SustiNet board approves final proposal 7-1

The SustiNet board voted Wednesday on its final recommendations for a health insurance plan that would cover state employees and retirees, Medicaid and HUSKY recipients, and ultimately be sold to municipalities, nonprofits, small businesses and the public.

The proposal, which will be submitted to legislators by Jan. 7, calls for creating a quasi-public agency to oversee the SustiNet health plan. The agency would initially be staffed by the state comptroller’s office, but under the proposal, would have its own executive director and staff by 2013.

Under the plan, state employees and retirees and people covered by state insurance programs would be joined into one health insurance pool. The pool would then be opened to municipalities, small businesses and nonprofits, and by 2014, everyone in the state.

The proposal includes plans for delivery system reforms including offering incentives for health care providers to serve as patient-centered medical homes and eventually requiring providers to use health information technology like electronic medical records.

It also calls for the legislature to make changes to state law, including expanding the scope of practice for nurse practitioners so they can play larger roles in medical homes and creating “safe harbors” for malpractice liability for providers who are appropriately following clinical guidelines.

And the proposal urges the legislature and SustiNet board to find resources to expand HUSKY eligibility before 2014, when federal health reform will expand Medicaid coverage, and to fund public health initiatives such as preventing tobacco use and obesity, expanding the state’s health care workforce and addressing racial and ethnic disparities.

Seven board members voted for the proposal during a conference call Wednesday. Board member Paul Grady cast the lone vote against the proposal.

Grady, a partner in the consulting firm Mercer, has raised concerns about the feasibility of offering SustiNet to the public as a plan that competes with commercial insurers. He has suggested that SustiNet be considered to have two separate roles. One would be providing “strategic oversight,” promoting delivery system reforms and public health improvements that could save money. The second is having a health plan offered to the public, in competition with commercial insurance companies.

If SustiNet does not succeed in the private insurance market, Grady has said, the state should still use the oversight role to help manage the $7 billion the state already spends on health care for groups including state employees and retirees and people in public insurance programs.

SustiNet grew out of an effort to establish universal health care in the state before the federal health reform law was passed, and supporters are now hoping it will serve as a public option for Connecticut. Gov. M. Jodi Rell vetoed the initial legislation creating SustiNet, citing cost concerns, but the legislature overrode her veto. More recent cost projections presented by SustiNet board consultants have suggested that SustiNet could save the state money, largely by capturing federal funds made available under health care reform.

The legislature and governor must approve any plan for SustiNet before it becomes law.