In Hartford, the battle lines being drawn aren't always along party lines
There are at least two ways to do most everything. There's a right way and the wrong way. There's the "well thought out" way and the "hold your nose and jump in" way. In Connecticut's brewing debate over the future of health insurance, there's a Republican way and a Democratic way. And then some. When it comes to health-care reform in Connecticut, both parties vow that - on this issue - there will be a blurring such coverage must be financially sustainable, of high quality and easily accessible. This newfound consensus was apparent in the amount of time the issue has been given in General Assembly sessions so far this year. But even this early in the game, there are major sticking points.Last year, many lawmakers were watching neighboring Massachusetts for an example. Soon-to-be-ex-Gov. Mitt Romney had just rolled out a new universal health-care plan that promised high-quality, accessible care for all Bay State residents for a mere $250 a month. But the "plan" appeared to be little more than a rough idea. Universal coverage, it turns out, will cost closer to $380 per resident in Massachusetts.
Back at home, Gov. M. Jodi Rell similarly had her sights set on a $250-per-month target for Connecticut residents, too. State Democrats have set the same price per person as a target, but there the similarities end.
Democrats
The plan: Connecticut Health First Initiative, a "Medicare for all"-type program
Notable players: Senate President Donald E. Williams Jr. (D-29), State Sen. Joseph Crisco (D-17), New Haven Mayor John DeStefano Jr.
Devil in the details: Democrats believe that adding onto an existing health-care system that is already too complex and costly is not the answer. But what is the answer?
New Haven Mayor John DeStefano Jr. says he is 100-percent in support of a strong universal health-care system. He has his own ideas about how to build one: through the creation of a Connecticut Health Care Consortium from which small businesses, families and individuals could purchase health insurance coverage. He also proposes to restructure the tax code to encourage and help businesses to provide affordable and portable health coverage to their employees.
Under DeStefano's program, all plans participating in the consortium would be required to offer annual wellness assessments and personalized wellness plans for their members. Individuals below the federal poverty level could be eligible for an increased subsidy if they participate in the wellness assessments and take steps outlined in their wellness plans.
However, the plan before the legislature right now is slightly different. At the end of January, State Sen. Joseph Crisco of Woodbridge, co-chair of the Insurance and Real Estate Committee, and Senate President Donald E. Williams Jr. of Brooklyn unveiled the Democratic lawmakers' plan to expand access to quality, affordable health care in Connecticut.
The Connecticut Health First Initiative would provide coverage in the first year for more than 140,000 Connecticut residents currently without health insurance and works toward a Medicare-for-all type plan that brings better quality, simplicity and affordability in health care for all Connecticut citizens. The Democrats believe that 40 percent of those currently without health insurance - anywhere from 250,000 to 400,000 - can be covered by expanding the state's existing HUSKY and Medicaid programs for both children and adults.
First, the HUSKY-A income limits for parents and relative caregivers would be increased from 150 percent of federal poverty level to 185 percent. For a family of two, this would increase the income limit from $19,800 to $24,420. For a family of three, this would increase the income limit from $24,900 to $30,710. This expansion would make an estimated 24,000 adults newly eligible for the program. The Health First Initiative would restore continuous eligibility, which makes enrolling and re-enrolling in HUSKY easier.
The Democrats' initiative would increase income limits for State-Administered General Assistance (SAGA), a state-run and state-funded program for childless adults, from 60 percent of federal poverty level to 100 percent.
For a single person, this increases the annual income limit from $5,880 to $9,800. The plan would seek a seek a federal waiver to include this population in the Medicaid program. This would provide the state with a 50-percent match in funds from the federal government, gaining reimbursement for a plan that is now entirely state-funded. This would ensure health-care coverage for more than 10,000 Connecticut residents who now go without.
Williams says the Connecticut Health First initiative would fulfill the promise of existing HUSKY and Medicaid programs and it would end what he calls the unfairly low reimbursement rates to doctors and hospitals that contribute to denying care to Connecticut residents.
Expanding HUSKY and SAGA would cost the state about $225 million. Actually the initial cost would be close to $450 million, but half of that would be reimbursed by the federal government. The logic is that a significant portion of the $572 million spent on the uninsured right now would be recouped.
Of Connecticut's three million residents, less than ten percent are uninsured. Compared to the 20 percent of the population that is uninsured in Texas, we're not in bad shape. But everything's relative.
Connecticut residents spend $22 billion a year on health care, or about $7,300 per person. Middle-income families are paying more for the health insurance they have because our Medicaid rates are so low and that results in a hidden cost of cost shifting.
According to Williams, because we pay low Medicaid rates, providers shift those costs onto middle-income families and other people who have insurance and pay higher rates, which in turn, translate into higher premiums.
The second part of the Democrats' solution would be to allow families to carry their dependent children on their private health insurance until those children are at least age 26. The intent would be to help many young adults, starting out in their first jobs, to be covered by health insurance. But that brings about a new round of questions: Suppose there are no parents? Suppose the parents are facing the same health-care challenges as their children? Parents or their children would still have to pay for the insurance.
