Courtesy of CT-N
Healthcare Advocate Ted Doolittle (Courtesy of CT-N)

HARTFORD, CT — While Congress tinkers with changes to the Affordable Care Act, Connecticut is considering a public option that piggybacks off its successful Medicaid program.

“This is the most important and productive bill before the legislature in this session,” Healthcare Advocate Ted Doolittle told the Human Services Committee on Tuesday.

The legislation would create a new Husky E program that would be “funded by premiums assessed by the commissioner on enrollees,” and if approved by the federal government it would also include “federal premium tax credits and cost-sharing subsidies.”

Doolittle estimated there are still anywhere between 5 and 10 percent of Connecticut residents who are uninsured and this may benefit them because it would presumably lower premiums for those who don’t currently qualify for any tax credits or subsidies.

Allowing this population to buy into Medicaid, where the administrative costs are low, would not cost the state anything, according to Doolittle. It would simply allow consumers to buy into the insurance program.

“If you buy into this program, you’re going to pay what the state pays for normal Medicaid enrollees,” Doolittle explained.

Rep. Cathy Abercrombie, D-Meriden, said at the moment they’re looking to turn the legislation into a “study.” In the meantime, they are looking at what other states are doing and have modeled the legislation after the Medicaid For All proposal in Nevada, which was vetoed by Nevada Gov. Brian Sandoval in July 2017.

Doolittle suggested they move up the timeline for completion of the study to November or December so that it doesn’t fall through the cracks of a new administration.

At one time, Connecticut embraced the idea of a public health insurance option, but the proposal — which pre-dated the ACA — was watered down every time a fiscal note was released.

In 2009, Connecticut set into motion the ability for the state to create its own public option when it created the Sustinet board of directors. The board ended up figuring out how to run a state-based exchange, and it never moved forward with a public option.

Then Congress passed the Affordable Care Act in 2010 without a public option. Former U.S. Sen. Joseph Lieberman threatened to filibuster the legislation unless the public option was removed.

There were plans back in 2011 to add about 577,949 municipal and 174,342 nonprofit employees to the state employees’ health insurance pool. At the time, the state employee plan covered about 202,000 current employees and retirees.

Both proposals were panned by Gov. Dannel P. Malloy’s administration and a coalition of state employees who were considering changes to their health insurance benefits at the time. In order to get state employees to believe they had killed the proposal, lawmakers had to be very public about the defeat of Sustinet.

This is the first time legislation for a public option has resurfaced in the past seven years.

The legislation instructs the Insurance Commissioner to consult with the Office of Health Strategy and the Health Care Cabinet and take steps to ensure the HUSKY E plan does not diminish the long-term sustainability of, or negatively impact, the Medicaid program or the Connecticut Health Insurance Exchange.

The Universal Health Care Foundation, which was the grassroots support behind the previous effort, believes it’s a necessary conversation for the state to start having based on what’s happening with the ACA.

The federal Affordable Care Act was passed in March 2010 and since then Connecticut has concentrated on effective implementation of the ACA. However, in the past year that success has been threatened as the federal government has acted to erode the gains made by the ACA. 

“The vacuum of positive healthcare leadership in Washington, D.C. makes it vital that states take action,” Universal Health Care Foundation President Frances G. Padilla said. “We look forward to being part of the discussion.”

State Comptroller Kevin Lembo, who chaired the first Sustinet board, said “a Medicaid public option may allow the state to offer participants lower premiums and deductibles than are currently available on the state’s exchange.”

Senate President Martin Looney said a public option is a moderate step.

“It does not replace the health insurance market with either single-payer healthcare or socialized medicine; it merely allows a public option to compete in the existing market,” Looney said.

Tom Swan, executive director of the Connecticut Citizens Action Group, told the committee Tuesday that the state of Connecticut is one of the largest purchasers of health insurance and it has an obligation “to use our purchasing power to protect consumers.”

He said a public option is like a standard offer in the electricity market.

“It’s not that radical of a proposal,“ Swan said.