use, and a shortage of health care workers — and make recommendations to the board.

The work on SustiNet comes against the backdrop of a massive push for health reform on the federal level. If federal health reform is enacted, the state bill passed Monday calls for the SustiNet board to submit recommendations to the legislature within 60 days.

The state, Figueroa said, will have to adapt to whatever happens on the federal level. It's possible a wide-ranging federal health plan would eliminate the need for a state plan, something Figueroa said would be fine with him.

Lawmakers critical of SustiNet note the legislature still has no plan to pay for expanding health coverage, meaning that fights over the cost are still to come. Rell has concerns about who will be involved in shaping the plan, noting the nine-member board lacks representation from hospitals, insurance industry and business world.

The state's health commissioner and state budget director do not have seats, which Rell said makes no sense because universal care could cost the state an estimated $1 billion per year.

The law states specifically that the SustiNet board will be co-chaired by the state comptroller and state health care advocate. Both positions are currently held by Democrats (Comptroller Nancy Wyman and Healthcare Advocate Kevin Lembo).The law states that House Speaker Christopher Donovan, a longtime union advocate, must appoint a member of organized labor to the board.

The group will also include a primary care physician and experts in employee benefits and health economics, among others.

House Republican leader Lawrence Cafero of Norwalk said he believes some legislators were unaware of the full ramifications of the detailed, 19-section bill as they voted to override Rell's veto Monday, when six other bills passed over the governor's objection.

"Unfortunately, we do legislation to send a certain message and we start to go down a path and we go, 'What did we do here?'" Cafero said Tuesday. "If you read it carefully, it's almost a study group with a foregone conclusion. ... This is the most major overhaul of health care in our history. Last year, we hadn't heard of it. Guess what? It's the law."

Senate Republican leader John McKinney said that pushing off the implementation of SustiNet into the future was critical for obtaining votes because the law does not have any immediate fiscal impact.

"They get a vote for universal health care, but they don't have to live with the consequences," McKinney said. If the Senate had been forced to allocate money to start the program immediately, McKinney said, "There is no way it would have passed. It would have been difficult to get 19 votes."

The House of Representatives passed the SustiNet bill by 102 to 40 — one more vote than needed to override the veto. Five moderate Democrats — Linda Schofield of Simsbury, Jason Rojas of East Hartford, John "Corky" Mazurek of Wolcott, Brian O'Connor of Clinton, and Shawn Johnston of Thompson — supported Rell's veto.

Figueroa, the plan's prime advocate, rejects the notion that what the legislature approved was simply a study. "It's not a study," Figueroa said. "SustiNet is a framework for a solution."

"If the state were in a better financial circumstance and the economy was better, we could have perhaps done this in a way that more concrete steps could have been taken to implement this approach," Figueroa said. "But it is what it is. We have to be mindful of the economy, and we have to be mindful that the feds are wanting to do something so this gives you the best of both worlds."

Figueroa said he looks forward to working with the governor's office. While they disagreed on how to address health care problems, he said, they agree on the need to do so.

"Since SustiNet is the law of the state," Figueroa said, "we all need to figure out a way of working together." Copyright © 2009, The Hartford Courant