Flanked by fellow legislators and advocates for health reform, Speaker of the House Christopher G. Donovan launched what’s likely to be his final push for the state to adopt one of his favorite causes — opening the state employee health care pool to the public.

The concept is a top item on the wish list of advocates for universal health care who want an alternative to private insurance, but they could face an uphill fight in getting it adopted. Gov. Dannel P. Malloy’s administration has been cool to the concept, which has drawn opposition from the insurance industry and some business groups.

This year’s proposal would let employers with fewer than 50 employees, including people who are self-employed, buy insurance through the state employee health plan. It would also change some rules for the small group insurance market, prohibiting insurers from adjusting premiums based on age, gender, occupation or group size, and requiring insurers to give premium quotes to groups of small businesses that seek coverage together as an association.

The bill grew out of the recommendations of a working group on small business health care that Donovan established, which was led by Insurance and Real Estate Committee Co-Chairman Robert Megna, D-New Haven.

Malloy spokesman David Bednarz the administration is still reviewing this year’s bill.

Opening the state employee plan to small businesses and the public was part of last year’s proposal to create a state-run health plan called SustiNet, but it was left out under a compromise between the Malloy administration, Donovan, D-Meriden, and Senate President Pro Tempore Donald E. Williams Jr., D-Brooklyn. Malloy had raised concerns about the proposal’s cost and potential effect on the insurance industry.

This year’s proposal has drawn support from advocates for universal health care and small businesses, as well as state Comptroller Kevin Lembo, who said in written testimony that opening the state employee pool to outside groups would give them access to lower administrative fees and premiums and cost stability. His office is in the process of offering state-run insurance to municipalities, something made possible through last year’s SustiNet compromise.

But critics say the proposal could put the state at risk for higher costs and is inconsistent with provisions of federal health reform that take effect in 2014.

Eric George, a lobbyist for the Connecticut Business and Industry Association, said it would be problematic to open the state employee health care pool to the public because the population that would join could include older, less healthy people whose health care needs would raise the costs the state would have to bear.

In addition, he said, prohibiting insurers from adjusting premiums based on age, gender and other factors would likely raise the cost of insuring younger people, which could cause them to drop out of the pool, leaving it more heavily weighted with older people — also causing costs to rise.

Donovan is running for Congress and is in his last session leading the House. Asked whether his departure adds to the urgency of passing a pooling bill this year, Donovan said he expects other lawmakers, including Megna, Public Health Committee Co-Chair Betsy Ritter, D-Waterford, and Insurance and Real Estate Committee Co-Chair Joseph Crisco Jr., D-Woodbridge, to continue pushing for it.

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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