CT leaders debate how to fix health care: Blunt federal cuts, up reimbursement or kill private health care?

For decades, Connecticut and federal lawmakers have tried in vain to rein in medical costs as expenses have continued to soar for patients and employers.

In response, a key legislative committee voted on mostly party lines last week to spend $200 million in order to make costs more affordable and also blunt the expiration of enhanced premium subsidies by the federal government.

Democrats who control the state Senate are pushing hard for Senate Bill 3, which has been highlighted this year with a low number to show that it is among the highest priorities for the caucus.

The 36-page bill calls for the creation of a new “Connecticut Option” and the Connecticut Affordable Health Insurance Trust Fund that would include $200 million from an emergency response fund of $500 million that the state legislature created last year to plug holes in budget cuts made by President Donald J. Trump and the Republican-controlled Congress. The $500 million fund has more than $300 million remaining as lawmakers scramble to obtain part of the remaining pool for a wide variety of priorities.

“Last year, they passed cuts of $1 trillion to the Medicaid program nationally,” said Sen. Matt Lesser, a Middletown Democrat who co-chairs the human services committee. “They also cut hundreds of billions of dollars in tax credits that make health care affordable for the middle class. Senate Bill 3 is our response to that. … We are promoting hospital stability. We’re tackling medical debt with the strongest consumer protections anywhere in the country to make sure that folks aren’t straddled with crippling medical debt. … We are starting a planning process around Governor Lamont’s Connecticut option because that work needs to start this year.”

While Connecticut is known nationally for quality health care with prominent hospitals like Yale New Haven, about 10% face high medical debt and 23% said in a survey last year that they have medical bills that remain unpaid, officials said. The highest percentage of those with financial burdens was families earning less than $50,000 per year.

Senate Majority Leader Bob Duff of Norwalk agreed that Connecticut is making a direct response to the federal government actions including Trump’s tax-and-spending bill that is known as HR 1.

“We have to unfortunately clean up the mess that has been made in Washington, D.C.,” Duff said. “We will do it because it’s the right thing to do.”

On a personal basis, Sen. Jorge Cabrera of Hamden said that his own experiences over the years have shaped his views on health care.

“I was the son of a very sickly mother who was in and out of hospitals when I was a young boy,” Cabrera said. “It was very difficult. As I got older, I tried to find work that provided good health care, and I was lucky enough to do that. When my twin boys were born prematurely at Yale New Haven Hospital, we spent 10 long weeks in the hospital, around the clock care for newborn babies. We didn’t have time to really assess how much this would cost.”

Cabrera continued, “Weeks after we got home, I got two large paper packets, back when they used to send explanation of benefits in the mail, and saw the bill — and I was shocked how much it cost to take care of our boys. Lucky for me, I had really good health insurance. But I know, in speaking to people across the state, that that is not the case. … Health care in Connecticut is a right and not just a privilege for the few.”

Republican, CBIA opposition

But Republicans and others are cool to Senate Bill 3, saying the state needs other solutions to solve the health care crisis that impacts hospitals, patients, doctors, and employers.

Sen. Jason Perillo of Shelton, the ranking Senate Republican on the human services committee, opposes the bill and said lawmakers must attack the root cause of the medical funding crisis.

“It’s because one third of our residents are on Medicaid, and our Medicaid reimbursement rates are among the lowest in the country,” Perillo told The Courant in an interview. “The only way that hospitals can stay in business is by shifting the costs over to commercial insurers. That’s why premiums in Connecticut are high — because hospitals are reimbursed at a very low rate by Medicaid.”

Statewide, about 1.2 million residents are currently on Medicaid, ranging from young mothers with children to elderly patients in nursing homes.

Removing certain sections of the 36-page Democratic bill, Perillo said, is not the answer.

“There’s no one thing you can pull out of this to make it a good bill,” Perillo said. “I don’t see how this bill can be salvaged. We’ve got to start from scratch. … We scrap it, and we start over, and the first thing we do is we increase Medicaid reimbursement rates to help our hospitals.”

During the committee debate, Perillo said the reimbursement rate is not only lower than what the hospitals charge but also lower than the amount it actually costs to treat the patient.

“We don’t do anything about it year after year after year,” Perillo said of Medicaid rates, adding that the measure is a “dangerous and risky” proposal. “Senate Bill 3 actually exacerbates the problem that we are trying to solve. … We are putting out a candle with a fire hose. … We’re not looking at this in a very holistic way.”

