This is new for me and I may be alone, but I found a lot to like in the Governor’s budget. This fall the administration must have been listening to complaints about their disappointing healthcare record. Their new budget proposal starts to turn that around, tackling the drivers of soaring healthcare costs – prices for drugs and services from huge health systems. The proposal would add resources to agencies to build analytic capacity, a prerequisite for responsible reform, and holds providers accountable for promises made to regulators. It’s not going to solve everything, but it’s a start.
The biggest news is the plan to pay down medical debt for state residents. We need to rest here for a minute. One in five US households carries medical debt, just because someone in the family got sick, and it is crowding out money for food, utilities, and rent. Two thirds of bankruptcies are attributable to medical bills. This burden falls hardest on Black and brown communities and people with disabilities. A few local communities have done this, but if this passes, Connecticut would be the first state to cancel medical debts.
The Governor has proposed using a nonprofit charity, like RIP Medical Debt, that buys medical debt from collections companies for pennies on the dollar and erases it. RIP Medical Debt helps households with modest incomes and substantial debts. They also have practical advice for people to avoid medical debt in the first place. It shouldn’t be necessary in a rich county, but it’s a very efficient way to maximize relief that’s meaningful for struggling families.
To address skyrocketing prices from huge monopoly heath systems in our state, the Governor is proposing legislation to limit anti-competitive contracting. The consolidation of hospitals and providers into large health systems has stifled competition, allowing prices to rise unchecked. Two lawsuits have been filed against Hartford Healthcare for using their monopoly power to drive out their competition and raise prices. Other states have taken action to protect competition in consolidated markets, and it’s working to control costs and insurance premiums. A bill to prohibit anti-competitive contract clauses passed the Senate overwhelmingly last year but died on the House calendar.
The Governor’s proposal also starts to take on extreme drug prices. The administration plans to join with other states to negotiate better prices, not just for state programs but for all of us. They also want to regulate the army of gift-bearing drug representatives who visit doctors’ offices to push their expensive products. It might work. They have also proposed a study of Pharmacy Benefit Managers – middlemen who pull off more profit from the drug supply chain with questionable benefit. Other options that didn’t make the administration’s cut could go farther, but I’ll take it.
The Governor wants to cap out of network “surprise bills” at more reasonable Medicare rates. The proposal also includes hiring more state analysts. Healthcare is complicated and messy. Consultants are expensive and they are long gone when programs hit problems. Without good data and analytics, policymakers are flying blind when designing reforms, and they won’t know if they are working. The Governor also wants to add staff to hold health systems accountable for promises they make when applying for service changes. This is critical as birthing centers are sidestepping state requirements and closing across the state.
I wish the administration was doing more. We need massive investments in public health, not only for the next pandemic but also because proven, evidence-based interventions can keep us healthy and lower costs. Decent housing, healthy affordable food, and safe communities do more to promote health than 15-minute doctor visits. We need workforce supports to help providers who are burned out and make the field attractive to new recruits. But this proposal is more than Connecticut has done in the past. So, I am grateful.