SustiNet backers not giving up on public option

Supporters of the proposed SustiNet state-run health plan were meeting Wednesday night when word trickled in that lawmakers had reached an agreement on the proposal. It would not include offering state-run insurance to the public, a key goal of supporters. But it would create a SustiNet cabinet to oversee health reform efforts.

A doctor in the room asked, “You mean to say that the patient still has a pulse?” recalled Juan A. Figueroa, president of the Universal Health Care Foundation of Connecticut, which is leading the push for SustiNet. Others in the room said it did.

“That’s certainly better than not having a pulse at all,” Figueroa said.

And so, even with an agreement among Democratic leaders that puts them short of their goal, SustiNet backers plan to continue pushing for a plan that offers state-run insurance to the public. Next week, they are holding a march to the state Capitol, where supporters will surround the building and, Figueroa said, express frustration that the plan hasn’t gone further. Inside the building, he said, organizers will continue to press for a firm commitment to creating a public option.

One major barrier: Gov. Dannel P. Malloy isn’t likely to agree to a public option, at least not this year.

“[The governor] does not believe that is a viable option at this point,” said Roy Occhiogrosso, a senior advisor to Malloy. “He thinks it might not ever be. And he thinks it might not be necessary to achieve the ultimate objective, which is to provide quality, affordable health care for every resident in Connecticut, which is the goal he shares with the SustiNet proponents.”

The agreement between the Malloy administration and Democratic leaders in the legislature calls for allowing municipalities to buy health insurance through the state employee and retiree plan beginning next fiscal year. Nonprofits that contract with the state would be allowed to buy in the year after, but there’s no plan to sell state-run insurance to small businesses or the public, as the SustiNet proposal calls for.

There are pieces of the agreement that appeal to Figueroa and other SustiNet supporters, including the co-chairwomen of the legislature’s Public Health Committee. It creates a SustiNet advisory panel to oversee health reform efforts, keeping the SustiNet “brand” alive. Members of the board that developed SustiNet would be on the panel, giving them a role in health reform efforts.

It also provides a line item in the state budget–and $1.5 million–for staff and consultants related to SustiNet.

The agreement does not include a public option, but it also doesn’t rule out one in the future. On Wednesday, Ben Barnes, Malloy’s budget director, said that whether the state health plan is ultimately expanded beyond municipalities and nonprofits will depend on how the first round of pooling goes and whether an expansion is needed after federal health reform rolls out.

Under federal health reform, every state will have in place a marketplace for individuals and small businesses to buy insurance, called an exchange, by 2014. The exchange is one of the major ways health care coverage will be expanded under the federal reform law, with federal subsidies for people below certain income levels to buy health insurance. Medicaid will also be expanded in 2014 to cover more low-income residents. Malloy has said he’s committed to implementing federal health reform and achieving universal coverage.

Keith Stover, a lobbyist for the Connecticut Association of Health Plans, said the SustiNet agreement rightly focuses the state on meeting the requirements of federal health reform.

“I think the focus right now is precisely where it should be, and that is on implementation of federal reform and the creation of a robust, progressive exchange,” he said. “I think, quite frankly, continuing to have wishful, hopeful feelings about the public option really saps energy and resources from the main goal, and that is to get people insured.”

Figueroa, meanwhile, said there is still room to shape the plan for SustiNet going forward. He pointed to comments from House Speaker Christopher G. Donovan, D-Meriden, that characterized the plan as a work in progress.

“Frankly, there is a lot of repressed anger,” he said. “But that does not mean that it’s time to walk away from the table. We’re in this for the long haul.”

The co-chairs of the Public Health Committee, Rep. Elizabeth B. Ritter, D-Waterford, and Sen. Terry Gerratana, D-New Britain, also said they will continue to push for a public option and hope to move forward the proposed SustiNet bill. They said they were encouraged that the agreement put funding for SustiNet in the budget.

“Am I disappointed not to be getting everything? Yes,” Ritter said. “Would I like to get more? Of course. In all reality, I think we’re definitely moving forward.”

Ritter noted that even the proposed SustiNet bill would not have created a public option in the upcoming biennium.

Where does the agreement leave the potential for a public option in the future?

“I think that it’s an open discussion item, absolutely, and that’s my intention and my expectation,” Ritter said.

“I think the public option is on hold at this point,” Gerratana said. “Off the table, on the table, I can’t really discern that.”

Figueroa said it’s not clear from the signals from the Malloy administration whether the concern is the timing of the proposal or a more fundamental difference about the proper approach.

Occhiogrosso said it’s a combination of factors, including concern about timing, uncertainty and cost.

“I think the agreement that has been reached and that will be part of the budget is one that allows the goals to ultimately be achieved, but in a way that Connecticut can afford,” he said.

Taking steps into “a great unknown” with a $3.3 billion budget deficit “just doesn’t make sense,” he added.

Figueroa said it’s important that the advisory board recognizes the work already done by the board that developed SustiNet. And the administration must address the problems of uninsured residents and small businesses that can’t afford to insure their workers, he said. Some of their concerns were included in letters to Malloy, delivered this week, from organizations leading the push for SustiNet.

“There’s a lot of frustration,” Figueroa said, adding that many people have been involved in pushing for a public option for more than four years. “The governor and the legislature need to at some level acknowledge it and deal with it.”

Figueroa also criticized the insurance industry, which Malloy sees as a key source of job growth, for opposing the proposal.

“They’ve taken this on like a jihad, unfortunately,” he said. “And that’s true at the national level, and it’s certainly true at the local level.”

Stover said he was not surprised that SustiNet advocates would blame insurers for the plan not being adopted, but he said the real problem is that it would not work. A report by the legislature’s nonpartisan Office of Fiscal Analysis said the proposal could cost the state hundreds of millions of dollars, although the Universal Health Care Foundation has disputed the analysis.

“I think it is, I suppose, at the end of the day, not a surprise that when the financial and governing aspects of your plan simply fall apart, and the math simply doesn’t work, to find someone to attack on sort of an ad hominem basis,” he said. “I’m also not surprised, given the millions of dollars that that foundation has spent, that they need to find a boogeyman who, but for that boogeyman, we would all be at the gates of heaven. Unfortunately, that’s not the case. Their plan does not hold together.”

Stover said the state is on a path toward significant reforms that will insure more people.

“I think perhaps in the minds of the advocates, SustiNet equals reform,” he said. “Good, bad, indifferent, the train passed SustiNet by when they acted in Washington. And the focus in Connecticut is appropriately on implementation of federal reform, capturing and implementing the promise of exchanges, and that’s the work and business we need to be about right now.”