Who will lead state’s health care reform?

Grappling with a $3.3 billion budget deficit and a bad economy might dominate the work of Governor-elect Dan Malloy’s administration, but his staff’s to-do list will also include implementing federal health care reform, a law that gives considerable responsibility–and work–to the states.

Connecticut is one of many states expected have a change in leadership in handling the health care law. Twenty-six states are changing governors, and many, like Connecticut, have a political appointee in charge of the implementation effort.

The Patient Protection and Affordable Care Act won’t be fully rolled out until 2014, and it could still be revised if Republicans in Congress get their way. But some provisions require planning now, including building the health insurance exchange, a marketplace for purchasing coverage that must be operational by Jan. 1, 2014.

Connecticut’s lead in implementing health reform, Cristine Vogel, serves as a special adviser to Gov. M. Jodi Rell and expects to leave the job sometime before Malloy takes office. Vogel also heads the state’s Health Care Reform Cabinet, which includes the commissioners of 11 agencies.

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Cristine Vogel

The Department of Social Services, which is already facing a surge of new Medicaid enrollees because of the economy and new eligibility rules, will need to prepare for a projected 114,000 or more new Medicaid clients under health reform. The department is certain to get a new leader: Commissioner Michael Starkowski is already retired and has been leading the department on a contract basis.

The Connecticut Insurance Department, which will have more responsibilities as insurers face more data reporting requirements, also will get new leadership. Commissioner Thomas Sullivan, who came under fire after approving double-digit rate hikes for some individual-market health insurance plans, is leaving the job after this week.

“There’s just so much that the new governor will need to focus on, I’m just hopeful that health care will pop back up on the radar screen,” Vogel said. “But he does have a lot of work ahead of him.”

Malloy’s chief of staff-designee Timothy F. Bannon, who is leading the transition team along with Lieutenant Governor-elect Nancy Wyman, said there have not been any major decisions made about health reform implementation efforts yet.

“Right now, it’s just one of those things that we’re trying to figure out how to best address,” he said.

Vogel said federal officials have acknowledged that many of state officials working to implement the law across the country are departing.

“They acknowledge that new governors have a learning curve and they come with their own different policy approach,” she said. “The policymakers down in Washington DC are changing a little bit too. It’s a time of great flux.”

In her remaining time in the job, Vogel plans to focus on the health insurance exchange. The state recently received a planning grant and Vogel hopes to hire a manager for the grant to move forward with research on the insurance market and information technology infrastructure that will help inform the exchange-planning process, including determining whether a state-run exchange is a viable option.

In addition to making information about health insurance plans available to the public, the exchange will have a variety of data collection and reporting functions. It will be responsible for certifying and rating insurance plans, ensuring that quality and satisfaction are being measured, reporting to the federal government and tracking which employers do not offer insurance to their employees.

By 2015, the exchange must be financially self-sustaining. The state will need legislation to create the exchange.

It’s not clear how many people would be required to staff such a program; a similar effort in Massachusetts, called the Health Connector, has dozens of employees. States have the option of outsourcing the functions, teaming with other states to create regional exchanges, or having the federal government run their exchanges.

The Department of Social Services might also need to add jobs to handle the influx of applications and inquiries likely as Medicaid eligibility expands to nearly all state residents with incomes up to 133 percent of the poverty level in 2014.

Asked what advice she had for her successor, Vogel said she had many opinions, but that “I advise Governor Rell.”

“We in state government typically know where our lines are, and so if asked by the governor-elect, I would at least share my thoughts and opinions with him,” she said. “But during the transition, it’s important for him to create his vision and his policy and make sure his administration knows what he believes in.”

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