At the December 5, 2009 Fall Conference, the LWV of Weston website manager asked the question:  "What about allowing those fifty-five (55) years old and up be eligible for Medicare?"  The answer was that it would be too expensive, and anyway A.C.A. was designed to fail.  Once it was passed, it was thought the next step was to fix it (speaker on the left, below).  How about this, from a non-LWV source, in 2018:  https://www.nationalreview.com/2018/08/medicare-for-all-proposal-fiscally-implausible/

To go to League video:
Five years later, these words in response to our question ("Why not just make medicare available to those 55 years and older?") sound pretty reasonable, as does the far-fetched question.

And more on the "public option" from Jacob Hacker:  http://www.nytimes.com/roomfordebate/2016/08/24/is-obamacare-sustainable/a-public-option-would-greatly-improve-obamacare

On another note:  Connecticut State Motto:  "Qui Transtulit Sustinet" -

Prof. Hacker (2010) - M.S. Wirtenberg graphic.

FALL CONFERENCE 2010 NOW ONLINE:  Click below.  Best results will be obtained by using Internet Explorer, which will open the video in Windows Media Player.

http://www.lwvweston.org/LWVCT12-4-10CableVersion.wmv (385MegaBytes)

http://www.lwvweston.org/LWVCT12-4-10ModemVersion.wmv (60MegaBytes)

News About Health Care

At South Congregational Church, Hartford, Connecticut

Fabulous program for Fall Conference this year, thanks again so much to Moderator Kay Maxwell!!!

Moderator Kay Maxwell followed up on last year's Fall Conference on Health Care by introducing this year's fantastic presenters and response panelists, for "One Year Later:  Health Care In Our Country And In Our State."

LWVCT President Cheryl Dunson graciously introduced the program, and closed the event precisely on time!

Video to be available in DVD (2 different versions) around the turn of the year.  Contact LWVCT Office to reserve your copies for either one or both.  Version one is the entire conference (approx. 2 1/2 hours).  Version two is a one-hour (for Public Access) version consisting of excerpts from the presentations of the four speakers.  LWVCT office telephone and e-mail contact information listed just below.



New York Times article on Vermont experience here:  http://www.nytimes.com/2015/06/05/us/in-vermont-frustrations-mount-over-affordable-care-act.html?hp&action=click&pgtype=Homepage&module=first-column-region&region=top-news&WT.nav=top-news

Does Hospital Conversion Bill Go Too Far?
by Christine Stuart | Mar 20, 2014 12:24pm

Tempers flared at the end of last year’s legislative session over a bill that would have made it easier for a private, for-profit hospital company to purchase physician practices from a nonprofit hospital that it planned to take over.

Gov. Dannel P. Malloy vetoed the bill saying that it needed further consideration “to determine whether current law provides adequate safeguards to guard against any perceived or actual threat to the independence of medical decisions made by providers employed by for-profit entities.”

It’s an area where the state has little experience. The only for-profit hospital in Connecticut is Sharon Hospital.

Lawmakers, Malloy, and union officials have been wary of unknowns when it comes to for-profit hospitals and what they mean for the residents of Connecticut. While the hospitals seeking to convert are desperate to bring new capital to their facilities in order to save the community institutions.

“We should not allow additional for-profit hospitals into our state until we have all of the information on, all of the various entities that are bidding to make profits on the healthcare needs of our citizens,” Sen. Majority Leader Martin Looney, D-New Haven, told the Public Health Committee Wednesday.

[Please read the rest of this article in the archives at the CTNEWSJUNKIE website]

So, what's an exchange?
Arielle Levin Becker, CT MIRROR
December 6, 2012

It's a major piece of "Obamacare," and set to debut in just under 10 months. But unless you've been paying close attention, you might not be totally clear on exactly what a health insurance exchange is. Here's a primer.

What is an exchange?

An exchange is a store for selling health insurance. Every state is supposed to have one as part of federal health reform. Connecticut's is expected to begin selling coverage in October; the plans will take effect Jan. 1, 2014.

Connecticut Health Insurance Exchange CEO Kevin Counihan said it's intended to be a simpler, more transparent way to buy coverage than the market that exists now.

Who will use it?

If you buy coverage for yourself, you will have the option of buying it through the exchange. So will small businesses. Anyone who gets subsidies through the federal reform law to buy coverage (more on those later) will have to buy their coverage through the exchange.

The exchange is not intended to replace Medicare or Medicaid. People who qualify for those programs will continue to receive that coverage separate from the exchange. Similarly, people who get their coverage through their jobs won't be using the exchange. And people will still have the option of buying insurance through the state's existing individual and small group insurance markets, outside the exchange.

What will the exchange sell?

The exchange will sell health plans offered by private insurance carriers, like Aetna, Anthem Blue Cross and Blue Shield and ConnectiCare. (Insurers can decide whether to sell plans on the exchange or not, so it's not clear which ones will or won't yet.) In addition, Counihan said two new nonprofits are coming to the state and could sell plans on the exchange: a new plan called Healthy CT that's being launched with federal funds, and Harvard Pilgrim Health Care, a nonprofit Massachusetts insurer.

[Please read the rest of this article in the archives at the CT MIRROR website]

Chief Justice Roberts for the majority:
"We do not consider whether the Act embodies sound policies. That judgment is entrusted to the Nation's elected leaders. We ask only whether Congress has the power under the Constitution to enact the challenged provisions."

