Keep talking about a ‘public option’

There’s no question that health care is expensive — for many, prohibitively so — and it was encouraging that Connecticut legislators had been working so closely with the insurance industry here to find a way to lower costs by involving the state in the process.

But it was deeply disappointing that the discussion imploded last week, shortly after Gov. Ned Lamont and legislative leaders announced a plan that had merit.

Despite the apparent failure of the so-called “Connecticut Option,” though, some sort of public option for health insurance — in which governments allow businesses or individuals to buy into a state-run plan — is an idea worth pursuing, and local insurance and government leaders must continue to work together.

In the coming months, we should expect the national debate over health care and “Medicare for All” to heat up. Connecticut can, and should, drive the conversation. With the insurance industry inextricably woven into the state’s economic and political fabric, Connecticut is the natural leader on the issue, even though Washington recently became the first state in the nation to create a public option.

A Connecticut bill was unveiled in March, and many changes and amendments were incorporated along the way.

Some parts of the evolving plan were clearly positive. For example, it would have created a state-sponsored insurance plan for individuals and businesses with fewer than 50 employees, and it would have required insurance companies to offer plans to them that were 20 percent cheaper than average plans. The bill also added a tax on opioids to help expand HUSKY, the state’s Medicaid program, to tens of thousands of low-income people who lost eligibility in 2016. It also would have allowed state officials to ask the federal government for approval to import cheaper prescription drugs from Canada. Some of those components could be pursued independently of a broader plan.

For reasons that might never become fully transparent to the public, negotiations between Connecticut legislators and the insurance industry that had been going on for months came apart in the last week. Comptroller Kevin Lembo told The Courant’s editorial board on Wednesday that the Connecticut option “is dead” and said insurer Cigna had finally torpedoed it with a threat to reconsider whether to stay in Connecticut if the bill passed.

But insurers had already grown more full-throated in their opposition to the bill, even as legislators were celebrating it. In a letter to Mr. Lamont last week, representatives of Aetna, Anthem Inc., Cigna Corp., ConnectiCare, Harvard Pilgrim and United Healthcare wrote, “Bills of this magnitude, representing a fundamental and material change to insurance market operations and regulation, require careful and thoughtful consideration to avoid unintended consequences that could have a deleterious effect on job growth and economic development.”

That is a reasonable criticism. Mr. Lamont’s casual attitude toward the lack of research concerning the costs of the plan was worrying. Noting that the state would have two years to get all the pieces lined up, he said, “There will be plenty of insight going forward.”

That’s not how government works. Pass the law when the numbers have been crunched, when you have industry buy-in, when you have reasonable certainty concerning how the legislation will help people and how much it will cost.

Nobody was certain how the plan would work, economically. Part of it relied on federal approval for reinsurance, for example, to avoid a situation where the pool of participants became too high-risk. It also created a new layer of bureaucracy in Connecticut, a move that should give pause. It would cost only $1 million to set up and find staff to manage the operation, according to the fiscal analysis, but it opens the door to escalating costs.

The conversation over health care has been evolving for decades. Connecticut and the insurance industry appear to have missed a chance to plot a cooperative path forward this spring, but their voices can still carry.

Don’t give up.