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HARTFORD, CT — With 800,000 Connecticut residents at risk of losing their health insurance if the American Health Care Act becomes law, state Comptroller Kevin Lembo says expanding Medicare and creating a public health insurance option would help ensure people continue to have coverage.

In letters sent Wednesday to U.S. Senators Chris Murphy and Richard Blumenthal, Lembo urged expanding Medicare, which is typically available to individuals once they turn 65,  include those at least 55 – and then offer an option for all people regardless of age to buy into the program as well.

“I believe a Medicare option for all would be the most ideal solution,” he wrote. “However, at a minimum, a Medicare buy-in option for Americans from at least age 55 is essential to ensuring people continue to have access to quality and affordable health care coverage.”

Making Medicare available to people who are at least 55, he said, would lower costs for people who buy insurance through the state individual market and also lower the average cost of Medicare by adding younger participants to its pool.

“Regardless of the outcome of ongoing federal health care debate, this proposed Medicare reform would help stabilize costs in Connecticut’s individual insurance market, lower premiums and expand the number of people insured,” he wrote.

Action needs to be taken quickly, he said, because millions of people nationwide and hundreds of thousands in Connecticut could lose their insurance coverage under the American Health Care Act. People with pre-existing conditions are in particular jeopardy of losing coverage, or having coverage become unaffordable under the Republican plan.

Lembo said the AHCA and various proposals that Senate Republicans are considering “are not health care reform, but an immoral and outrageous attack on millions of Americans.”

The comptroller also is pushing for a public health insurance option in Connecticut. He sent a separate letter about that Wednesday to Lt. Gov. Nancy Wyman, who has convened a bipartisan group to examine the health care landscape and co-chair of Access Health CT, Connecticut’s insurance exchange.

“State officials cannot afford to sit idly while potentially hundreds of thousands of Connecticut residents risk losing access to health care,” Lembo wrote to Wyman. “The increasing instability of Connecticut’s health care exchange and federal health care policies demands immediate action. The time has come for a public health insurance option.”

Many state’s health insurance exchanges, created in the wake of the Affordable Care Act, have faltered or failed entirely. Some insurers have pulled out of Connecticut’s exchange, known as Access Health CT, leaving it with just two.

Anthem Health Plans and ConnectiCare Benefits, the two remaining insurance carriers, have said they plan to participate in the exchange in the exchange next year – but warned state lawmakers earlier this month that they could leave if federal subsidies disappear. Both companies are asking state regulators for double-digit rate increases on plans sold on the exchange.

A public option would offer an alternative to the plans offered by private insurance carriers.

“Connecticut’s existing exchange is broken,” Lembo wrote to Wyman. “A public option would ensure that more than 110,000 at risk of losing coverage will have at least one viable option to access affordable, quality health coverage.”

Wyman, who chairs a bipartisan working group on the Affordable Care Act, said “the Comptroller put forward a constructive idea that I will bring to the group for consideration and examination.”

Congress debated a public option back in 2009, which ultimately failed. Connecticut Sen. Joseph Lieberman was among those who opposed the measure.

When it was discussed on a national level, opponents of a public option said it would create unfair competition to private insurance carriers and that, by decreasing prices, it would reduce insurers’ ability to provide high-quality care.

A public option is feasible in Connecticut, according to Lembo: Section 1332 of the Affordable Care Act lets states apply for innovation waivers that could allow them to develop their own insurance and delivery system innovations while receiving the same level of federal reimbursement.

The state could potentially create a public option by leveraging the purchase power of the state Medicaid program or the state employees plan to create a plan with “very low” administrative overhead, Lembo said. Those administrative savings, he added, would let the plan provide improved benefits and lower premiums.

But exploring a run for governor like Lembo is doing and then actually governing are two completely different things.

On the campaign trail in 2009,  Malloy said he supported a public option, and he even stood side-by-side with religious leaders in calling for a public option just weeks before taking office. However, campaigning is different than governing and faced with a $3.6 billion budget deficit, Malloy backed off his support for a public option.

Back in February 2011, Ben Barnes, the governor’s budget secretary, said that the administration supports moving forward with federal healthcare reform, but wasn’t necessarily ready to embrace a state-run public option or hand over rate-setting power to a “quasi-public agency” as recommended by the SustiNet Board of Directors.

“It’s a little premature to set up SustiNet with the aggressive timetable in the bill,” Barnes told lawmakers in 2011.

SustiNet was a program set up by lawmakers to create a plan for health insurance reform in Connecticut, including a state operated public option. It was created by a Democratic legislature as a homegrown way to bring universal coverage to the state, and, ideally, save money and improve health care in the process. Last year, the SustiNet bill was essentially neutered turning what advocates had hoped would be the nation’s first public option into a powerless advisory board.