For Insurers, A Daunting Task Ahead — Making Reform Work
The Hartford Courant
By MATTHEW STURDEVANT, msturdevant@courant.com
11:14 PM EDT, June 28, 2012

Insurers face a daunting task now that the U.S. Supreme Court has declared the health reform act constitutional — creating a market that delivers affordable coverage to millions more people while meeting a slew of new mandates and continuing to underwrite quality medical care.

In some ways, it's as massive a task as private insurers such as Aetna and Cigna would have faced if the law had been overturned.

But Thursday's historic decision allows the companies to stay on the course they've been following for more than two years, planning for and adapting to the laws. So it's a relief for the insurers, as it is for doctors and hospitals who no longer have to change strategies put in place since the law passed.

Now, the job is managing a law that contains provisions many of these very same people once fought.

[Please read the rest of this article in the archives at the Hartford COURANT website]

Federal opinion undermines state's health-pool concept
Mark Pazniokas, CT MIRROR
May 4, 2012

The U.S. Department of Labor has advised the Malloy administration that opening Connecticut's state employee and retiree health plan to nonprofits and small businesses could jeopardize the legal protections it now enjoys as a government plan.

The advisory opinion sought by Gov. Dannel P. Malloy could undermine a health care pooling bill passed last year and an expansion proposed by House Speaker Christopher G. Donovan, D-Meriden, that is now awaiting action in the House.

The legislature last year passed a law opening the plan to employees of nonprofits, beginning Jan. 1, 2013. The bill pending in the House would add employees of small companies, beginning Jan. 1, 2014.

A third aspect of the pooling concept -- opening the state plan to municipalities -- is unaffected by the opinion. The state comptroller's office is marketing the state plan to cities and towns.

[Please read the rest of this article in the archives at the CT MIRROR website]

Insurance exchange board faces key policy decisions
Arielle Levin Becker, CT MIRROR
January 19, 2012

There's still nearly two years before the major pieces of federal health reform roll out, but for the planners designing Connecticut's health insurance exchange, one of the central pieces of the law, the time line is much tighter.

The exchange will serve as a marketplace for individuals and small businesses to buy insurance beginning in 2014, and the board at work designing it has a number of key decisions to make well before people start signing up for coverage next year.

Among them:

How will the exchange, a quasi-public agency expected to employ about three dozen people, be funded?

Will insurance plans sold on the exchange be required to cover all state-mandated benefits, which could leave the state with added costs?

And in offering coverage, should the exchange combine the individual and small group insurance markets, or keep them separate -- a choice that could have significant ramifications for the costs each group faces in buying coverage?

Board members discussed preliminary recommendations on those and other issues during a meeting at the State Capital Thursday.

[Please read the rest of this article in the archives at the CT MIRROR website]

Health insurance exchange board searching for CEO, quickly
Arielle Levin Becker
Oct. 11, 2011

Wanted: Educated, experienced senior-level manager to develop and run a key piece of health care reform. Must pass muster with the governor and, preferably, be willing to start work early next year.

Those are the basic qualifications to become the first chief executive officer of the state's health insurance exchange, a marketplace for individuals and small businesses to buy health insurance that will launch by 2014. Legislation this year established the exchange as a quasi-public agency.

The job is expected to be posted in the next couple days, seeking candidates with advanced degrees and at least five years of senior-level management experience. The board that oversees the exchange will be charged with narrowing down the candidates, first through a smaller committee of board members that will conduct two rounds of interviews, and then the full board, which will hold the final interviews and recommend three candidates to Gov. Dannel P. Malloy. Malloy will then select the CEO.

The schedule for picking the CEO is expected to be tight. A timeline for the search process calls for having the interviews in December and a CEO in place in February.

[Please read the rest of this article in the archives at the CT MIRROR website]

SustiNet cabinet starts work Monday
Arielle Levin Becker
11 September, 2011

The SustiNet Health Care Cabinet, an advisory board created as part of a compromise on the proposed SustiNet state-run health plan, will hold its first meeting Monday.

The cabinet will be led by Lt. Gov. Nancy Wyman and includes 16 members appointed by Gov. Dannel P. Malloy, legislative leaders and the board that developed the SustiNet proposal. Eleven members of Malloy's administration are on the cabinet as ex-officio members.

SustiNet was originally proposed as a state-run health plan that would include state employees and Medicaid recipients and would be available to small businesses, nonprofits, municipalities and, eventually, anyone in the state. That plan did not pass, but a compromise that became law this year created the cabinet to make health care policy recommendations, including developing a business plan for alternatives to private insurance.

The compromise also allows municipalities and some nonprofits to buy health insurance through the state, and established an Office of Health Reform and Innovation to coordinate state and federal reform efforts.

[Please read the rest of this article in the archives at the CT MIRROR website]

Report: There's no consensus on what constitutes 'medical homes'
Arielle Levin Becker, CT MIRROR
August 16, 2011

The number of physician practices officially considered "patient centered medical homes" has grown dramatically in the past six months, helped along when the state's largest group of primary care practices earned the designation last week.

The proliferation mirrors a widespread national push toward the model, which encourages care coordination and making it easier for patients to access care. Private insurers are sponsoring pilots to test the model, and it's being used in state Medicaid programs, Medicare, and the military's TRICARE health plan, which has a goal of having 2 million beneficiaries enrolled in medical homes by the end of the year.

