SustiNet and health insurance exchange bills heard

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The Public Health, Human Services and Insurance Committees had a public hearing on the SustiNet bill and competing visions for CT’s health insurance exchange yesterday. Public support was overwhelming for SustiNet; most legislators were supportive. Some asked for concrete assurances of how much the plan will reduce costs and improve access to care. But as several speakers pointed out, there are no guarantees in health care. SustiNet is an option – if it doesn’t save money, people won’t join it. And where we were headed is not working for anyone.

The two visions for the state’s new health insurance exchange share many features but differ in some very important ways. Under national health reform, states create health insurance marketplaces that make coverage choices clear for individuals and small businesses. CT’s exchange will help residents eligible for subsides purchase coverage. Exchanges will set standards for insurance companies to participate in the exchange and monitor marketing for deceptive practices. One vision, SB-921, puts insurers and providers on the governing body that will decide which insurers can participate in the exchange – a clear conflict of interest. CA, MA and ME’s exchange boards do not include people with current financial ties to the industries they will regulate or oversee and the conflict of interest may raise legal problems. The other version of exchanges, HB-6323, does not allow those conflicts of interest. HB-6323 also includes more sensible protections and innovations including consumer surveys, focus groups and secret shopper studies to make the exchange user-friendly, rate plans based on customer satisfaction, seamlessly coordinates with enrollment into Medicaid for eligible applicants, creates a standing consumer advisory committee, ensures that no plan’s marketing is designed to discourage high-need patients, strong transparency and quality of care standards, requires coverage of emergency care and adequate provider networks.
Ellen Andrews