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Yesterday’s health care forum started with a strong presentation of the SustiNet proposal by Juan Figueroa of the Universal Health Care Foundation of CT and Stan Dorn of the Urban Institute. Juan described the inclusive process to develop the plan engaging diverse voices including business, providers, clergy, advocates, and consumers. Stan described the major tenets of the plan – creation of a large, new, self-funded coverage plan, improved care coordination, management of chronic disease, transparency, health information technology, and public health measures to reduce disease such as tobacco control and obesity prevention. Questions from legislators included costs, the structure of the program and the inclusive process to develop the plan. Many legislators thanked the speakers for developing a thoughtful, CT-based plan.

Next Scott Cleary of eHealthConnecticut and Greg Farnum from VT’s information technology plan presented on health information technology. Greg outlined VT’s successful health information exchange and how it is funded. Scott described two eHealthCT projects , with funding, starting soon including one to collect and analyze quality information and another for a health information exchange and e-prescribing for HUSKY, Medicaid and SAGA patients. Questions included how to fund information technology and the merits of an information exchange structure vs. creating a database with patient records held in a central service.

Next Bob Carey, formerly at the Commonwealth Insurance Connector, described MA’s health care reforms. He is a strong proponent of MA’s individual mandate. The individual mandate is the largest tax penalty in MA’s state system – reaching almost $1000 this April and more next year. He acknowledged that while public support for the plan is high now, the full impact of the mandate penalties has not hit people yet. He also noted that standards of what counts as coverage for purposes of the mandate have risen and that next year some people who have been purchasing insurance and paying premiums all year will be penalized as if they had been uninsured. He did acknowledge that, despite an individual mandate, MA will never achieve universal coverage (absent a single payer system). While MA’s rate of uninsurance has been cut in half by the reforms, the majority of newly insured joined expanded public programs such as Medicaid and SCHIP. The Connector only covers 20,000 people.

Legislative questions challenged the speaker on the wisdom of an individual mandate and trusting the private insurance market to offer decent options. The speaker stated that the mandate only falls on certain groups – he noted that a 50 year old making $90,000/year with children is unlikely to be subject to the mandate, but he is also unlikely to be uninsured. The mandate only applies to the uninsured – mainly young, low income consumers without an employer offer of coverage. The speaker was unfamiliar with autoenrollment, consumer education, certifications of responsibility/liability, and other policy alternatives to an individual mandate which are included in SustiNet. Other questions focused on health care workforce capacity, difficulty getting appointments for care, and emergency room utilization which did not decrease after the reforms. The speaker believed that the problem of capacity is partly one of perception – previously uninsured consumers assumed that now that they have coverage that they would be able to get appointments quickly. However he also stated that previously uninsured consumers used to going to the ER for care are not likely to change their behavior and try to make appointments for care.

Unfortunately, despite requests, no balancing viewpoints were offered outlining the weaknesses of a mandate from states that considered an individual mandate and decided against it. There was no description of CT’s context of weak insurance market regulation, high costs, or lack of federal funding to match MA’s generous subsidies for lower income consumers and expansions of public programs.

Other speakers included a panel on strengthening CT’s public health care systems, cost and quality issues, and a report from the Health 1st Authority on their report.
Ellen Andrews