Connecticut has a medical home pilot program for state employees and retirees, and is developing plans to encourage health care providers to serve as medical homes for Medicaid patients. Six months ago, just 21 practices and clinicians in the state had been recognized as medical homes by the National Committee for Quality Assurance, one of several accrediting organizations. After the 70 practices of ProHealth Physicians achieved recognition last week, the number was up to 412.

But despite the broad-based support for the concept, there is no broad agreement on what a medical practice must do to be considered a medical home, and no solid evidence about what pieces are required to improve care and reduce costs, a report released this month warned.

"The medical home model does have the potential to transform the way health care is delivered--but potential is the key word here," wrote the report's authors, Dr. Robert A. Berenson, Kelly J. Devers and Rachel A. Burton of the Urban Institute. "The danger posed by the current enthusiasm for the concept is that it could lead to the adoption of unproven models on a wide scale nationwide before evaluations of existing pilots can show us what works in what situations, and what levels of reimbursement are needed to get providers to engage in all the new activities encompassed by the medical home model."

[Please read the rest of this article in the archives at the CT MIRROR website]

Connecticut Will Soon Pick A Board To Oversee State Health Insurance Exchange
Hartford Courant
By Matthew Sturdevant
July 15, 2011 4:17 PM

Connecticut will soon pick a board and staff members to oversee the development of a state health insurance exchange, where individuals and small businesses will be able to compare health plans online or by phone starting in 2014.

The exchange is federally mandated as part of healthcare reform and must be available to consumers by Jan. 1, 2014. U.S. Department of Health and Human Services offered a framework for developing the exchanges, which will be a marketplace for health plans first sold to individuals, and, in later years, to small businesses.

Connecticut is one of 49 states and Washington D.C. that accepted grants to plan and develop a state-based health exchange. In September, Connecticut received a one-year planning grant of $996,848 from the federal government. The state is applying for $6.6 million to pay for a second phase of developing the exchange.

"In the past six months we have taken many critical steps in development of the exchange and Connecticut is in a good position," said Jeannette DeJesús, special advisor to Gov. Dannel P. Malloy on federal healthcare reform. "We have enacted legislation establishing Connecticut's exchange as a quasi-public agency and have begun working with multiple stakeholders to address key policy questions. With the release of these proposed rules, Connecticut can continue moving steadily forward."

[Please read the rest of this article in the archives at the Hartford COURANT website]

Controversial 'provider tax' being scrutinzed in debt talks
Deirdre Shesgreen, CT MIRROR
July 14, 2011

WASHINGTON--One of the most contentious elements of Gov. Dannel P. Malloy's recently-passed budget was a new tax on Connecticut hospitals, which won legislative approval despite fierce opposition from the industry. Now, policymakers in Washington may restrict the ability of states to enact such taxes--and they could even force Connecticut to scale back or eventually repeal its new levy.

So-called "provider taxes" are one item under discussion in the increasingly-fraught debt negotiations between the White House and congressional Republicans.

Critics say that states use provider taxes as a "gimmick" to raise revenue for their share of Medicaid spending--and to generate increased federal matching funds in the process. And they say it's time to stop states from "gaming" the system by imposing taxes aimed mainly at snagging more federal dollars.

States say the provider taxes are a legitimate way to raise desperately needed revenue to helps pay for the exploding costs of Medicaid, a joint state-federal health insurance program for the poor. Medicaid is often one of the top three ticket items in state budgets, and the program's rolls have swelled with the recession.

As President Barack Obama and House and Senate leaders look for ways to trim federal spending, provider taxes have become a target. The shape of any final budget-and-debt agreement--if there even is one--is still murky at best. But the scope of state provider taxes could still be an issue even if a broader debt deal falls apart.

[Please read the rest of this article in the archives at the CT MIRROR website]

Last-minute windfall pops up in retiree health care account

Keith M. Phaneuf, CT MIRROR
May 27, 2011

It almost sounds too good to be true: State budget officials, who already saw revenues surge by nearly $400 million over the past month, now say anticipated savings in retired worker health care costs have grown by some $100 million in the same period.

And though Comptroller Kevin P. Lembo said his office was somewhat conservative in assessing the account that it controls, he added that a number of factors made the $117.4 million savings--equal to nearly 20 percent of the entire annual allocation--difficult to predict before now.

"As soon as you start to see a positive development you can't just jump up and say, 'We have some extra money here. What do you want to do with it?'" said Lembo, who inherited the retiree health care account in mid-fiscal year when he began his first term as comptroller on Jan. 5. "Since then I've looked at this on a regular basis, but there were a lot of factors."

One is that state government converted its health insurance coverage, both for active and retired workers, to a self-insured program. Lembo said he believes the previous legislature and former Gov. M. Jodi Rell's administration may have underestimated the savings in shifting from paying private insurance companies to manage the fiscal risk, particularly involving the older, generally sicker retired population

Lembo said the reduced spending also results from higher-than-expected federal cost-sharing for prescription drug coverage and increased patient use of generic pharmaceuticals.

But the single-largest and most volatile factor, Lembo said, simply involves a retiree population that has been healthier than in most years. A 2009 retirement incentive program that coaxed 3,800 senior state workers to retire at an earlier age than they might have otherwise could have contributed to that.

[Please read the rest of this article in the archives at the CT MIRROR website]

Agencies welcome chance to join state health plan--at the right price
Arielle Levin Becker, CT MIRROR
May 5, 2011

State leaders are poised to allow nonprofits to buy insurance through the state employee health plan, and the agency Patrick J. Johnson Jr. runs is in many ways an ideal candidate.

