Diluted health care bill advances in Legislature
A multipronged health reform bill is awaiting floor votes in the General Assembly, as supporters wonder whether it would have been stronger if state Comptroller Kevin Lembo hadn’t declared the heart of it dead on Wednesday.
The measure was known as the public option bill, so named because it contained a health insurance plan, the Connecticut Option, that would be designed and directed by the state. An earlier version of the bill contained a so-called pooling option, under which small businesses would have been able to buy into the state employees’ health plan, or a plan similar to it.
The goal here, as it is across a nation mired in a health coverage crisis, was to expand coverage at lower prices on the market for individuals and small companies — those not covered by corporate or public employees’ plans.
Insurers all along opposed the sweeping bill, which contained other, somewhat less controversial parts. Cigna, the giant, Bloomfield-based health management corporation, organized a write-in campaign for employees to let lawmakers know they opposed it.
Now the public option portion of the public option bill is out because on Wednesday, Lembo — without consulting with Gov. Ned Lamont or the bill’s main sponsors — declared it was out, citing threats to exit the state from Cigna, in comments to the Hartford Courant.
A diluted but still important version of the sweeping bill is on the docket, expected to win approval if lawmakers have time to debate it in the closing days of the session.
But it’s tempered by frustration and anger over two things: First, Lembo’s move has supporters of the bill scratching their heads. Lembo has offered no explanation, and he did not
return calls to his phone and his office seeking comment.
And second, everyone agrees it’s nearly impossible to enact meaningful health care reform in the postObamacare scene, as one or another powerful interest — such as Cigna — always cries foul.
“We were at the negotiating table and we were making progress,” said Rep. Sean Scanlon, D-Guilford, the main sponsor along with Sen. Matthew Lesser, D-Middletown. “Whether we would have gotten there, I don’t know.”
Gov. Ned Lamont, heavily invested in the bill, said, when a couple of us in the media asked him Friday whether a public option could have been salvaged in ongoing talks with Cigna and other industry companies, “They just needed a little more time, didn’t they?”
Lamont also said he didn’t think Cigna had made a threat to leave.
That’s a matter of interpretation. Late on Tuesday afternoon, Deb Hutton, a lawyer and ranking lobbyist for Cigna, called three people at the state Capitol: Lesser, Scanlon, and Ryan Drajewicz, Lamont’s chief of staff. She clearly tried to exercise muscle, according to multiple accounts that I’ll describe in a minute.
Wide reforms remain
As for what’s left of the reform, Lesser and Scanlon described it as a bill that would be viewed as major advancement in its own right if it had been proposed as it stands now, without the public option.
“It doesn’t have everything I want but health care is hard and big changes take time,” Scanlon said. “I’m still really proud of this bill and it’s going to make a difference in a lot of people’s lives.”
After Wednesday, many people believed the whole bill was dead. Along with the public option, known as the Connecticut Option, a provision to bring back the individual mandate for people to buy health insurance was removed Wednesday. That had been part of the federal Obamacare reform, but was removed by the Trump administration.
The parts of the health reform that remain include:
An aggressive program through a “Cost Containment Commission” to beat down medical costs. The idea is to set a benchmark for price increases by insurers or providers. “We’re going to stop the blame game of everybody saying it’s somebody else’s fault that costs are going up,” Lesser said. “If you blow through the cap, you’re going to be required to come up with a plan for improvement . ... We’re going to be
holding hearings on it, we’re going to name them and shame them.” Massachusetts has such a commission, and apparently it works.
A plan to import pharmaceuticals from Canada at lower prices that local pharmacists could distribute. That idea reignited earlier this year when Florida Gov. Ron DeSantis suggested it and President Donald Trump said he’d support it. Big Pharma, of course, would oppose it vehemently, saying the drugs shipped to Canada are meant for Canadian customers. “It may work, it may not,” Lesser said. “We’ll see what Washington comes up with,” said Sen. Kevin Kelly, R-Stratford, an opponent of the bill.
