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After eight months, the Health First Authority is getting to consider some options to cover CT’s uninsured. Five options to be specific. And while most of the conversation was predictable, it did get interesting near the end. The five options include single payer universal coverage, a bolstered employment based system (employer mandate, state subsidies for low income/high risk people, reinsurance, market reforms, and tax incentives), insurance choice (Donovan’s plan – using the state employee pool to cover everyone), regionally organized networks of care building on Charter Oak, and universal primary care (Sen. Dem.s plan – with insurance for inpatient care only). Issues cutting across all options include benefit package, IT, quality, efficiency, defining affordability, cost control, individual vs. societal responsibility, financing, workforce shortages, evidence based medicine, licensure/scope of practice, and undocumented immigrants.

The comments were predictable with criticism of public programs and praise for the private system from those proponents, concerns about reimbursements from providers, and defense of public programs from the likely suspects. There were many comments opposing an employer mandate, but no one came to the defense of consumers on proposals for an individual mandate. Thankfully statements about adverse selection, risk magnets and “polluting” risk pools drew an impassioned comment from Margaret Flinter, Co-Chair of both Authorities, noting that high risk patients are exactly who needs coverage and who is being left out of the current system – if the plan only addresses the needs of healthy people, it isn’t solving anything. At the end it did get interesting – a discussion of whether single payer is the only moral option or whether trying to implement an option that the commenter believes is not feasible and won’t work is immoral.
Ellen Andrews