Lawmakers eye health care reforms in short session
Last year, the coronavirus pandemic was a catalyst for a raft of health care reform proposals before the General Assembly, with lawmakers addressing everything from health equity measures to staffing and safety protocols in nursing homes.
When this year’s legislative session begins on Wednesday, some of that work will continue but on a pared-down schedule. The 2021 session was 22 weeks long; this year’s is just 12.
“It’s a very, very short session,” House Speaker Matthew Ritter, a Hartford Democrat, said. “It’s going be very hard to get a lot of substantive legislation done if it’s not ready by sometime in mid-April.”
The ambitious health care agenda for this year includes a revival of bills tackling the high cost of prescription drugs, a plan to expand the state’s Medicaid program to older undocumented children, a controversial measure that would allow doctors to prescribe a lethal dose of medication to terminal patients and a ban on flavored vaping products.
One of the highest priorities is drafting and passing a sweeping bill that addresses the mental health crisis in Connecticut, especially among children. Emergency departments saw an overwhelming number of children seek psychiatric care as the toll of the pandemic fell on the state’s youngest residents over the past two years.
“We have been on the precipice of a crisis for many years. And the pandemic really exacerbated the issue and exposed some holes in what we have available for kids,” said Rep. Liz Linehan, a Democrat from Cheshire and a key backer of the proposal. “This legislation is probably going to be the biggest change in our mental health system for the better that we’ve seen, possibly ever.”
Lawmakers are also exploring whether additional oversight is needed in signing off on mergers, acquisitions, closures and other changes across the health care industry. Saint Francis Hospital and Medical Center recently sued Hartford HealthCare and its subsidiaries, including Hartford Hospital, claiming it is trying to create a monopoly on services by acquiring physician networks and demanding that they refer their patients only to Hartford HealthCare. The suit has prompted some lawmakers to consider whether legislative action is needed this session.
Here are some of the top health care issues under consideration by legislators this year.
Aid in dying
Proponents of a bill that would allow terminally ill patients to access lethal drugs are hoping the measure will get a vote in the House and Senate this year. Last year, the legislation made it out of the Public Health Committee for the first time, though it failed to advance beyond the Judiciary Committee.
State Rep. Jonathan Steinberg, a longtime supporter of the proposal and a co-chair of the health committee, said he is making a hard push for votes in both chambers. Steinberg is considering not seeking re-election this year after six terms in the General Assembly, and the aid in dying bill has been a key priority for him.
“It’s certainly something I’d like to see done on my watch,” he told the CT Mirror. “But I’m not exactly sure how long my watch is going to last.” Leaders of the Public Health Committee consider it their “No. 1” issue this session, he said.
Under last year’s bill, an adult patient with a terminal illness — having six months or less to live — would have been able to access lethal drugs by making two oral requests, at least 15 days apart, and one written request. The written request would have to be done in the presence of two witnesses who could attest that the patient is of sound mind and acting voluntarily.
A physician would prescribe or dispense the medication, and the patient would self-administer the drug. Requests for the medication may be rescinded by the patient at any time “without regard to his or her mental state,” according to the measure. A doctor would have to refer the patient to another consulting physician for medical confirmation of the person’s diagnosis and for confirmation that the patient is competent and acting voluntarily.
Legislative leaders say that while attitudes are shifting and the bill has gained favor among lawmakers in recent years, it’s still unclear whether it will have enough support to win votes in the House and Senate.
“It’s one of those issues where everyone has their own personal feeling about it. It’s not the kind of thing where the speaker can come in and say, ‘Here’s what we’re going to do,’” Ritter, the House Speaker, said. “This is a very, very emotional, personal thing for members of the caucus. And they will determine the fate of this bill.”
Medicaid expansion
Last year, the legislature approved a measure allowing children 8 years old and younger, regardless of their immigration status, to qualify for Connecticut’s Medicaid program, known as HUSKY, beginning on Jan. 1, 2023.
Children must come from households earning up to 323 percent of the federal poverty level to qualify for coverage. That’s an income of $41,603 for a household of one or $85,595 for a household of four.
The plan also extends prenatal care to women, regardless of immigration status, whose household income is between 196 percent and 318 percent of the federal poverty level, and up to a year of postpartum care for women whose household income is at or below 263 percent of the FPL.
This year, some lawmakers want to widen that eligibility further, extending HUSKY coverage to all children — regardless of immigration status — up to age 18.
“You have so many children who are without health care being brought to emergency rooms, because that’s the default care mode for people who don’t have insurance of any kind. And that’s really not the most efficient form of care,” Senate President Pro Tem Martin Looney, D-New Haven, said. “We would like to expand [coverage] beyond the age of 8 and get as close to age 18 as we possibly can. That’s certainly a priority.”
Health care consolidations
With the Saint Francis/ Hartford HealthCare lawsuit in the spotlight, some legislators are weighing whether to draft a bill that would bring additional state oversight to mergers, closures, acquisitions and other changes in the health care system.
Connecticut currently has a Certificate of Need program that requires certain providers to get state approval for mergers, “substantial” investments in new equipment or facilities, halting a medical service or changing access to a service. But Sen. Matthew Lesser, a co-chair of the Insurance and Real Estate Committee, said he and others want to review the process to see if more oversight or protections are needed.
“There is going to be a lot of attention on service cuts and growing consolidation in the industry. The Saint Francis/Hartford HealthCare litigation is something we’re going to be looking at but also some of the growing market forces that have changed the delivery method and could adversely impact consumers and providers,” Lesser said. “We have a [Certificate of Need] process that’s designed to ensure resources are distributed adequately, but I’m not sure that process alone, especially as it’s used currently, is really adequate to ensure competition.”
