The Middletown Press (Middletown, CT)
New agenda shifts away from public option
A day after the legislative session ended and still reeling from the defeat of a sweeping public option bill, lawmakers and Gov. Ned Lamont vowed in June to revive the health care overhaul next year.
But as the General Assembly gets closer to reconvening, prospects for a resurrected public option measure are looking dim, and the debate around health care reform has shifted to cost containment, prescription drugs and reinsurance proposals that have bipartisan support.
“Any bill runs the risk of a short session. We get in during early February and adjourn the first Wednesday in May. There are so few session days that to get a complicated bill through a public hearing, through a committee, maybe more than one committee – and the public option has a fiscal note – it’s difficult,” House Majority Leader Matthew Ritter said. “You’d have to move pretty quickly.”
Along with a limited timeframe in 2020, Ritter said the tension surrounding this year’s effort is still lingering, dampening plans for a comeback.
The Democratic cochairs of the legislature’s Insurance and Real Estate Committee last March introduced a proposal that would have opened the state’s health plan to nonprofits and small companies and established an advisory council to guide the development of a public option. The bill would have allowed the state to create a program, dubbed “ConnectHealth,” that offered lowcost coverage to people who don’t have employersponsored insurance.
In May, with less than two weeks left in the legislative session, the lawmakers, joined by Lamont and Comptroller Kevin Lembo, rolled out a new and expanded version of the bill. The updated proposal – called the “Connecticut Option” – would have created a statesponsored health plan for individuals and small businesses that don’t have employer subsidized coverage, and reestablished an individual mandate to help pay for it.
The measure was dramatically enhanced to also include a tax on opioid manufacturers; a cap on rising costs imposed by providers, insurers and others; drug importation; and the reversal of a major cutback in the state’s Medicaid program for working poor adults.
Proponents said the aim of the Connecticut Option was to guarantee a 20 percent premium savings compared to plan rates in 2020. Lembo’s office would have sought bids and partnered with an insurer to bring the Connecticut Option as a publicly sponsored competitor to individual and small group markets.
But hopeful plans were dashed only six days later, when Lembo told The Hartford Courant’s editorial board that a threat by the head of Bloomfieldbased Cigna Corp. had effectively killed the proposal.
Lembo said Cigna CEO David Cordani warned he would uproot the company and leave Connecticut if a public option passed. And within days, legislators gutted the bill, leaving only the pieces that pertained to drug importation, cost containment and reinsurance.
The watered down version cleared the House but died in the Senate.
Now, lawmakers appear to be using that diluted version of the bill to shape their health care agenda for 2020.
“You’re going to see a lot of work on drugs in 2020. Importation was something that 75 percent of the legislature in the House voted for back in June, and it will remain something that we push for in 2020,” said Sean Scanlon, DGuilford, a cochairman of the Insurance and Real Estate Committee.
The proposal would allow state officials to seek permission from the federal government to import prescription drugs from Canada at deeply discounted prices. Similar laws have passed in Vermont, Florida and Colorado.
The drug effort will also involve addressing the skyrocketing cost of insulin, which has become a crisis in the U.S. as people forgo the medicine or switch to alternatives, sometimes with grave consequences.
The Health Care Cost Institute has reported that Type 1 diabetes patients – who generally must inject themselves every day — paid an average of $5,705 for insulin in 2016, nearly double what they paid four years earlier.
Over the last decade, the list prices of some types of insulin have tripled, even though they’re the exact same products offered 10 years ago.
Other initiatives at the forefront of legislative discussions include the pursuit of a reinsurance waiver to mitigate risk from sizable claims. Under last spring’s unsuccessful proposal, insurers and health care centers would have been required to pay an annual fee, and that money would have covered large medical bills to keep premiums down.
The tax on insurance companies will be up for debate again next year. Republicans in the Senate have opposed it, opting instead to use money from Connecticut’s general fund for reinsurance.
Lawmakers also want to set yearly benchmarks to contain the swelling cost of care, and work with providers who exceed that threshold.
Sen. Kevin Kelly, RStratford, had scheduled a forum in September to kick off discussion on those ideas. But his event was postponed after Democrats in both chambers said they wanted more consensus and private debate around the issues.
“The challenge is always trying to get it right. You want to get the policy that works the best for the most people,” he said. “The challenge is getting the political will and then getting the stakeholders around the table to try to move something forward.”
Kelly said many Republicans are supportive of an agenda that includes drug importation, reinsurance and cost containment. But the details of those plans are still being ironed out. He remains opposed to placing a tax on insurers. States that rely on premium assessments in connection with a reinsurance program receive fewer federal dollars than those who use money from the general fund, he said.
Democrats have not yet offered specifics on what the health bills might look like. Sen. Matthew Lesser, a cochairman of the insurance committee, said the goal is still to lower the cost of care by 20 percent or more.