The agency, Oak Hill, serves people with disabilities and has faced double-digit premium hikes in recent years. Its benefits package is considered high-end for nonprofits, Johnson says, and its cost--about $7,000 for an individual and $19,000 for family coverage--is close to the average cost of a state employee plan.

But it won't be for long.

"We can't afford to continue what we're doing," Johnson said. "So we're going to be cutting back."

Many nonprofit leaders are in a similar position. They have lobbied for the chance to buy their health insurance through the state employee and retiree plan, hoping that it would give them another coverage option. Being part of a larger risk pool could remove the fluctuations in cost that can occur when even a few employees in a small pool have major medical problems, they say.

[Please read the rest of this article in the archives at the CT MIRROR website]

Hospitals facing a double hit from Hartford, Washington
Deirdre Shesgreen and Arielle Levin Becker, CT MIRROR
April 25, 2011

WASHINGTON--Frank A. Corvino, the CEO of Greenwich Hospital, is still reeling from the fiscal punch from Hartford, in the form of a proposed new tax on hospitals across Connecticut. Now, he's girding for a second hit from Washington, where federal Medicare officials are fine-tuning a cut to hospital reimbursement rates.

The two blows, Corvino and other hospital executives say, would ripple across the health care system and take a toll on the quality of care.

"The combination of these two... is going to have a devastating effect on patient care in the state," Corvino said. "It's going to pierce the safety net that hospitals provide for their patients."

Even before Gov. Dannel P. Malloy unveiled a budget plan that included a new levy on hospitals, Connecticut institutions were focused on a federal proposal to pare back Medicare payments. The Connecticut Hospital Association and others have lobbyied against the measure, drafted by the federal Centers for Medicare and Medicaid (CMS).

But they appear to have lost that battle, at least the first round. Last week, CMS released a proposal to slice nearly $500 million from its Medicare payments to hospitals across the country. The Connecticut Hospital Association said it will file a formal protest against the rule in June. And it's still subject to public comment, and possibly revision. But hospitals failed in their efforts to soften a similar cut imposed at the start of this fiscal year.

[Please read the rest of this article in the archives at the CT MIRROR website]

SustiNet deal reached, but without a 'public option'

Arielle Levin Becker, CT MIRROR
April 20, 2011

The Malloy administration and Democratic legislative leaders have reached an agreement on the proposed SustiNet state-run health plan, with a deal that calls for opening the state employee health plan to municipalities and some nonprofits, but not for offering insurance to the public.

The agreement would also establish a "SustiNet cabinet" advisory panel within the lieutenant governor's office that would be charged with overseeing health reform efforts in the state, said Ben Barnes, Gov. Dannel P. Malloy's budget director.

The agreement does not call for the state to combine the Medicaid and state employee and retiree health plans into a large pool, as the current legislative proposal does.

Barnes said the language for the new proposal is still being developed, with existing bills and new pieces being combined.

"I doubt they'll be passed tomorrow, but maybe next week," he said.

The proposed SustiNet bill, which has drawn passionate support and opposition, has passed three legislative committees. It calls for combining state-funded health plans under a quasi-public authority that would also offer state-run insurance to small businesses, municipalities, nonprofits and, ultimately, anyone in the state who wants to buy it.

[Please read the rest of this article in the archives at the CT MIRROR website]

Analysts: SustiNet would cost the state hundreds of millions per year
Arielle Levin Becker, CT MIRROR
April 4, 2011

The proposed state-run SustiNet health insurance plan could cost the state hundreds of millions of dollars a year, according to the legislature's nonpartisan Office of Fiscal Analysis.

The analysis, released Monday night, offers the first nonpartisan projection of how SustiNet could affect the state's finances. Although it does not provide a total dollar figure, the analysis cites a variety of potential added costs from the proposal, which calls for reorganizing existing state-funded health plans and selling state-run insurance to municipalities, small businesses, nonprofits and, eventually, anyone in the state who wants it.

Previous assertions about what SustiNet would cost have offered competing pictures. Supporters have cited estimates that the state could save more than $224 million a year with SustiNet, although most of the projected savings were the result of funding from the federal health reform law and could be achieved with or without SustiNet. Opponents have argued that SustiNet would likely increase state spending.

According to the analysis released Monday, the largest new cost to the state--between $222.8 million and $478.6 million a year--would come from offering coverage to low-income adults who earn slightly too much money to qualify for Medicaid.

Consultants to the board that developed the SustiNet plan projected that covering those adults would save the state millions of dollars, because the state would receive federal funding for it. The Office of Fiscal Analysis, or OFA, projected that the cost of offering coverage would exceed the federal funds the state would likely receive.

The SustiNet proposal has passed three legislative committees but must still receive approval from at least three more. It has drawn passionate support from many people who want a public insurance option for the state and say SustiNet will make health coverage more affordable, and passionate opposition from business groups and insurers who say it is too costly and sends a bad message to the state's health insurance industry. Gov. Dannel P. Malloy has said he shares many of the goals of the proposal, but has expressed concern about several parts of it, including the potential cost.

[Please read the rest of this article in the archives at the CT MIRROR website]

Cardiologists drop SustiNet support over loss of liability protection
Arielle Levin Becker, CT MIRROR
March 22, 2011

A group of cardiologists and cardiac care associates has pulled its support for the proposed state-run SustiNet health plan because lawmakers removed a malpractice liability protection provision from the bill.

