Members of the public got their chance to weigh in on the SustiNet plan this week, and their questions and comments offered a hint at what could lie ahead as policymakers attempt to create a public health insurance plan for the state.

Many of those who spoke at presentations in New Haven and Hartford identified themselves as supporters of the concept, the details of which are still being hashed out by a board. Some with a particular interest in the shape of the plan, including a chiropractor and an optometrist, wondered how it would affect their fields.

There were questions about how an expanded state insurance program could be done in the midst of a massive state budget deficit and whether a public insurance option would threaten the business of private health insurers. And some speakers raised concerns or reservations about what the process would ultimately produce.

The SustiNet board is expected to make recommendations early next year to the legislature, which must approve any plan. The board will likely vote on the recommendations Dec. 15.

SustiNet Lembo Wyman

SustiNet board co-chairs Kevin Lembo and Nancy Wyman

Katharine London, one of the consultants working with the board, described SustiNet as a publicly run health insurance plan intended to rein in costs, promote wellness and make better use of the $7 billion the state spends on health care.

London said much of the board’s discussion has focused not on whether to do certain things, but when. Board members agree that they want SustiNet to initially, in 2011, include those covered by state-funded health insurance–Medicaid and HUSKY enrollees and state employees and retirees.

The HUSKY program, which covers some 400,000 mostly low-income children and their parents, could be expanded to people with higher incomes in 2012 if the money can be found to do it, she said.

And as soon as it is feasible, the board would like to allow municipalities, small businesses and nonprofits to buy into SustiNet for their employees. The health plan would also be sold to the public, London said.

Among the issues the board is now addressing, she said: Who should be on the SustiNet board going forward, as its role moves toward governing the program, and who should appoint them? And how much flexibility should the board have over time to make changes and implement them?

Those who spoke at the presentations Monday and Tuesday had other questions.

One woman asked whether SustiNet is threatened by the state’s fiscal condition, or whether cost savings are built in.

State comptroller and lieutenant governor-elect Nancy Wyman, who co-chairs the board, said SustiNet might need to roll out slower than the board hoped. There could be federal money to help implement SustiNet and savings in what the state already spends, she said.

“We spend $7 billion right now on health care in the state of Connecticut,” she said. “We believe that there are savings we can find.”

Several questions addressed issues the board has not yet decided: Could undocumented immigrants – a group left out of federal health reform–buy into SustiNet? What specific steps will be taken to address racial and ethnic disparities?

Two health care providers raised concerns about the role their fields would play in Sustinet.

Branford optometrist Brian Lynch, who spoke on behalf of the Connecticut Association of Optometrists, asked board to commit SustiNet to covering particular services, including comprehensive eye care. SustiNet is expected to promote the use of patient-centered medical homes, in which teams of health care providers coordinate patients’ care, and Lynch asked that a wide range of health care providers be included as possible medical homes.

SustiNet presentation

Chiropractor Richard Duenas (2nd from left) and minister David Nelson (center) listen to questions on SustiNet

State Healthcare Advocate Kevin Lembo, the board co-chair and comptroller-elect, said he did not expect the board would support a plan that did not include comprehensive benefits currently required by state law. But he noted that the board’s charge now is to put forward a proposal. Going deeper into issues of what specific items should be covered will likely fall to the next phase of the board’s work.

He offered a similar answer to West Hartford chiropractor Richard Duenas, who represented the Connecticut Chiropractic Association and asked whether the SustiNet program would “take a fair and unbiased look” at non-physician providers to help relieve the workforce burden and provide care.

Many speakers expressed support for SustiNet, including several who said they worked with people without health insurance.

David Nelson, a retired minister from Mansfield, said SustiNet will be critical for people without health coverage.

“People are literally dying because they don’t go to doctors,” he said, wearing a red “healthcare4every1” shirt that SustiNet supporters wore when trying to get legislators to support the plan last year.

Nelson acknowledged concerns about whether the state can afford SustiNet, but said he hopes the state will adopt it.

“It’s going to cost a lot of money, but if we don’t, we know what’s going to happen,” he said. “People are going to die and it’s going to cost more money anyway.”

The cost of SustiNet has been a source of dispute. Gov. M. Jodi Rell cited financial concerns when she vetoed the bill creating SustiNet last year, pointing to a projection from her budget office that it would likely cost about $1 billion per year. She warned that SustiNet could prompt employers to drop health coverage, raising costs even further. The legislature later overrode the veto.

By contrast, a recent analysis by Stan Dorn, a consultant to the SustiNet board, suggested that SustiNet could save the state between $32 million and $427 million per year, depending on how many groups are included in the insurance pool. The savings would come largely from the state capturing additional federal money. Some would also come from the delivery system changes that are aimed at slowing the growth of health care spending, including the use of medical homes, electronic medical records, and payment reform that would reward health care providers for doing the “right” things, rather than simply doing more tests and procedures.

Dorn’s analysis also showed that one option the board is considering, raising rates paid to health care providers in HUSKY, could cost the state more money. The board has agreed that raising HUSKY payment rates is important, consultant Anya Rader Wallack said, and is now discussing how to fund it.

The cost projections will likely be a major source of debate when legislators consider SustiNet’s future. So might the effect it could have on the state’s insurance industry. One speaker addressed that issue Monday, saying there is concern in the industry that SustiNet will threaten for-profit insurers.

Lembo said SustiNet could serve as a model for other insurers if its practices work and save money.

“I won’t apologize for a group of potentially a million lives that can affect positive change in this environment,” he said. “We’ve allowed one model to function and it hasn’t worked for many, many, many, many, many of us.”

Arielle Levin Becker covered health care for The Connecticut Mirror. She previously worked for The Hartford Courant, most recently as its health reporter, and has also covered small towns, courts and education in Connecticut and New Jersey. She was a finalist in 2009 for the prestigious Livingston Award for Young Journalists, a recipient of a Knight Science Journalism Fellowship and the third-place winner in 2013 for an in-depth piece on caregivers from the National Association of Health Journalists. She is a 2004 graduate of Yale University.

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