The lawsuit filed by Saint Francis Hospital and Medical Center accuses Hartford HealthCare of buying physician practices with the predatory intent of controlling the referrals that feed patients to its hospitals, surgical centers and other affiliates. Saint Francis says Hartford HealthCare’s practices took away its major referrers of cardiac cases and produced a stunning migration of physicians — a 25 percent increase in Hartford HealthCare’s staff in just two years.
Hartford HealthCare has said the suit is without merit.
Lesser did not specify what the potential legislation would do, saying it’s too early to elaborate on a strategy.
Children’s mental health
Legislators have described the mental health crisis among children as the one of the most pressing priorities this session. They are crafting what is expected to be an omnibus bill that ties in myriad proposals, from recruitment and retention efforts in the field to resources in schools and hospitals.
“We’ve come at it from so many different angles, from the provider perspective, from the hospital perspective, from the parent perspective, from the child perspective and from the school perspective,” said Linehan, a co-author of the measure, which is still being developed. “We have a bipartisan group of legislators who are really putting a lot of work into this to make sure that we have well-rounded, truly effective legislation.”
Part of the effort involves creating a grant program so schools can develop their own initiatives tailored to each district or facility and apply for funding to support those endeavors. Linehan pointed to a school district in Waterbury that has a team of people who go door to door to assess student needs and help children struggling with absences get the support they need to return to school. Another district might develop a similar program or focus on oneon-one support for students within school buildings, she suggested.
“When writing this legislation, we really wanted to make sure we weren’t providing programs that would only work in some districts,” Linehan said. “Instead, we’re allowing districts to say, ‘This is what we need, and this is how much funding we need.’ And we have the ability to grant funding for those programs.”
Legislators have not settled on a figure for how much funding would be included in the grant program.
The bill would also include incentives to help with recruitment and retention of mental health providers.
“It could look like the ability to have sign-on bonuses or ensuring there is enough support staff in facilities, so providers feel they have a good system working for them,” Linehan said. Lawmakers will seek input from people working in the field and incorporate those recommendations into the proposal.
The measure is expected to tie in several other provisions, including support for pediatricians, who are often children’s first point of contact in the health care system, and mental health education for school administrators. A draft of the bill is expected to be made public during the first few weeks of the session.
Flavored vaping
Advocates are pushing for a revival of a measure that would ban the sale of flavored vaping products in Connecticut. The proposal has been introduced in recent years but failed to win passage.
A group of legislators and health advocates, including Public Health Committee vice chair Sen. Julie Kushner, called on Gov. Ned Lamont to include the prohibition in the package of bills he submits to the General Assembly this year.
Officials with The Campaign for Tobacco-Free Kids said about 20 percent of high school students and 5 percent of middle school students are using e-cigarettes — nearly all of them flavored products. Vaping delivers large doses of nicotine; for example, each Juul pod contains as much nicotine as a pack of 20 cigarettes, advocates said.
Neighboring states, including Massachusetts, New York, Rhode Island and New Jersey, have banned flavored vaping products.
“Somehow Connecticut has allowed itself to become an island of youth addiction, as we’re now the only state in southern New England or the tri-state area that still allows the sale of these products,” said Kevin O’Flaherty, northeast region advocacy director for the Campaign for Tobacco Free Kids. “It is inconceivable to me that Gov. Lamont or any member of the General Assembly would let another year go by without doing everything they can to protect our kids.”
Backers of the legislation said the state stands to lose only $2.5 million per year in revenue from banning the flavored products.
Republican health care bills
Republican legislators have proposed their own package of reforms aimed at reducing health care costs.
Included in the plan is a proposal to use reinsurance, a program that would pick up a portion of residents’ health care costs rather than having insurance companies pay, which leads to lower premiums. They also recommended cost growth benchmarking — developing a statewide target for the rate of growth of total health care expenditures.
“The benchmarking policy was designed to enhance the transparency of the state’s health care system and identify health care cost drivers,” they wrote in the proposal.
The package also features plans to address the high cost of prescription drugs, such as exploring manufacturing rebates and how those savings can be passed on to patients.
Republicans have also released their own outline for upcoming legislation that tackles the mental health crisis.
“Health care is anything but affordable. Cost growth is out of control. Premiums are often the size of a monthly mortgage payment. Drug prices are an enormous burden,” said Senate Republican Leader Kevin Kelly, D-Stratford. “All these factors weigh down family budgets and eat into savings, leaving Connecticut families struggling to make ends meet.”
Other proposals
Democrats, too, are planning to resurrect a bill that targets prescription medication prices, though they have been tight-lipped about what approach they will take.
Last year, Lamont introduced a measure that would have capped annual increases in the cost of prescription drugs, limiting yearly hikes to the rate of inflation plus 2 percent. Drug manufacturers who exceeded that amount would get hit with a fine.
Legislative leaders declined to comment on what form the bill would take this year but said prescription drug costs are a priority.
Also expected to return is a plan to address health care sharing ministries, nonprofit entities that have been accused of masquerading as health insurance and refusing to cover members’ medical expenses.
Lawmakers last year raised a bill that would bar insurance agents and brokers from marketing and selling ministry plans in Connecticut. The measure was voted out of the Insurance Committee but did not come up in the House or Senate.
The legislative session begins Feb. 9.