Four other medical groups previously expressed concern about the move and warned that they could reconsider their positions on the proposal. But the Connecticut Chapter of the American College of Cardiology is the first medical group to withdraw its support.

The group plans to make its position known in newspaper advertisements this week that include an open letter to legislators, Gov. Dannel P. Malloy, and members of the SustiNet board.

In the letter, the chapter president, Dr. Neal Lippman, and president-elect, Dr. Gilead Lancaster, said the group was an early supporter of SustiNet, but that they cannot support it since lawmakers removed a provision that would have protected health care providers from liability if they injure a patient covered by the plan while following clinical care guidelines.

Without the protection, they wrote, the plan "would result in a dramatic increase in the cost of healthcare in Connecticut and expose patients to more tests of limited value" and fail to attract doctors to participate.

"Without these protections, we believe that SustiNet will share the fate of the disastrous Charter Oak insurance plan in which very few doctors are participating due to its poorly conceived support for quality medical providers," the doctors wrote, referring to a program created in 2008 to provide coverage for uninsured residents.

[Please read the rest of this article in the archives at the CT MIRROR website]

Despite Malloy's support, expansion of medical homes faces obstacles
Arielle Levin Becker, CT MIRROR
February 17, 2011

Dr. Cliff O'Callahan's practice submitted an application last week to become officially recognized as a patient-centered medical home and, in the process, became critical to Gov. Dannel P. Malloy's administration's goals for providing health care to more than 500,000 state residents.

As part of an overhaul of state Medicaid programs, the administration plans to aggressively expand the use of patient-centered medical homes, an increasingly popular model for delivering care that is still relatively rare in practice.

Patient advocates have long urged the state to embrace the model, which calls for having health care providers coordinate patients' care. Some were heartened by Malloy's campaign pledge to expand a small Medicaid pilot program that pays providers for care coordination.

Details have not been fleshed out, but the administration has indicated that it wants to go even further, encouraging providers in Medicaid to become fully recognized patient-centered medical homes--the designation O'Callahan's practice is seeking. So far, only four medical practices in the state have achieved it.

The goal of expanding medical homes to all Medicaid programs, which serve more than 500,000 people, puts the state in line with physician groups, private insurers and the federal government in promoting a model that some studies say can improve care while reducing costs.

But it is expected to be a gradual process.

[Please read the rest of this article in the archives at the CT MIRROR website]

Hospitals v. Insurance Companies?
New rankings add complexity to health care choices
Arielle Levin Becker, CT MIRROR
February 2, 2011

Patients used to navigating the differences between in-network and out-of-network providers might soon learn another distinction: tier one and tier two.

A new Aetna program divides hospitals in the insurer's network into tiers based on cost and requires patients to pay significantly higher out-of-pocket charges if they go to those deemed less affordable. A woman who gives birth at the "tier one" John Dempsey Hospital, for example, might pay 10 percent coinsurance under the plan. But if she had her baby at MidState Medical Center, a "tier two" hospital, she might pay closer to 35 percent of the total bill.

The program, "Choose and Save," is small so far, with only a handful of employers, including Aetna, using it for their workers. But it is part of a larger push toward making patients more active in controlling medical costs. And in rating hospitals, the program represents something that even critics say is likely to become more common as employers and insurers seek ways to stem the growth of health care costs.

[Please read the rest of this article in the archives at the CT MIRROR website]

Insurance industry says no to repeal of health care reform, but reticent on details
Deirdre Shesgreen, CT MIRROR
January 10, 2011

WASHINGTON--As House Republicans make their first run at the health care reform law, Democrats say the GOP is doing the bidding of big insurance.

"Why are they engaged in this effort?" asked Rep. Rosa DeLauro, D-3rd District. "Because, quite frankly, I believe it's what the insurance companies want."

It just ain't so, comes the response from Hartford, where insurance giants such as CIGNA, Aetna, and UnitedHealthcare all have major corporate offices.

"Our focus remains on implementing the law and the various provisions that just recently took effect, from extended dependent coverage to enhance preventive care and tax credits for small businesses," said Daryl Richard, a spokesman for UnitedHealthcare.

The true role of Connecticut's big insurance firms, and other industry players across the country, remains to be seen. But there's little question they have much at stake as this new twist in the debate over health reform gets underway.

The House proposal to repeal the health care law is almost certain to pass, but it will likely die in the Senate. (The House vote was originally set for this week, but it has been delayed in light of the Arizona shootings that targeted, among others, a Democratic congresswoman from that state.)

If full repeal fails, Republican opponents have promised a fresh offensive, going after the law in bits and pieces.

[Please read the rest of this article in the archives at the CT MIRROR website]

Malloy taps hospital association executive to take the lead on health reform
Arielle Levin Becker, CT MIRROR
January 4, 2011

Gov.-elect Dan Malloy has appointed a Connecticut Hospital Association executive and former head of the Hispanic Health Council to lead state efforts to implement federal health care reform.

As a deputy health commissioner and special advisor to Malloy, Jeanette DeJesús will oversee a wide range of efforts intended to prepare the state for an expansion of health care coverage. Although the Patient Protection and Affordable Care Act does not fully roll out until 2014, it leaves considerable responsibility to the states.

By 2014, each state must have a health insurance exchange, a marketplace for purchasing coverage that will also be charged with collecting data, reporting to the federal government, certifying and rating insurance plans, and tracking which employers do not offer insurance to their workers. By 2015, the exchanges must be financially self-sustaining.

