There is a common and troubling misconception among legislators and policymakers the Capitol – that with the passage of national health care reform, health insurance is fixed and SustiNet is no longer needed.
Nothing is further from the truth. In fact, national health reform makes the need for SustiNet even more critical.
In 2014, under the Affordable Care Act, everyone will be required to secure coverage unless they qualify for a public program. People who don’t qualify for Medicaid and don’t have a decent benefit offer at work will be forced to buy it in the private market.
Historically, the insurance market has been hostile to consumers. The offerings available to my low income clients are so meager, that many are better off putting their money under their mattress. The most rational economic option for them is often to forgo insurance and to pay for doctor visits in cash; if the worst happens, they would then likely qualify for some public or private assistance.
While there are new rules to vastly improve the value of insurance, enforcement is left mainly to stats and our state insurance department has a checkered history of protecting consumers. Regulation, by its nature, is reactive – waiting for something bad to happen and changing rules to react. It is necessary, but not enough to protect people.
And so we get to why SustiNet is so critical. SustiNet will provide a good insurance option – one that covers what insurance should cover, at a reasonable cost. Most important it is a public option, answering to the public not to stockholders and highly paid executives.
SustiNet’s connection to the rest of state health care programs will for the first time allow individuals, usually at a severe disadvantage in the market, to share in the benefits of bulk purchasing and innovations such as patient-centered medical homes and payment reforms to drive down costs.
What makes SustiNet is so scary to its opponents? It is an option, purely voluntary. If it doesn’t work for my clients, they won’t sign up. Because SustiNet provides what people need, it will serve as a rational competitor, keeping the insurance companies honest and raising the bar—improving the system for everyone.
While national reform provides some subsidies and limits on costs to working families, those subsidies and limits will not be enough. . Some consumers will have to spend as much as 20 percent or more of their income on health care. It is critical that we ensure consumers are not wasting money on insurance that won’t cover what they need when they need it. The private market will not protect consumers – if it did, we wouldn’t have needed health care reform in the first place.
National health care reform is a great start, but the provisions of SustiNet that help individuals and small businesses struggling to find affordable, quality health insurance are critical to making health care reform work for every Connecticut resident.
Ellen Andrews is executive director of the Connecticut Health Policy Project.