The long awaited SustiNet health care legislation (HB 6305) recently passed the Senate, 22-14, after legislators reached a compromise that left the state insurance plan without a state option.
In addition, the watered-down plan will not cover the uninsured.
The revised legislation, already approved by the House of Representatives, now moves to Gov. Dannel P. Malloy’s desk to become law.
SustiNet was originally envisioned to be a state-run health insurance public option (Healthcare 4 Every 1), utilizing the state’s self-insured government employee health plans as the basis for the program that eventually would have been open to every company and individual in Connecticut.
Originally drafted by the state Democratic majority, SustiNet could not be enacted under Republican Gov. M. Jodi Rell and had to wait for a Democratic governor in order to be passed. Because opponents of President Obama’s Affordable Care Act, signed into law last year, have vowed to overturn it through the court system, supporters of universal care put pressure on legislators to create a state insurance plan of its own.
The scaled-back version allows municipal employers (in 2012) and certain nonprofit agencies (in 2013) to sign onto the state employees health insurance for their employees, retirees and their dependents.
“I was always for SustiNet and I voted in favor of it, but I don’t think the plan goes far enough because it got watered down,” said Deputy Majority Leader Sen. Edwin Gomes (D-23rd). “I think everyone should have universal coverage but we’ve been waiting for this bill to be signed for about two years so it was time to do something.”
The SustiNet Health Care board recommended pooling everyone into the system, but the measure fell far short of that goal due to budgetary concerns.
“SustiNet moves in the direction of insuring those who are uninsured and underinsured,” said Assistant Majority Leader Sen. Bob Duff (D-25th) who voted in favor of the plan. “It’s just a first step.”
State officials estimate about 578,000 municipal employees, retirees and their dependents could join the new plan, and more than 174,342 people could join from nonprofits.
While SustiNet will not yet offer the plan to all Connecticut residents, Duff is hopeful that modifications down the road will expand coverage to include everyone.
“Given the budget deficit, I find it remarkable we were able to pass anything at all,” said Duff. “But, Nancy Wyman is the attack dog on this and she’ll stay on it until it gets done.”
The plan will establish an advisory committee of 21 members called the SustiNet Health Care Cabinet to address health policy issues, including an examination of alternatives to private insurance — possibly with federal health care exchanges — and an Office of Health Reform and Innovation to coordinate state and federal health reform efforts.
The health care exchange proposal passed the Senate earlier and passed the House, 108-30, hours before the session ended. On its way to the governor’s desk, the exchange satisfies requirements of the federal Patient Protection and Affordable Care Act, which will take effect Jan. 1, 2014.
Similar to former Massachusetts Gov. Mitt Romney’s program, the goals of the Connecticut exchange are to reduce the number of people without health insurance and assist them in getting it. The quasi-public agency will enable individuals and small business employers to compare and purchase health insurance plans across state lines.
“This exchange will help ensure that every person in Connecticut has a choice of health care coverage, whether it’s a basic plan or comprehensive, and elaborate,” said state Sen. Terry Gerratana (D-6th), chairwoman of the Senate Public Health Committee, who spearheaded the effort.
However, Gerratana said the state already has a public option called the Charter Oak Health Insurance Plan put into place by Rell.
But some who have attempted to sign up with Charter Oak say it wasn’t worth the paper it was written on.
“I tried to get on that plan because my employer doesn’t offer health insurance, I don’t earn enough to afford insurance and I make slightly too much to qualify for Medicaid,” said Seal Turtletaub of Bridgeport. “I spent months trying to get on the program — filling out paperwork, calling the Charter Oak office a hundred times and nobody seemed to know what was going on.”
Turtletaub, who works as a nanny, said she was finally told she didn’t qualify because she earned too much money.
“It was ridiculous,” she said. “They kept claiming I made thousands more than I did, even though I supplied them with my tax returns. Finally I just gave up. I currently have no health insurance coverage. I was so happy when I heard SustiNet passed until I found out it wouldn’t cover me, either.”
Critics of universal coverage say that people in Turtletaub’s position can just go to the emergency room and the state will pay the bill.
“I went to the emergency room last summer with an eye injury,” she said. “I explained at the time that I had no insurance and no money. Five days later I received an astronomical bill from the hospital. I tried many times to describe my financial situation, but they kept calling and sending bills and finally turned my case over to a collection agency that is threatening me if I don’t pay up. Is that what they mean by saying the uninsured don’t have to pay hospital bills?”
SustiNet will begin the process of addressing the lack of access to health care and other issues in the health care system. The SustiNet Cabinet will advise the state on how to increase access, and whether to offer a public option to cover low-income residents who earn above the amount allowed under Medicaid.
Since no Republican members of the Senate voted in favor of the legislation, why didn’t the Democratic majority pass a universal coverage bill with the public option that it wanted?
“We’re not short on ideas; we’re short on cash,” said Duff. “It’s a very expensive plan so we didn’t want to rush the legislation. We want to take it one step at a time. This may just be one step but it’s an important one.”