Connecticut policymakers’ plan to radically reform our state’s health care system just got more radical. The plan, labeled the State Innovation Model (SIM), is meant to change how health care is paid for and delivered for everyone in Connecticut, where we spend billions of dollars on health care each year.
Connecticut has a poor history with impulsive moves toward reckless, untested new incentive schemes in health care. Unfortunately, SIM planners are proposing just that — putting efforts to win a modest federal grant to fund state agencies ahead of those lessons and what is best for Connecticut consumers and taxpayers.
The final SIM plan, approved in December, grew from a $3 million federal planning grant. The plan was drafted by state agencies, with virtually no consumer input. Advocates have concerns about many provisions in the plan, and we’ve been vocal about them, but we were comforted by the SIM plan’s commitment to respect and build upon hard won progress in our Medicaid program. But now SIM proponents are chasing a bigger federal grant with millions to fund state agencies. Assurances about building on what works and learning from the past are being tossed aside.
Medicaid, the safety net health program that covers almost 800,000 low-income, high-need state residents, is Connecticut’s largest health care purchasing plan. Driven by consumer advocates, two years ago the state shifted Medicaid from a traditional insurance model with incentives to deny needed care, to focus on care coordination and patient-centered care. Thanks to that move, things are getting better — health care quality is up, fewer people are going to the emergency room for non-urgent problems, more providers are joining the program, and the cost of care per person is down. And thanks to the Affordable Care Act, total Medicaid costs are going down for Connecticut even as enrollment climbs.
Building on that success, Medicaid has been working for more than a year on a health neighborhood pilot program , now in the final stages of development. Health neighborhoods were designed in an open, inclusive process to deliver substantial savings while improving care for thousands of elderly and disabled state residents. The final SIM plan had committed to first implementing the health neighborhoods, learning from that program, and then evaluating whether to proceed farther.
The new SIM proposal, rushed out last week, includes dangerous shifts back to those failed Medicaid incentive schemes, a waiver with a cap on federal reimbursements risking massive future deficits for Connecticut taxpayers, and silly health savings accounts for Medicaid, among other bad ideas. SIM proponents argue that the provisions will give policymakers and consumers flexibility in health care spending, allowing, for instance, the purchase of air conditioners for children with asthma. However, if health costs continue to rise and our state’s economy doesn’t rebound, there may be no money for air conditioners and future state policymakers will have to decide who or what to cut from the care we cover now.
SIM proponents claim that the change in the application is necessary to effectively compete with other states for the federal grant. However the federal funding announcement includes no such requirement or preference. Other, more mature states may propose aggressive payment changes in their SIM applications, but those reforms build upon what is working in those states and represent natural progressions from their longer histories of successful health reform.
Connecticut state policymakers should regroup and begin again with a thoughtful, inclusive health reform planning process, bringing all voices to the table, to develop a feasible plan that works for our state. The only objective should be to build value for Connecticut consumers. If we miss this federal grant opportunity, so be it.
At the very least, the new SIM grant application should honor the commitment in their own final plan and abandon these reckless, last minute Medicaid payment schemes. Connecticut consumers don’t care if state government gets a federal grant to benefit state agencies. We only care about making our health system work better.
Ellen Andrews is the executive director of the Connecticut Health Policy Project.