The measure is also opposed by the Connecticut Hospital Association and the Connecticut Business and Industry Association, two of the most influential lobbying groups at the state Capitol.

“CBIA has significant concerns with this proposal, including potential violations of the state’s fiscal guardrails, insufficient legislative oversight, and the creation of new subsidies that would ultimately shift costs to the commercial market,” the business lobby said in written testimony. “Rather than bending the cost curve, SB 3 is likely to increase healthcare costs with minimal regulatory accountability.”

The hospital association opposes the idea of a new Connecticut option.

“We believe Connecticut should focus on strengthening what already works within the healthcare system rather than creating new government-run plans that may jeopardize access and affordability,” the association said. “Hospitals across the state are already facing significant financial pressures driven by workforce shortages, rising costs, and persistent underpayment from existing government programs. Introducing a new public option built on top of the current Medicaid program without addressing these underlying challenges, risks destabilizing the healthcare delivery system.”

State Rep. Jay Case, the human services committee’s ranking House Republican, said, “I’ve been on this committee 14 years. We’ve talked about [Medicaid] rates since I’ve been here. … We haven’t done a darn thing in this building with reimbursement rates.”

But Rep. Stephen Meskers, a moderate Democrat from Old Greenwich who voted against the bill, said he would agree to increased Medicaid rates if the hospitals simultaneously agreed to lower the rates on private payers.

“Some lobbyists tell me if you eliminate the mandates, you’ll get a lower cost,” Meskers said. “If we don’t grow our small businesses, if we don’t grow our economy, we’re not going to be able to pay for anything.”

Concerning the long-running problem of medical debt, Senate Bill 3 would block hospitals from billing certain low-income patients. Those include patients who currently receive food benefits under the Supplemental Nutrition Assistance Program or the Women, Infants and Children program. Known as WIC, the program helps 11,000 pregnant women, 11,000 newborns, and about 30,000 children in Connecticut. The program provides food aid that includes fresh vegetables and infant formula.

Dr. Bill Begg, head of the emergency room at Danbury Hospital, said the bill will help to improve health care.

“This legislation can truly save lives,” Begg said. “You sit in our ERs for hours and days at a time, and it’s all avoidable. … Insurance companies essentially have an unlimited amount of time to decide your care. … Infection rates can go up if you’re in the hospital for an extended period of time.”

Connecticut Option

Gov. Ned Lamont and comptroller Sean Scanlon are working on a new idea known as the “Connecticut Option,” which is not the same as a government-operated “public option” that has been discussed on the national level. The idea is still being studied, but Lamont says he wants to set up a market-based system where state employees, retirees and others could band together and go to specific, designated hospitals and providers in a plan to save costs in the future. These would include John Dempsey Hospital on the University of Connecticut’s health care campus in Farmington and UConn-owned Waterbury Hospital.

Senate Bill 3 calls for starting the planning process for the option proposal because it is not yet ready to be launched.

“All are in agreement that we are not ready to set this up on Day One,” Lesser said. “This bill starts that conversation.”

The state legislature covers the gamut on health care, from those defending the current system to those who want to replace it.

State Rep. Josh Elliott, a Hamden Democrat who is running for governor against Lamont from the left, recently posted a video saying that the best way forward is by creating a public option. In a plan that is different from Lamont’s, Elliott says that all municipal and nonprofit workers could join into the state employees’ system and then small businesses would join into an even larger system.

“That is how you ensure that we destroy the health insurance industry,” Elliott said on the video. “Yes, you heard me. I do not think it is an industry that should exist. … You do not need private health insurance.”

While the solutions vary, all sides agree that health care is highly expensive and the system needs to be improved.

Ayesha R. Clarke, executive director of Health Equity Solutions who was described by Lesser as “one of the smartest” policy wonks on health care, said the legislature cannot afford to wait and needs to pass Senate Bill 3.

“This time is now — not next session. Not after a study,” Clarke said. “No one should be driven further into poverty simply by seeking necessary care. This is not radical. This is reasonable legislation. … Connecticut should not just be catching up. We should be leading.”

Clarke added, “No one should walk out of the hospital with a prescription and a lifetime of debt.”

Christopher Keating can be reached at [email protected] 

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