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Connecticut has recently focused attention on the release of two health reform proposals in what many are calling Connecticut’s year for health reform.[1]  In December, the 10-member, legislatively-created HealthFirst Connecticut Authority released a draft report that has identified an urgent need for expanded health coverage and transformation of the system of care.  The draft report provides recommendations for expanding and improving health coverage, while also addressing issues that affect both the insured and uninsured, such as health information technology, wellness, and chronic disease.  The Authority focused on the complementary goals of universal coverage and access to safe, effective care for all Connecticut residents by first establishing two workgroups—the Cost, Cost Containment, and Finance Workgroup (CCCF) and the Quality, Access, and Safety Workgroup (QAS).  More than 50 individuals representing a broad range of interested stakeholders made up each workgroup.  The Authority held 27 meetings between October 2007 and December 2008 to review research and expert testimony, and also hosted nine public forums throughout the state.

While the Authority is waiting for cost estimates before making final recommendations, the basic design of their coverage expansion proposal is:

• Expanded Medicaid/SCHIP eligibility for all residents with family incomes below 300 percent Federal Poverty Level (FPL), including sliding scale cost-sharing; uninsured with access to employer-sponsored insurance would receive premium assistance to purchase private coverage
• Access to a restructured Charter Oak program, which currently allows families to buy health insurance at premiums based on their family income, regardless of their health status
• A Connecticut Health Partnership, using the state employee health benefit plan as a base, made available to all residents and employers in order to improve employer offer rates and employee take-up rates, and to offer coverage to those in the non-group market

The Authority also offers multiple recommendations for containing costs and improving quality.  In particular, they focus on the role of data collection and analysis, emphasizing that data should drive policy development, implementation, and evaluation. The Authority recommends that a public entity be assigned or developed to oversee the proposed reforms and to better coordinate state spending on health care.[2]

Another proposal, unveiled in early January by the Universal Health Care Foundation of Connecticut (UHCF), is also primarily intended to expand health coverage.  Specifically, it is designed to cover up to 98 percent of all state residents by 2014 through the SustiNet program—an expansion of the state employees’ health plan into a large health insurance pool which would incorporate those already enrolled in Medicaid or the HUSKY program (the state subsidized health insurance for children and families).  Additionally, the SustiNet program would be made available to any state resident who wants health coverage, starting with those who do not have access to employer-sponsored insurance.  Even small employers would eventually be able use the state’s pool by paying in as they would if they had their own health plan.  The program is designed to compete with private insurance plans and would automatically enroll those without insurance unless they opt out.  UHCF officials predict that, as a result of such a large insurance pool, the program would save individuals and employers as much as $1.7 billion by 2014.  Finally, the UHCF proposal also calls for greater preventive care and chronic care management, as well as an increase in the use of electronic health records.[3]

These proposals are the first two among what is expected to be many proposals released over the next year.  Advocates for reform in Connecticut acknowledge that the state budget gap could be an obstacle for substantial changes in the health care system, but that the difficult economy and rise in unemployment actually highlight the need for health reform.[4]