Finally, the Democrats initiative would place emphasis on strengthening the fiscal health of school-based health centers. The intent is to increase capacity at community health centers and federally qualified health centers in identified shortage areas.
It would also require employers to allow health-care insurance premiums to be deducted pre-tax, to make insurance more affordable for employees.
Republicans
Notable players: Gov. M. Jodi Rell, House Minority Leader Lawrence Cafero (R-142)
The plan: Charter Oak Health Plan, Senate Bill 1, House Bill 6332, House Bill 6843
Devil in the details: The governor's proposed Charter Oak Health Plan would operate on a sliding fee scale. Cost would be about $75 a month per person for lower-income wage earners, but even that might be difficult to afford for state's poorest residents.
The governor's proposed budget contains $18.9 million for fiscal 2008, $36 million in fiscal 2009, and $45 million in fiscal 2010 to support the initiative. The target monthly cost for an unsubsidized member is $250, plus co-payments and deductibles. Rell hopes to take advantage of proposed federal funding for premium assistance that President Bush offered in his State of the Union address.
The Charter Oak Plan is intended to cover uninsured adults irrespective of income who lack insurance through the workplace by providing basic, quality health insurance to adults from ages 19 to 64. The governor hopes to see her new plan in place by the fall.
The Charter Oak Plan would include prescription medications, laboratory services and pre- and post-natal care, but wouldn't include co-pays and any applicable deductibles.
The new proposal for premium subsidies would have Connecticut helping adults without children pay for health coverage. HUSKY covers parents with incomes of up to 150 percent of the federal poverty level - but not childless adults. The Charter Oak Health Plan would also help parents who do not qualify for HUSKY because their income is too high.
The governor's plan includes: a prescription package co-pays ranging from $10 to $15, coverage for those with pre-existing conditions, no maximum annual benefits, lab, X-ray and other diagnostics would carry a 20 percent co-pay and assignment of customers to a primary care physician.
The governor also recommends a premium assistance plan for HUSKY A (Medicaid) members who already have health coverage through an employer. The Department of Social Services would accomplish this by developing a "wrap-around" program that will coordinate coverage between Medicaid and the employer-sponsored insurance, assuring no loss of benefits or additional expense for the client.
Just as DeStefano's plan differs from that of Democrats in the legislature, Republicans lawmakers have a plan that differs from the plan laid out in the governor's budget proposal.
Republican lawmakers recognize the need to address the state's HUSKY program, and they agree it needs to be done thoroughly and quickly.
According to House Minority Leader State Rep. Lawrence Cafero of Norwalk, the HUSKY is the most important group to reach, since uninsured kids do not have the choice to seek out and inform themselves and avail themselves about health-care insurance and coverage.
In addition to expanding outreach to eligible families, the 'Republican Senate Bill 1' would require parents either to enroll their children or show proof of their enrollment in HUSKY in order to receive assistance through other state-sponsored programs.
This Republican proposal would require up to five standard plan options, including a mandate-light option for adults between the ages of 19 and 26.
According to Cafero, Connecticut is a national leader in health-care mandates placed on all policyholders. There are 50 mandates that add between six and 46 percent of the cost of premiums paid by policyholders.
The proposal also calls on employers and insurance companies to provide a variety of plans that better meet the individual needs of employees. Employees would be allowed to buy these plans as individuals or keep their coverage, regardless of their place or status of employment.
Cafero also would like to see individuals allowed to deduct their portion of premium payments from their state income tax. Small businesses that previously offered no insurance would receive a tax credit for their share of premium paid. This would offer another incentive to small businesses to make sure that those who work for them are covered by health insurance.
The state plans to put out a request for proposal to insurers, asking them to devise a benefits package at approximately $250 per month for a community-rated premium that shows no age distinction.
Proposed House Bill 6332 would require every Connecticut resident to show proof of health insurance coverage. It would become unlawful for any resident to be without health insurance coverage for more than six consecutive months. The law would require any individual who is eligible for or receiving state-sponsored assistance who has a dependent child to enroll the child in the HUSKY Plan, and there would be increased funding for HUSKY outreach programs.
If H.B. 6332 became law, private health insurance providers would be required to establish up to five new health insurance plans that would be exempt from certain state health insurance mandates. Small businesses with 50 employees or fewer would be able to participate in such new health plans. Under this plan, individuals would be permitted to purchase new health insurance plans, independent of their employment status and regardless of whether their employer participates in such new health insurance plans and these employees would be allowed a deduction of out-of-pocket expenses.
Uninsured small businesses would be eligible for a tax credit to assist them in affording such new health insurance plans. There would be increasing Medicaid reimbursement rates for providers in order to increase the number of quality health-care providers available and willing to provide services to Medicaid recipients so as to provide quality health care.
Finally, a state-sponsored health insurance subsidy program called the "Deferred Health Insurance Payment Program" would be created for individuals with income levels between 150 and 400 percent of the federal poverty level.
They know what they want to do, it's just a matter of how. Good luck with that.
