Commercial health insurance premiums in Connecticut are the sixth highest in the nation and they continue to grow faster than inflation. While we’re making progress, it’s too slow. Legislators heard this loud and clear from voters during the last campaign. A public health insurance option to compete with private plans is getting a lot of attention from legislators and it makes sense conceptually.
In 2010, our nonprofit CT Health Policy Project signed up with the Comptroller’s office to cover our staff through MEHIP, Connecticut’s first iteration of a public option. It seemed to make sense and we wanted to do the right thing. Unfortunately, it became too expensive and we moved to a private option the next year. Since then, the state has tried other versions of a public option; they’ve all disappointed for varying reasons.
Connecticut consumers deserve a robust public option that is affordable and sustainable into the future. We need one that provides high-quality care, with stellar member satisfaction rates, one that providers want to participate in, and doesn’t save money by shifting costs onto consumers or taxpayers. There are important improvements to the current proposal that would bring the public option closer to that goal.
Nonprofit directors and small business owners choosing between plans should be able to compare the quality of the public option with private plans already available. The state health insurance Consumer Report Card compares private plans offered in Connecticut on dozens of quality metrics including how many pregnant women get early prenatal care, how well they help people control their high blood pressure, and member satisfaction rates. It also includes the number of providers participating in the plan by specialty and county, member satisfaction levels, claim denial rates, complaints, access to mental health and substance use treatment, and how much of premiums are spent on health care versus administration. The new public option should be included in the Consumer Report Card for an apples-to-apples comparison.
There are serious concerns about the state’s liability for a public option if premiums do not keep up with health care costs. Private insurance is backed by large insurers, banks and Wall Street. But a public option is backed by the state – meaning the liability falls on taxpayers as well as schoolchildren, nursing home residents, people with disabilities and others who rely on state services.
The latest iteration of the public option, the Partnership Plan 2.0, is losing money. Another public option attempt, Connecticut’s Charter Oak Plan, ended in a death spiral for this reason. Artificially keeping premiums lower than health care claims helps the municipalities that participate, but it costs taxpayers millions and the price tag is growing. In uncertain times, it would be tragic if keeping the public option solvent caused cuts in efficient, proven coverage programs like HUSKY.
It is very hard to get any fiscal information on the Partnership Plan or on the much larger state employee health plan. Complete public financial reporting should be required of any public option plan. Taxpayers have a right to know how much it is costing us and what the trade-offs are.
The public option should live by the same rules that govern private insurance. Under the Affordable Care Act, insurers have to offer coverage to anyone who applies, regardless of preexisting conditions. The current public option plan is allowed to cherry-pick members with fewer health problems to keep the pool solvent. This leaves the exact people suffering now for lack of an affordable option out of luck. People with more health care needs will have to stay in the private plans, raising private premiums even higher.
The public option should allow groups to leave at the end of a year, without a penalty, as for private plans. Small businesses and nonprofits can’t afford to be locked into a plan for three years without knowing the costs. My nonprofit board wouldn’t let me sign a contract like that.
All these provisions must be included in legislation, so they apply to future comptrollers and administrations. Changes should not be made behind closed doors but should follow a transparent legislative process with public input.
A good public option could make Connecticut’s insurance market more competitive and help keep costs down, but it won’t work alone. We have to address the input costs that are driving up all health care spending. Prices for drugs and services at huge health systems are to blame. Both lack effective competition to keep prices reasonable. Addressing those will have a meaningful, lasting impact on affordability. But the ongoing controversy over a public option is taking all the oxygen out of the room. We should try everything, including the best possible version of a public health insurance option.
Ellen Andrews, PhD, is the executive director of the CT Health Policy Project. Follow her on Twitter @CTHealthNotes.
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