As the SustiNet Board of Directors handed its consultants the last of its thoughts Wednesday morning more questions were raised about what exactly SustiNet is and how exactly does it address the issue of the more than 400,000 uninsured residents in the state.

“What happens to the uninsured?,” Cristine Vogel, special advisor on health care to Republican Gov. M. Jodi Rell, asked toward the end of the meeting. “The red shirts in the room are for healthcare for all, but I don’t know if we’ve addressed all the uninsured issues.”

The red shirts Vogel referred to were those in the audience with red “Healthcare4everyone1” tee-shirts. Individuals wearing them are part of the grassroots campaign for universal health care in the state.

She said what exists of the health plan design involves pooling populations such as Medicaid clients and state employees, two groups that already have insurance.

Margaret Flinter, senior vice president and clinical director of the Community Health Center, Inc. said a “rising tide will float all boats.” She said the idea is to create a large pool of individuals through the public health insurance plans currently offered through the state which at some point uninsured individuals and employers will be able to join.

Along with pooling these populations SustiNet aims at finding cost savings by changing the health care delivery system by doing things like implementing electronic medical records and creating medical homes, Stan Dorn, a consultant with the Urban Institute reminded the board. He said once you start adding together all the various populations there are fewer individuals that get left out of the group of uninsured since the federal poverty level for public plans such as HUSKY will be raised.

But it seemed difficult for many members of the SustiNet board to think about the fact they will be offering, managing, and marketing a health insurance product.

“I know why we’re all struggling because we’re not used to thinking like a health plan,” Vogel said. “That is very new. We’ve never thought like a health plan.”

Paul Grady, a SustiNet board member and principal of Mercer Health and Benefits in Norwalk, warned the board that over the past few years several health plans have left the state because they couldn’t remain competitive. He worried that the board hasn’t spent any time preparing a budget or talking about the cost implications.

At the moment though there aren’t many cost implications.

If the Patient Protection and Affordable Care Act hadn’t passed then the state would need to spend hundreds of millions of dollars to fund the plan, Dorn said. However, passage of the federal legislation means most of the tab will be paid by the federal government.

Based on preliminary modeling of SustiNet, Dorn said the state could see between $224 million to $427 million in savings in fiscal year 2017, depending on how firmly the changes to the health care delivery system take root. Aside from giving vague estimates, he said it’s impossible to quantify the cumulative impact federal dollars for the program may bring into the state because there are so many moving parts.

As a health plan SustiNet doesn’t have a plan structure or benefit levels yet. On Wednesday it gave its final thoughts about what SustiNet should look like to the consultants to draft a final report which will be voted on by the board on Dec. 29 during a conference call.

Kevin Lembo, state healthcare advocate and co-chairman of the SustiNet board, said following the Dec. 29 vote the SustiNet board will help the legislature draft legislation to implement the program.

The final recommendations will be presented to the legislature in January.