SustiNet board to present recommendations for new state health plan to legislature
State-backed program would help uninsured, lower costs
Published 1:32 pm, Saturday, January 8, 2011
A long awaited state health care reform plan that could cover more than half of the state's uninsured and save taxpayers at least $226 million a year is now headed for state lawmakers.
Last week the SustiNet Health Partnership Board of Directors unveiled a lengthy set of recommendations on how to enact the health-reform plan. The SustiNet proposal grew out of legislation passed in 2009 by the General Assembly, which formed the board and tasked it with creating a plan that would increase the quality of health care, improve access and rein in health care costs.
Among other things, SustiNet would expand coverage offered by the state HUSKY program to include adults with incomes up to 200 percent of the federal poverty level. Currently, HUSKY covers children and teenagers, parents, relatives, caregivers and pregnant women. Though Medicaid does cover childless adults and empty nesters, it only applies to those at about 60 to 70 percent of the federal poverty level, according to proponents of the plan.
In addition to expanding HUSKY coverage, the SustiNet plan will implement a variety of payment reforms and changes to health care delivery that will, according to its proposal, "move toward a more coordinated, patient-centered, evidence-based approach to health care."
More InformationAbout SustiNet In 2008 and 2009, an average of 377,000 uninsured people were living in Connecticut. If trends continue, nearly 390,000 people in the state will be uninsured by the end of the decade and private employers will spend $14.8 billion a year on insurance premiums. SustiNet is the name of the health-insurance program that would help insure people. The name comes from the state motto: "Qui Transtulit Sustinet," (He Who Transplanted Still Sustains). SustiNet would initially cover only individuals currently covered through the state, including state employees, retirees, and Medicaid HUSKY beneficaries. Eventually, it would become a new health-coverage option for municipalities, private employers and families. SustiNet would be available for purchase both inside and outside the state health care exchange that will be established as part of federal health care reform. Among other changes, SustiNet would expand HUSKY coverage to include adults with incomes up to 200 percent of the federal poverty level. Currently, HUSKY covers children and teenagers, parents, relatives, caregivers and pregnant women. Supporters say the combination of federal and state health-care reform would end up covering 55 percent of Connecticut's uninsured by 2017. The SustiNet report also claims that the combination of the plan and federal reform could save taxpayers anywhere from $226 million to $277 million a year by 2014.
The proposal comes at a time when state lawmakers are facing a $3.5 billion budget deficit and when a newly elected Republican majority in the U.S. House of Representatives is pressing ahead with efforts to repeal federal health care reform.
Though the SustiNet legislation was passed before Congress approved -- and now is undertaking efforts to repeal -- the federal health care reform package, both reforms are aimed at fixing what advocates see as broken health care systems, said Stan Dorn, senior fellow at the Urban Institute in Washington, D.C. and one of the consultants who helped the SustiNet board create the recommendations.
Dorn said the original impetus for SustiNet was to both insure more people and keep costs under control. The passage of federal health care will likely help achieve those goals to some degree, but it was hardly a cure-all, said Janet Davenport, spokeswoman for Universal Health Care Foundation of Connecticut.
In 2008 and 2009, there were an average 377,000 uninsured people living in Connecticut. According to the SustiNet report, if recent trends continue, nearly 390,000 people in the state will be uninsured by the end of the decade and private employers will spending $14.8 billion a year on insurance premiums.
"The federal health care reform has started some of the work, doing away with some of the limitations put on consumers by health-insurance companies," Davenport said. "But even under federal reform, there are still people who are uninsured and under-insured."
Like federal reform, the SustiNet plan would be slowly integrated between now and 2014. SustiNet will initially only cover individuals currently covered through the state, including state employees, retirees, and Medicaid HUSKY beneficiaries. Eventually, it would become a new health coverage option for municipalities, private employers and families. SustiNet would be available for purchase both as part of the state health care exchange that will be established as part of federal health care reform and outside the of the federal program.
If SustiNet goes into effect as planned, supporters said the combination of federal and state health care reform would end up covering 55 percent of the state's uninsured by 2017. As with federal reform, the major pieces of the state proposal wouldn't go into action until 2014, and it would likely take a few years for its impact to be fully felt, Dorn said. The SustiNet report also claims that the combination of the plan and federal reform could save taxpayers anywhere from $226 million to $277 million a year by 2014.
Dorn said despite the current climate, he's optimistic about SustiNet's fate. "State officials all over the country are preparing to implement health reform," he said. "I don't know why Connecticut would be any different."
Davenport said the proposal has supporters in the Malloy administration. One of the chairs of the SustiNet Health Partnership board was Nancy Wyman, who was sworn in as the state's lieutenant governor on Wednesday, which Davenport said bodes well for the future of the proposal. "It does seem like a good environment for the change to happen," she said.
Yet, even if it goes into effect, SustiNet -- like federal health care reform -- won't be a solution for everyone, said Karen Gottlieb, executive director of AmeriCares Free Clinics, which has branches in Bridgeport, Danbury and Norwalk. Last fiscal year, the three offices saw a total of about 3,100 patients. Though Gottlieb said some might seek coverage in the wake of federal or statewide reform, not all will.
Some of those served by the clinic are undocumented immigrants or face other barriers to insurance that won't be removed by reform. In fact, Gottlieb said, the implementation of reform measures would likely make competition for physicians fiercer, and could drive even more traffic to free clinics like AmeriCares. "I think a lot of people will continue to fall through the cracks," she said.