A restoration of Medicaid to 26,000 parents who were cut off two years ago. That component would be partially financed through a surcharge on opioids. It’s now part of the state budget.
Additional subsidies beyond the Obamacare schedules for moderateincome people to buy coverage. That would be financed through three sources, including a new tax on health plans and the opioid surcharge.
A move for the state to bring reinsurance coverage to private carriers. In that part of the plan, the state would be able to funnel federal aid under a waiver program to insurance carriers to backstop their claims, thereby allowing lower prices. “That reinsurance waiver is a really big deal,” Lamont said. “It brings down the cost of health insurance for everybody.”
The debate never ends
A public option would have delivered savings of at least 20 percent, the bill’s authors and Lamont promised. As it stands now, there’s no savings figure.
Republicans and central Connecti cut’s health insurers say the added taxes and fees, combined with meddling in the market by the state Comptroller’s office, which would administer the plan, would cause more harm than good.
One big problem: The bill has constantly evolved, with the Connecticut Option rolling out in a press conference in late May, long after public harings and committee votes. “This whole process I felt like the sand moving under my feet,” said Kelly, who, like other Republicans, was not part of the planning.
“Republicans in Connecticut want to solve the problems of the Affordable Health Care Act that were caused by its design,” Kelly said. “It wasn’t properly funded.”
The industry was mainly opposed to the public option.
“We principally believe that any advancement of a government-run insurance
program is the wrong direction for the state, the economy, and our locally based health plans of Anthem, Aetna, Cigna, ConnectiCare, Harvard Pilgrim and United, who contribute significantly to the region’s livelihood and employment,” said Susan Halpin, head of the Association of Connecticut Health Plans. “The health plans have successfully worked with the state before to build Access Health, the exchange program for ACA, and going forward we should focus on improving that exchange instead of adding another government-run insurance plan.”
An industry lobbyist sent an email to legislators saying the association had some issues with remaining parts of the bill, but would not fight it.
So what happened?
Even if the bill passes, supporters will long remember the weird events of this past week and wonder what might have been. Lembo, formerly the state health care advocate, is an ardent fighter for expanded coverage, and to be sure, the public option was on shaky ground with time running out when he declared it dead for the year.
Talks with Cigna and others in the industry were underway when Hutton made the calls to Lesser, Scanlon and Drajewicz, on Tuesday.
“She expressed her displeasure with the bill,” Scanlon said. “She talked about how they would have to make some business decisions depending on whether or not this bill was to pass.”
“Business decisions” is code, of course, for whether a locally based, global company will keep its headquarters and full staff in place, or erode its presence. Lesser declined to give specifics but suggested that Hutton, whom he did not name, in essence “threatened to threaten” that Cigna would reconsider some of its 4,000-plus staffing in Connecticut.
After those calls, the key backers — including Lembo — huddled together immediately. They asked Cigna to keep talking and they promised not to hold votes on the bill for at least a couple of days. “They said yes,” Scanlon said.
Then the next day, without warning, Lembo talked with The Courant’s editorial board, saying the key section of the bill was dead. “There was probably a healthy dose of miscommunication on all sides,” one person familiar with the talks said.
Lembo talked with Lesser the next morning in a phone call. “He expressed regret for the lack of communication but he felt it was important to call out one specific corporation and he thought it was necessary,” Lesser recounted. “Every person in
elected office fancies himself a master tactician. I’m no exception. We just disagree.”
Now, even on the cusp of a significant bill passing, advocates and sponsors are looking ahead.
”The setback that we experienced in the public option part, I think is temporary,” said Tom Swan, head of the Connecticut Citizen Action Group and a key health care reform advocate, who said Lembo’s move took “a lot of courage.”
Scanlon said he was “bummed” about the loss of the public option but will come back to it. Lamont echoed that, with a broader remark: “We’ll be revisiting how we can bring down the cost of health insurance for small businesses.”