Under a timeline beginning to take shape for Connecticut’s SustiNet health care reform law, it appears unlikely that individuals will be able to buy in before 2014, when the federal health-care reform law takes effect.
SustiNet is facing a much friendlier political environment with incoming Gov. Dan Malloy, but the state’s financial picture is far starker than it was 18 months ago, when the universal health care plan passed the General Assembly despite a veto from M. Gov. Jodi Rell. On Monday night at New Haven’s Hill Regional Career High School, members of the board trying to put meat on the plan’s bones shared some details and took questions from doctors, advocates and citizens eager to find out what’s next.
“We might have to do SustiNet a little slower than we’d hoped,” said Comptroller Nancy Wyman, the co-chair of the SustiNet Health Partnership Board as well as Malloy’s lieutenant governor.
But, she said, the state should be able to start saving money quickly, by expanding its buying power and encouraging better management of the $7 billion in health care the state’s already paying for.
That’s because SustiNet will start by pooling these customers: current and retired state employees, Medicaid recipients, and kids eligible for the HUSKY program. That will happen next year. In 2012, if possible, towns and cities will be allowed to buy into the plan, along with small businesses and nonprofit organizations.
Finally, in 2014, “exchanges” set up in the federal health reform law passed by Congress earlier this year will open up, with SustiNet as an option. At that point, individuals and larger companies will be able to purchase coverage, either with SustiNet or a private company. Insurance coverage in the exchanges will be subsidized by the federal government.
SustiNet should also be available outside the exchange for those who want to buy it that way, although they would be giving up the subsidy, said Kevin Lembo, who will take Wyman’s job in January after six years as the state’s health care advocate.
Wyman and Lembo said that if the fiscal situation makes it possible for the schedule to be accelerated, they’ll push for that.
“When we can do it, nobody can tell right now, until we see that budget,” Wyman said, emphasizing that Malloy’s administration remains firmly committed to covering the uninsured.
The board is preparing a set of recommendations for the General Assembly, which will include the makeup of a separate panel that will oversee the program as it evolves.
Consultants who have been working with the board outlined some general goals SustiNet, including controlling costs, promoting good health and offering high-quality, affordable health care to people in Connecticut.
Getting there means pushing for better and more widely available preventative care, using “medical homes,” where patients can consistently see the same doctor and access other services. Board members said they’d like to raise reimbursement rates for doctors—especially for those who take HUSKY patients—but that in exchange, the state will move toward paying for better outcomes, not just more procedures.
“We are trying to not reinvent the wheel here where the wheel is working,” Lembo said. “And we’re looking for a spare tire where the wheel is not working.”
Wyman said cities and towns can save money by enrolling their employees in the larger pool when the time comes. And the entire state can start taking advantage of federal dollars that will start flowing as the health-care bill rolls out.
The audience, which was small—under 40 people—but engaged, peppered the board with questions. Would SustiNet cover comprehensive eye care? Almost certainly. What about mental health services? Ditto. A gynecologist who supports the program warned members that they’ll need to help doctors navigate the changes in order to avoid pushback.
After what sounded like a remarkable string of meetings, with the full board, subcommittees, working groups, and consultants, Clodomiro Falcon did ask board members a question they hadn’t spent much time talking about: whether Connecticut, unlike the federal government, will allow undocumented workers to buy in.
After the meeting, Wyman and Lembo said they might be receptive to letting immigrants purchase insurance, especially those who are here legally but have lived in the U.S. for less than five years. The federal legislation bars them from the insurance exchanges and any subsidies.
Falcon, who’s the president of the Hispanic Chamber of Commerce of Greater Bridgeport, said he’s asked about SustiNet all the time.
“A lot of people are assuming that they’re going to be covered,” he said. “I think that the federal government made their decision, but I think in Connecticut things could be different.”