Advocates urge Cost Cap delay for data, safety

A group of advocates sent Governor Lamont a letter about the Cost Cap project today raising new, heightened concerns since our May letter. This follows a similar letter sent last week from Connecticut’s three legal services organizations, which also included concerns about Medicaid’s PCMH Plus program. The Cost Cap is a controversial project of the Office of Health Strategy (OHS) intended to control healthcare costs by setting a limit on how much costs can grow. Consumers are very concerned about rising healthcare costs as the ultimate payers. For decades, Connecticut advocates have collaborated with state policymakers on developing and implementing policies to lower costs without harming people, especially in Medicaid.

The advocates’ first letter asked for a delay in the Cost Cap planning due to concerns about rushing a significant, potentially very harmful policy shift during a pandemic and to open the tightly closed process to engage stakeholders who will be critical to success. We’ve received no answer.

The new letter raises concerns that have surfaced as OHS has advanced the Cost Cap quickly over the summer. The Cap chosen by OHS is very ambitious, reducing healthcare cost increases by almost half. The risk to high-need populations and prevention is troubling. However, there is no plan in place to monitor for harm to people or communities from a sudden drop in healthcare resources, especially as Connecticut’s healthcare system is reeling from the pandemic. OHS does not intend to address or monitor the quality of care in Connecticut, already mediocre, until at least a year after the Cap is in place inviting savings at the expense of quality and access to care.

Advocates are further concerned about OHS’s plan to enforce the Cost Cap in confidential negotiations with high-spending health systems and other entities. Without public input or transparency, profit could drive decisions rather than the best interests of Connecticut residents and communities.

Advocates are also concerned that, unlike other states, the data necessary to responsibly set a realistic Cost Cap is not available in Connecticut. A Cap created without a solid foundation in data is meaningless at best and potentially very harmful. Developing the Cost Cap would be very expensive for Connecticut’s state budget that is facing historic deficits into the future. There is little chance of devoting resources necessary to implement a Cost Cap that is realistic.

As in the past, advocates stand ready to work with policymakers to develop a feasible, safe plan to lower costs.