Lawmakers will tackle the high cost of insulin and an expansion of telehealth services during a brief special session that begins next week, along with reforms on police accountability and absentee ballots.
But absent from their agenda are broader health equity proposals that have resurfaced amid the coronavirus pandemic and protests in the wake of George Floyd’s death. Advocates say state leaders are missing a crucial opportunity to address health reforms that have long been needed.
“We’re at a critical precipice,” said Wizdom Powell, director of the Health Disparities Institute at UConn Health.“There’s a window opening for bold reforms. These moments don’t come that often for us as a nation or state, and I would hope that we would capitalize on them to make the necessary structural changes that would truly advance health equity.”
In June, following Floyd’s death at the hands of Minneapolis police and the protests that flared up nationwide in response, advocates issued a renewed call to address health equity measures.
One of their key proposals is data collection. Most race-related statistics gathered in Connecticut – from Medicaid enrollment to the uninsured population – show health outcomes for Black, Hispanic, Asian and white residents. But the broader categorization hides disparities that affect residents of specific races and ethnicities.
The pandemic has exposed other weaknesses in the state’s data collection. Information about the coronavirus’ impact on minority communities was at first incomplete and later adjusted to give a truer picture of how people of color have been affected.
Medicaid expansion is another priority. Many people in Connecticut make too much money to qualify, but not enough to purchase a plan on the state’s health exchange – a population that advocates say “falls through the cracks” when it comes to health coverage. They have asked legislators to push the qualifying threshold to 201% of the federal poverty level. It is currently 160%.
And health equity proponents have asked the state to again consider more extensive coverage for undocumented residents. State officials have extended some relief to the undocumented community since the pandemic began, including access to Medicaid for emergency medical conditions. But advocates say more is needed.
“I can understand that it’s a short session, but we’re in a pandemic where we’ve seen a gross differential impact on people of color,” said Tekisha Dwan Everette, executive director of Health Equity Solutions. “To not do anything related to COVID-19 other than the telehealth aspect was challenging to see. It’s a missed opportunity.”
Stronger insulin bill and permanent telehealth
Lawmakers introduced a bill in February to cap the monthly cost of insulin at $50. The measure also limited the price of insulin-related supplies, such as syringes, pumps and blood sugar meters, to $100 a month.
The legislation was shelved when officials suspended the regular session in March amid the pandemic. Broad bipartisan support for the proposal – leaders from both parties and both chambers have backed it – helped the bill land on the narrow agenda for the special session.
But its authors say they are drafting a new version.
In March, New Mexico adopted its own legislation capping monthly co-payments and out-of-pocket expenses for insulin at $25. Now Connecticut wants to do the same. Insulin supplies would still be capped at $100 a month.
“We saw that other states are passing lower thresholds. And in the six months since we first wrote this bill, other things have changed and the market has moved,” said Rep. Sean Scanlon, D-Guilford, a key proponent.
The measure also includes a provision that would give pharmacists the authority to dispense insulin without a prescription in emergency situations. That portion of the bill was modeled after an effort in Ohio known as Kevin’s Law, which allows pharmacists to give patients a 30-day supply of a lifesaving drug like insulin even if the prescription has expired. Kevin’s Law went into effect in 2016, and other states have passed identical legislation.
The newest version of the bill would also create a program for people struggling to afford insulin, similar to legislation adopted in Minnesota.
“It would set up a system where you have to get people who have a long-term problem affording insulin into a program to be able to afford it,” Scanlon said.
In addition, legislators want to pass into law telehealth measures made temporarily possible by a recent gubernatorial executive order. The order allows patients and health care providers to communicate over a wider range of platforms, including audio-only telephone calls. It also permits commercial insurers and Medicaid to cover telehealth services for all in-network providers, regardless of communication platform.
A public hearing on those bills is planned for Tuesday. The House of Representatives is expected to convene next Thursday, and the Senate would take up the proposals during the following week.
Scanlon and his co-chairman on the Real Estate and Insurance Committee, Sen. Matthew Lesser, both said broader health equity reforms must be addressed soon. A second special session is being considered for the fall.
“We have an obligation to tackle the elephant in the room,” Lesser said. “We have to deal with health equity in a meaningful and serious way. If not now, when?”