CT’s SIM draft plan to reform health care for at least 80% of state residents in five years is out for public comment. SIM is the state’s newest plan to radically reform health care delivery and payment across the entire state. Concerns raised in the CT Health Policy Project’s comments include potential incentives in the proposed payment system to stint on necessary, appropriate care. Advocates have urged the committee not to reward stinting — to include monitoring for inappropriate under-treatment and deny shared savings payments that are generated by denying needed care. The comments also outline concerns about the process, including the exclusion of critical stakeholders from decision-making, about the danger of reversing hard-won improvements in CT’s Medicaid program, and highlight leading examples of responsible reform from CT and other states.