In addition, states must prepare to ramp up their Medicaid eligibility by 2014. Connecticut is projected to have 114,000 new Medicaid enrollees, which will likely require additional staff to process applications.

DeJesús will succeed Cristine Vogel, who led health reform implementation efforts as a special advisor to Gov. M. Jodi Rell. Vogel has also led a Health Care Reform Cabinet, which includes the commissioners of 11 agencies.

[Please read the rest of this article in the archives at the CT MIRROR website]

Public weighs in on SustiNet plan
Arielle Levin Becker, CT MIRROR
December 7, 2010

Members of the public got their chance to weigh in on the SustiNet plan this week, and their questions and comments offered a hint at what could lie ahead as policymakers attempt to create a public health insurance plan for the state.

Many of those who spoke at presentations in New Haven and Hartford identified themselves as supporters of the concept, the details of which are still being hashed out by a board. Some with a particular interest in the shape of the plan, including a chiropractor and an optometrist, wondered how it would affect their fields.

There were questions about how an expanded state insurance program could be done in the midst of a massive state budget deficit and whether a public insurance option would threaten the business of private health insurers. And some speakers raised concerns or reservations about what the process would ultimately produce.

The SustiNet board is expected to make recommendations early next year to the legislature, which must approve any plan. The board will likely vote on the recommendations Dec. 15.

[Please read the rest of this article in the archives at the CT MIRROR website]

Who will lead state's health care reform?
Arielle Levin Becker, CT MIRROR
November 12, 2010

Grappling with a $3.3 billion budget deficit and a bad economy might dominate the work of Governor-elect Dan Malloy's administration, but his staff's to-do list will also include implementing federal health care reform, a law that gives considerable responsibility--and work--to the states.

Connecticut is one of many states expected have a change in leadership in handling the health care law. Twenty-six states are changing governors, and many, like Connecticut, have a political appointee in charge of the implementation effort.

The Patient Protection and Affordable Care Act won't be fully rolled out until 2014, and it could still be revised if Republicans in Congress get their way. But some provisions require planning now, including building the health insurance exchange, a marketplace for purchasing coverage that must be operational by Jan. 1, 2014.

Connecticut's lead in implementing health reform, Cristine Vogel, serves as a special adviser to Gov. M. Jodi Rell and expects to leave the job sometime before Malloy takes office. Vogel also heads the state's Health Care Reform Cabinet, which includes the commissioners of 11 agencies.

The Department of Social Services, which is already facing a surge of new Medicaid enrollees because of the economy and new eligibility rules, will need to prepare for a projected 114,000 or more new Medicaid clients under health reform. The department is certain to get a new leader: Commissioner Michael Starkowski is already retired and has been leading the department on a contract basis.

The Connecticut Insurance Department, which will have more responsibilities as insurers face more data reporting requirements, also will get new leadership. Commissioner Thomas Sullivan, who came under fire after approving double-digit rate hikes for some individual-market health insurance plans, is leaving the job after this week.

[Please read the rest of this article in the archives at the CT MIRROR website]

Health reform reshaping medical practice
Deirdre Shesgreen, CT MIRROR
October 20, 2010

WASHINGTON- Patients who suffer from heart failure are getting a radical new treatment at Hartford Hospital aimed at significantly reducing their chances of readmission.  It's doesn't involve new medications or a cutting-edge diagnostic. In some ways, it's a lot more complicated-entailing a more integrated way of practicing medicine that is being ushered in, in part, by the health care reform law.

Hartford Hospital's new program for heart failure patients, which relies on intensive post-discharge follow-up, is one element of a larger effort to retool that institution and its affiliates into an "accountable care organization", or ACO.  Some experts see ACOs as the linchpin of health reform-a way to bring down spiraling health costs while also improving the quality of care. But others are skeptical of their potential, and worry that Connecticut providers, in particular, will face unique difficulties in implementing this piece of health reform.

Under the health overhaul, ACOs are defined as a network of physicians, working across specialties and even at different institutions, who team up to provide a highly integrated continuum of care for their patients. If an ACO delivers quality care at reduced costs, its members will be able to share in any financial savings.

"What we're talking about is a complete and total re-engineering of care," said Amanda Forster, of Premier Inc., an alliance of hospitals and other providers that works on improving quality. Premier is helping Hartford Hospital and others prepare for the new ACO era.

Right now, hospitals and doctors are paid for every service they provide. So each surgical procedure, each test, each patient appointment translates into a reimbursement, whether from an insurance company or the government's Medicare or Medicaid programs.  This fee-for-service system provides "a perverse incentive," Forster says, because there are no rewards for keeping a patient healthy or for successfully managing a disease with minimal complications.

[Please read the rest of this article in the archives at the CT MIRROR website]

State struggles to implement health care reform
Deirdre Shesgreen, CT MIRROR
August 13, 2010

Huge. Complex. Difficult.

These are just a few of the adjectives Cristine Vogel throws out as she tries to describe her new job: special adviser to Gov. M. Jodi Rell for health care reform.

At the end of July, Rell tapped Vogel to oversee implementation of the sweeping Patient Protection and Affordable Care Act, which President Barack Obama signed into law last March. A 25-year health care veteran, Vogel started on July 23, and she already feels way behind. Not to mention short-staffed and under-funded.

But that's actually an improvement from a few weeks ago, when Vogel was still deputy commissioner for Connecticut's Office of Health Care Access, helping to oversee implementation of the massive reform law on top of her day job.

