This past legislative session, the Connecticut General Assembly shelved consideration of a public option insurance plan after Gov. Ned Lamont threatened to veto the bill. In fact, 2021 marked the third consecutive legislative session where the proposed insurance plan did not receive a vote.
But as a physician caring for Connecticut’s most vulnerable residents in the Emergency Department, we know that the Covid-19 pandemic has exposed the shameful unmet public need for more support — and the evidence in support of the public option is clear. Now, more than ever, the Connecticut General Assembly should pass a public option for Connecticut.
The public option (Senate Bill 842) proposes to allow small businesses and nonprofits to buy the same health plan coverage offered to state employees. Most importantly, the bill utilizes federally available money to permanently eliminate premiums for families making less than 200 percent of the federal poverty limit. This public option won’t fix the health care system in Connecticut. But it will make Connecticut residents healthier and will make health care more affordable for every person – not just people who don’t have health insurance now.
Many nonpartisan experts have detailed how this is possible. New gold standard research evidence shows that increasing the number of insured people reduces mortality – that is, fewer people die when they have health insurance coverage. If the public option increases the number of insured Nutmeggers, it may also drive down insurance prices across the board.
But this is not just expert opinion; it’s the public’s opinion, too. According to the nonpartisan nonprofit United States of Care, 71 percent of Connecticut residents support the public option, including 72% of small business owners, 82% of Black, Indigenous, and people of color, and 79 percent of people with a high school education or less. People instinctively know that health care in the United States provided without oversight does not work. Health care needs a push from local government to better serve the public.
Some lobbying groups – including insurance companies with offices here in Connecticut – have argued that the public option will increase costs and cause hospitals or doctors’ practices to close up shop. Others have stated that temporary pandemic funding already closed the uninsured gap in Connecticut. In a consulting report funded by political ‘dark money,’ insurance companies argue that vulnerable populations like rural Connecticut towns will lose: “When providers struggle, so do patients.”
But I am from rural Delaware and worked in search and rescue in rural New Hampshire. I am used to special interests appropriating our story to make a point – or to make some money.
In reality, the most recent evidence from other states suggests that the public option can reduce costs and provide a durable framework for future innovation. This current thinking also suggests that the Connecticut legislature’s public option design may avoid doctor and insurance participation issues with other state public options. And unlike temporary pandemic funding, the public option is built to reduce costs in the long term with a permanent solution.
It’s not possible to address the prices of the U.S. health care system with one fix. The foremost experts and advocates agree that we need many smaller changes – at all sizes of government and practice – to keep Americans safe from rising prices. By chipping away one percent at a time, or even one tenth of one percent, we build momentum and leave a better future for those behind us.
As a physician in the emergency department, I see the consequences of unaffordable health care every day. It’s always the most psychologically challenging to care for patients who do not have the money or time to take care of their chronic medical conditions. One of the most common refrains in the electronic medical record? “Patient lost to follow-up.” We know that 41 percent of Americans have foregone health insurance because they cannot afford it. We don’t want to lose patients to follow-up anymore.
Connecticut’s public option is a proud state contribution to the public’s health. If the General Assembly has the will to act, peers and future legislators will view their actions as a defining legacy – a new chapter in American health care. What is more, momentum may build for other states to develop contributing alternative payment models to support the public’s health. This has already happened in Colorado, Washington, and Arizona.
The COVID pandemic laid bare all that we have ignored in the U.S. health care system for a century – including care that many cannot afford. The only thing left is for us is for us to decide what we will do with the time left to fix it. The Connecticut public option is a perfect place to start.
Ryan Koski-Vacirca MD is a Resident Physician at the Department of Emergency Medicine, Yale University.