"We've just been putting out fires for the last few months on health care reform, so I'm looking forward to actually doing it in some coordinated, cohesive manner," Vogel said in an interview last week, as she was scrambling to meet the latest grant deadline from the federal Department of Health and Human Services (HHS). "A little more predictable and planned out would be nice."

[Please read the rest of this article in the archives at the CT MIRROR website]

Where the League stands on this...
SustiNet board outlines 'public option' for health coverage in Connecticut
Jacqueline Rabe, CT MIRROR
May 27, 2010

A plan for a public health care option in Connecticut - dubbed SustiNet - was released today in response to the new federal health care law.

"It's an outline of what we are looking at," said state Comptroller Nancy Wyman, also the co-chairwoman of the SustiNet Health Partnership Board that released the report. "We are ahead of most states. We have a plan that fits perfectly with the federal law. It’s amazing. We really are in good shape to go forward with the public option.”

Final draft legislation with detailed recommendations for implementing SustiNet will be made by the end of the year so the new General Assembly and governor can consider the package in 2011.

Kevin Lembo, co-chair of the SustiNet board and the state healthcare advocate, has said this plan, if adopted, would go above and beyond the federal reform.

"They set this new federal floor. Some states will chose to do nothing additional, but Connecticut I am confident will go above that," Lembo said two days after the federal law was signed in March by President Barack Obama.

[Please read the rest of this article in the archives at the CT MIRROR website]

1.  Hon. Nancy Wyman, Connecticut State Comptroller, who provided valuable information on SustiNet (Wikipedia information on Sustinet), of which she is Co-Chair.
Ms. Carolyn Salsgiver, Senior Vice President for Planning & Marketing, Bridgeport Hospital, who gave a most thoughtful and informative talk (and a creative thought-sharing process during Q&A);
3..  Elizabeth Rosenthal, MD (Physicians for a National Health Plan) roused the audience with her inspiring presentation from the perspective of a practicing physician.

Moderator Kay Maxwell kept things moving, the audience had terrific queries! 
President of the LWVCT Jara Burnett pointed out that unfortunately the planned insurance industry representative was unable to attend the event, and thus the balance on the panel was askew;  this resulted in a less comprehensive set of viewpoints than League would ordinarily provide, and thus she urged those present to be sure to find out about other views.

For background regarding why and how the League has studied Health Care, please click here.

TOP:  Gray Hall, site of the Conference;   CENTER:  Hon. Nancy Wyman, Comptroller, State of Connecticut;  Lyn Salsgiver, Senior Vice President, Planning and Marketing, Bridgeport Hospital;  Elizabeth Rosenthal, MD, Physicians for a National Health Plan.  BOTTOM: 
President of the LWVCT Jara Burnett;  Kay Maxwell, moderator.

W A T C H     T H I S    I M P O R T A N T    D I S C U S S I O N    N O W   ! ! !


For cable and dsl users: http://www.lwvweston.org/LWVCT12-5-09CableVersion.wmv
For dial-up modem users: http://www.lwvweston.org/LWVCT12-5-09ModemVersion.wmv

Health Care: The League’s History

In 1990, the LWVUS undertook a two-year study of the funding and delivery of health care in the United States. Phase 1 studied the delivery and policy goals of the U.S. health care system; Phase 2 focused on health care financing and administration. The LWVUS announced its initial health care position in April 1992 and the final position in April 1993.

The health care position outlines the goals the LWVUS believes are fundamental for U.S. health care policy. These include policies that promote access to a basic level of quality care at an affordable cost for all U.S. residents and strong cost-control mechanisms to ensure the efficient and economical delivery of care. The Meeting Basic Human Needs position also addresses access to health care.

The health care position enumerates services League members believe are of highest priority for a basic level of quality care: the prevention of disease, health promotion and education, primary care (including prenatal and reproductive health care), acute care, long-term care and mental health care. Dental, vision and hearing care are recognized as important services but of lower priority when measured against the added cost involved. Comments from numerous state and local Leagues, however, emphasized that these services are essential for children.

To achieve more equitable distribution of services, the League endorses increasing the availability of resources in medically underserved areas, training providers in needed fields of care, standardizing the services provided under publicly funded health care programs and insurance reforms.

The LWVUS health care position includes support for strong mechanisms to contain rising health care costs. Particular methods to promote the efficient and economical delivery of care in the United States include regional planning for the allocation of resources, reducing administrative costs, reforming the malpractice system, copayments and deductibles, and managed care. In accordance with the position’s call for health care at an affordable cost, copayments and deductibles are acceptable cost containment mechanisms only if they are based on an individual’s ability to pay. In addition, cost containment mechanisms should not interfere with the delivery of quality health care.

The position calls for a national health insurance plan financed through general taxes, commonly known as the “single-payer” approach. The position also supports an employer-based system that provides universal access to health care as an important step toward a national health insurance plan. The League opposes a strictly private market-based model of financing the health care system. With regard to administration of the U.S. health care system, the League supports a combination of private and public sectors or a combination of federal, state and/or regional agencies. The League supports a general income tax increase to finance national health care reform.

The LWVUS strongly believes that should the allocation of resources become necessary to reform the U.S. health care system, the ability of a patient to pay for services should not be a consideration. In determining how health care resources should be allocated, the League emphasizes the consideration of the following factors, taken together: the urgency of the medical condition, the life expectancy of the patient, the expected outcome of the treatment, the cost of the procedure, the duration of care, the quality of life of the patient after the treatment, and the wishes of the patient and the family.

As the LWVUS was completing Phase 2 of the study, the issue of health care reform was rising to the top of the country’s legislative agenda. In April 1993, as soon as the study results were announced, the LWVUS met with White House Health Care officials to present the results of the League’s position. Since then, the League has actively participated in the health care debate.

The LWVUS testified in fall 1993 before the House Ways and Means Subcommittee on Health, the Energy and Commerce Committee and the Education and Labor Committee, calling for comprehensive health care reform based on the League position. The League joined two coalitions—one comprised of consumer, business, labor, provider and senior groups working for comprehensive health care reform, and the other comprised of groups supporting the single-payer approach to health care reform.

Throughout 1994, the League actively lobbied in support of comprehensive reform, including universal coverage, cost containment, single-payer or employer mandate and a strong benefits package. The League continued to advocate for the inclusion of the state single-payer option in any health care package and emphasized LWVUS support for the inclusion of reproductive health care, including abortion, in any health benefits package. League leaders participated in countless lobbying visits in Washington, held grassroots meetings with members of Congress and spoke out in the media.

Health care reform advocates, including the League, continued to press for comprehensive health care reform through September 1994. But congressional sponsors were unable to reach accord, and comprehensive reform was declared dead for the 104th Congress. The focus then shifted to the states, where Leagues have worked in support of health care reform, while fighting off attempts to cut back on existing health care.

The LWVEF initiated community education efforts on health care issues with the “Understanding Health Care Policy Project” in the early 1990s. The project provided training and resources for Leagues to conduct broad-based community outreach and education on health care policy issues with the goal of expanding community participation in the debate.

In spring 1994, the LWVEF and the Kaiser Family Foundation undertook a major citizen education effort, “Citizen’s Voice for Citizen’s Choice: A Campaign for a Public Voice on Health Care Reform.” The project delivered objective information on health care reform to millions of Americans across the country. Local and state Leagues sponsored more than 60 town meetings in major media markets nationwide, involving members of Congress and other leading policy makers and analysts in health care discussions with citizens. In September 1994, the LWVEF and the Kaiser Family Foundation held a National Satellite Town Meeting on Health Care Reform, with more than 200 downlink sites across the country. The two organizations also undertook a major television advertising effort to promote public participation in the health care debate.

In 1997, the LWVUS joined 100 national, state and local organizations in successfully urging Congress to pass strong bipartisan child health care legislation. In 1998, the LWVUS began working for a Patients’ Bill of Rights, aimed at giving Americans participating in managed care health plans greater access to specialists without going through a gatekeeper, the right to emergency room care using the “reasonably prudent person” standard, a speedy appeals process when there is a dispute with insurers and other rights.

Also in 1998, the LWVEF again partnered with the Kaiser Family Foundation and state and local Leagues on a citizen education project, this time focused on Medicare reform, patients’ bill of rights and other health care issues. In the first phase of the project, more than 6,500 citizens participated in focus groups, community dialogues and public meetings. Their views were reflected in How Americans Talk About Medicare Reform: The Public Voice, presented to the National Bipartisan Commission on the Future of Medicare in March 1999. The report emphasized that people value Medicare but recognize its flaws. Fairness, responsibility, efficiency and access were identified as important values for any reforms of the Medicare system.

In spring 2000, the LWVEF and KFF developed and distributed two guides, Join the Debate: Your Guide to Health Issues in the 2000 Election and A Leader’s Handbook for Holding Community Dialogues. The project focused on five issues under debate in the election: the uninsured, managed care and patients’ rights, Medicare reform, prescription drug coverage and long-term care.

Throughout the 106th Congress, the LWVUS lobbied in support of a strong Patients’ Bill of Rights. In July 1999, the Senate passed a watered-down version of patients’ rights legislation opposed by the League. In October, the House passed a strong, bipartisan bill that guaranteed basic health care protections supported by the League. Despite several close votes in 2000, however, Senate opponents continued to block passage of real patient protection legislation. At Convention 2000, League delegates lobbied their members of Congress to pass a strong, comprehensive Patients’ Bill of Rights and send it to the President.

The League’s efforts in support of passage of real patient protection legislation continued throughout the 107th Congress. Delegates to Convention 2000 met with their Representatives and Senators in support of the Patients’ Bill of Rights, but the legislation was essentially shelved as Election 2000 drew near.

The LWVUS lobbied federal lawmakers in support of the Bipartisan Patient Protection Act of 2001, legislation that would provide patients with administrative and legal recourse in dealing with insurers and Health Maintenance Organizations (HMOs). Despite action in both the House and Senate and pressure from the LWVUS and other health care advocates, the legislation died in the conference committee that should have resolved the differences between the two bills.

In the 108th Congress, the League lobbied Congress in support of the Health Care Access Resolution, which expressed congressional intent to begin the debate on how to provide health care access to all. In November 2003, the League opposed the Medicare Prescription Drug bill that was signed into law by the President because its particular provisions undermined universal coverage in Medicare.

In May 2006, the League urged Senators to oppose the Health Insurance Marketplace Modernization and Affordability Act (HIMMA). While this proposal purported to expand healthcare coverage, it in fact limits critical consumer protections provided in many states.

In 2007 and 2008, the League supported reauthorization of the State Children’s Health Insurance Program (SCHIP) which provided health care coverage to six million low-income children in 2007. This support also included encouraging Senators and Representatives to fully fund the program. The legislation passed the House and Senate, but was vetoed by President Bush